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Certificate Appointing Form
To supervise the payment of my our employees beginning Date mm/dd/yyyy That he/she is in a position to have full knowledge of the facts set forth in the payroll documents and in the statement of compliance required by the so-called Kick-Back Statue which he/she is to execute with my our full authority and approval until such time as I we submit to the Name of Local Authority a new certificate appointing some other person for the purposes hereinabove stated. Identifying Signature of Appointee...
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