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Certificate of marriaged form CONFIDENTIAL LICENSE AND CERTIFICATE OF MARRIAGE MUST BE LEGIBLE MAKE NO ERASURES, WHITEOUTS, OR OTHER ALTERATIONS USE DARK INK ONLY Groom Bride FIRST PERSON DATA STATE FILE NUMBER 1A. FIRST NAME

Mass dps inspection certificat... Commonwealth of Massachusetts Department of Public Safety (DPS) Application for Certificate of Inspection APPLICATION FOR CERTIFICATE OF INSPECTION PROCEDURES s: dps webload active website forms certificate

Welder certificate format WELDER and WELDING OPERATOR PERFORMANCE QUALIFICATION RECORD Welder s Name Welder s SS No. XXX-XX- ATF No Test No. Reference WPS No Date VARIABLE Code or Specification Used Welding Process and Type Manual Semiautomatic Mechanized Automatic Backing Used Base Metal Not Used Required if used Spec/P or M-Number Plate/Pipe Thickness Groove Plate Pipe Thick. Pipe/Tubular Outside Diameter Groove Filler Metal Specification No. Classification No. F No. Diameter Consumable Insert Yes No Penetration Enhancing Flux Deposited Weld Metal Thickness Current/Polarity Current Range Type/Polarity Range Amperes Metal Transfer Mode GMAW or FCAW Torch Shielding Gas Type Root Shielding Gas Flow NA Type Position s Test Position s 1G 2G etc. Vertical Progression Uphill Qualified Position s F H V O or All Downhill NOTE Insert NA for Variables that are identified as Non-essential in the Code or Specification used for the Performance Qualification Test MECHANICAL TEST RESULTS Type And Figure No. Results Guided mechanical Testing Conducted By NONDESTRUCTIVE EXAMINATION RESULTS Radiographic Results Report No. Welding Witnessed By Visual Inspection Pass Fail reason We certify that the statements in this record are correct and the test welds were prepared welded and tested in accordance with the requirements of AWS D1. 1 AWS B2. 1Other Date Qualified ATF WPQR Blank Form 2010-04-15 ATF Name and Number Signed By CWI No.. WELDER and WELDING OPERATOR PERFORMANCE QUALIFICATION RECORD Welder s Name Welder s SS No* XXX-XX- ATF No Test No* Reference WPS No Date VARIABLE Code or Specification Used Welding Process and Type Manual Semiautomatic Mechanized Automatic Backing Used Base Metal Not Used Required if used Spec/P or M-Number Plate/Pipe Thickness Groove Plate Pipe Thick. Pipe/Tubular Outside Diameter Groove Filler Metal Specification No* Classification No* F No* Diameter Consumable Insert Yes No Penetration Enhancing Flux Deposited Weld Metal Thickness Current/Polarity Current Range Type/Polarity Range Amperes Metal Transfer Mode GMAW or FCAW Torch Shielding Gas Type Root Shielding Gas Flow NA Type Position s Test Position s 1G 2G etc* Vertical Progression Uphill Qualified Position s F H V O or All Downhill NOTE Insert NA for Variables that are identified as Non-essential in the Code or Specification used for the Performance Qualification Test MECHANICAL TEST RESULTS Type And Figure No* Results Guided mechanical Testing Conducted By NONDESTRUCTIVE EXAMINATION RESULTS Radiographic Results Report No* Welding Witnessed By Visual Inspection Pass Fail reason We certify that the statements in this record are correct and the test welds were prepared welded and tested in accordance with the requirements of AWS D1. 1 AWS B2. 1Other Date Qualified ATF WPQR Blank Form 2010-04-15 ATF Name and Number Signed By CWI No*. WELDER and WELDING OPERATOR PERFORMANCE QUALIFICATION RECORD Welder s Name Welder s SS No* XXX-XX- ATF No Test No* Reference WPS No Date VARIABLE Code or Specification Used Welding Process and Type Manual Semiautomatic Mechanized Automatic Backing Used Base Metal Not Used Required if used Spec/P or M-Number Plate/Pipe Thickness Groove Plate Pipe Thick. Pipe/Tubular Outside Diameter Groove Filler Metal Specification No* Classification No* F No* Diameter Consumable Insert Yes No Penetration Enhancing Flux Deposited Weld Metal Thickness Current/Polarity Current Range Type/Polarity Range Amperes Metal Transfer Mode GMAW or FCAW Torch Shielding Gas Type Root Shielding Gas Flow NA Type Position s Test Position s 1G 2G etc* Vertical Progression Uphill Qualified Position s F H V O or All Downhill NOTE Insert NA for Variables that are identified as Non-essential in the Code or Specification used for the Performance Qualification Test MECHANICAL TEST RESULTS Type And Figure No* Results Guided mechanical Testing Conducted By NONDESTRUCTIVE EXAMINATION RESULTS Radiographic Results Report No* Welding Witnessed By Visual Inspection Pass Fail reason We certify that the statements in this record are correct and the test welds were prepared welded and tested in accordance with the requirements of AWS D1.

Eur1 word blank template form MOVEMENT CERTIFICATE 1. Exporter (Name, full address, country) EUR1 No. See notes overleaf before completing this form. 2. Certificate used in preferential trade between 3. Consignee (Name, full address,

Trec forms fillable 2011 TREC FORM CHANGES (Including Form Changes Made by the Commissioners on Feb. 14, 2011, eff. March 1st) TREC NO. 20-10 ONE TO FOUR FAMILY RESIDENTIAL CONTRACT (RESALE): Paragraph 2 B is amended

Memorandum for certificate of... INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.912(a), MEMORANDUM FOR CERTIFICATE OF MILITARY SERVICE (12/10) When should this form be used? This form should be used if you KNOW

Form certificate necessity DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES Form Approved OMB No. 0938-0679 CERTIFICATE OF MEDICAL NECESSITY CMS-854 CONTINUATION FORM PATIENT NAME SECTION C DME 11. PHYSICIAN Attestation and Signature/Date I certify that I am the treating physician identified in Section A of this form. I have received Sections A B and C of the Certificate of Medical Necessity including charges for items ordered. PHYSICIAN S SIGNATURE DATE // Form CMS-854 09/05 EF 08/2006 INSTRUCTIONS FOR COMPLETING THE CERTIFICATE OF MEDICAL NECESSITY SECTION C CONTINUATION FORM CMS-854 To be completed by the supplier NARRATIVE DESCRIPTION OF EQUIPMENT COST Provide 1 a narrative description of the item s ordered as well as all options accessories 2 the product model and serial number of the product being delivered if applicable 3 the supplier s charge for each item option accessory and 4 the Medicare fee schedule allowance for each item/option/accessory/supply/drug if applicable. 02 PATIENT HICN Narrative Description of Equipment and Cost continued item accessory and option* see instructions on back. Any statement on my letterhead attached hereto has been reviewed and signed by me. I certify that the medical necessity information in Section B is true accurate and complete to the best of my knowledge and I understand that any falsification omission or concealment of material fact in that section may subject me to civil or criminal liability. PHYSICIAN ATTESTATION The physician s signature certifies 1 the CMN which he/she is reviewing includes Sections A B C and D 2 the answers in Section B are correct and 3 the self-identifying information in Section A is correct. AND DATE After completion and/or review by the physician of Sections A B and C the physician must sign and date the CMN in Section D verifying the Attestation appearing in this Section* The physician s signature also certifies the items ordered are medically necessary for this patient According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0679. The time required to complete this information collection is estimated to average 12 minutes per response including the time to review instructions search existing resources gather the data needed and complete and review the information collection* If you have any comments concerning the accuracy of the time estimate or suggestions for improving this form please write to CMS Attn PRA Reports Clearance Officer 7500 Security Blvd. Baltimore Maryland 21244. DO NOT SUBMIT CLAIMS TO THIS ADDRESS* Please see http //www. medicare. gov/ for information on claim filing. PHYSICIAN ATTESTATION The physician s signature certifies 1 the CMN which he/she is reviewing includes Sections A B C and D 2 the answers in Section B are correct and 3 the self-identifying information in Section A is correct. AND DATE After completion and/or review by the physician of Sections A B and C the physician must sign and date the CMN in Section D verifying the Attestation appearing in this Section* The physician s signature also certifies the items ordered are medically necessary for this patient According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number.

Certificate of amendment nj fo... L-102 NJSA 42 2/94 New Jersey Division of Revenue Certificate of Amendment Limited Liability Company This form may be used to amend a Certificate of Formation of a Limited Liability Company on file with the Department of the Treasury. Applicants must insure strict compliance with NJSA 42 the New Jersey Limited Liability Act and insure that all applicable filing requirements are met. 1. Name of Limited Liability Company 2. Identification Number 3....

F0103 form 11 F0103 Page 1 of 2 OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P. O. BOX 136 JACKSON MS 39205-0136 PHONE 601-359-1633 FAX 601-359-1499 Mississippi LLC Certificate of Dissolution The undersigned pursuant to Mississippi Code Ann. 79-29-801 1972 amended 2010 hereby executes the following Certificate of Dissolution and sets forth Name of Limited Liability Company 2. The reason for filing the Certificate of Dissolution 3. The future effective date of dissolution Any other information the members or managers determine to include By Signature Printed Name Please keep writing within box Title Physical address P O Box City State Zip 5 Zip4 Make Check for 50. 00 payable to SECRETARY OF STATE* Mail completed form with payment to SECRETARY OF STATE PO BOX 136 JACKSON MS 39205-0136. For assistance contact a customer service representative at 800 256-3494. Visit our website at www. The reason for filing the Certificate of Dissolution 3. The future effective date of dissolution Any other information the members or managers determine to include By Signature Printed Name Please keep writing within box Title Physical address P O Box City State Zip 5 Zip4 Make Check for 50. 00 payable to SECRETARY OF STATE* Mail completed form with payment to SECRETARY OF STATE PO BOX 136 JACKSON MS 39205-0136. 00 payable to SECRETARY OF STATE* Mail completed form with payment to SECRETARY OF STATE PO BOX 136 JACKSON MS 39205-0136. For assistance contact a customer service representative at 800 256-3494. Visit our website at www. The reason for filing the Certificate of Dissolution 3. The future effective date of dissolution Any other information the members or managers determine to include By Signature Printed Name Please keep writing within box Title Physical address P O Box City State Zip 5 Zip4 Make Check for 50. 00 payable to SECRETARY OF STATE* Mail completed form with payment to SECRETARY OF STATE PO BOX 136 JACKSON MS 39205-0136. For assistance contact a customer service representative at 800 256-3494. Visit our website at www.

Kci certificate pdf form exemption shall be validated annually by physician completion of KCI Form ... 4 week minimum interval between first 3 doses; 6 month interval required between ...

Roofing certificatepdffillerco... Texas Department of Insurance Property & Casualty AutoMobile / Homeowners MC 104-1A 333 Guadalupe P. O. Box 149104, Austin, Texas 78714-9104 512- telephone 512-490-1015 fax www.tdi.state.tx.us

Certificate doing form Certificate of Doing Business Under Assumed Name D/B/A Ulster County Clerk s Office 244 Fair Street Kingston NY 12401 845 -340-3288 Nina Postupack Ulster County Clerk www. co. ulster. ny. us. gov PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE 1. I certify that my name is print name 2. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I will do business under the name 5. I further certify that I am the successor in interest to the following person who formerly used this name or names to conduct transact business person s name My Signature Date Print or type name under signature If under 21 years of age state I am years of age STATE OF NEW YORK COUNTY OF SS On this day of 20 before me the undersigned personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity and that by his/her signature on the instrument the individual or the person upon behalf of the which the individual acted executed the instrument. Signature of individual taking acknowledgment Notary Public Instructions Use this form for a DBA by an INDIVIDUAL* Complete the form BUT DO NOT SIGN IT until you are in the presence of a Notary Public* My staff are Notaries and can witness your signature at no charge if you wish. Bring the form to the Ulster County Clerk s Office at 244 Fair St* in Kingston together with 25. 00 cash or money order payable to Ulster County Clerk s Office. A certified copy may be obtained at the cost of 5. 00 per copy. Our office hours are 9 00AM to 4 45PM Monday through Friday except holidays. There are other forms for Partnerships filing DBA s as well as amendment and termination forms. The Partnership form is available in our office for a fee of 1. co. ulster. ny. us. gov PURSUANT TO SECTION 130 OF THE GENERAL BUSINESS LAW OF NEW YORK STATE 1. I certify that my name is print name 2. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I live at 3. I intend to do business in ULSTER COUNTY at the following address in city town village New York zip 4. I will do business under the name 5. I further certify that I am the successor in interest to the following person who formerly used this name or names to conduct transact business person s name My Signature Date Print or type name under signature If under 21 years of age state I am years of age STATE OF NEW YORK COUNTY OF SS On this day of 20 before me the undersigned personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he/she executed the same in his/her capacity and that by his/her signature on the instrument the individual or the person upon behalf of the which the individual acted executed the instrument.

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