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South pacific county humane so... SPCHS. Adoption Application Last Updated 11/22/08 South Pacific County Humane Society Adoption Agreement I acknowledge receiving from the South Pacific County Humane Society hereafter referred to as the Society custody of the within described animal. I understand that the Society does not warrant the age health breed temperament or habits o said animal. I agree to save and hold harmless the Society from any and all claims demands causes of action damages costs expenses or liabilities of any kind and nature whatsoever directly or indirectly connected with the care control and ownership of said animal howsoever caused. The Society reserves the right to make in-home inspections and remove said animal if found tethered or penned for longer than ten hours a day and/or abused neglected in any way according to state laws and local ordinances 16. Adoption Application Date Dog Cat Male Female Animal s Name Brief Description Applicants please print Incomplete information will delay your application* Name Email Phone Cell Work Where You Live Street City State Zip Mailing Address Pet s Environment You live in House Apartment Duplex Mobile Other Do you Own Rent Landlord s Name This pet will be primarily Indoors Outside Fence Yes height type No If no describe how you will confine your pet to property Type of shelter outdoors Other Pets No Yes. Dogs Cats Other Vacinnated No Yes Name of Vet Allergies No Yes Children No Yes Ages Will someone be home during the day No Yes Do you have the means of caring for your pet when you are away for extended periods of time No Yes Describe Have you previously owned pets No Yes If yes what happened to them Reason for adopting Companionship Protection Sport Other Why did you choose the Humane society for your pet Page 1 of 2. 52. 205 animal cruelty in the first degree 16. 52. 207 animal cruelty in the second degree. I further agree that I will not permit said animal to be used for research experimentation or fighting purposes. Nor will I allow a cat adopted from the Society to be de-clawed* Veterinary Exam The Society provides a list of licensed veterinarians that will give free exams to animals that have been newly adopted from the Society. To take advantage of this exam I must phone the vet and schedule an appointment to be performed within the first five 5 days of the adoption* The free exam does not include immunizations or treatments. No refunds or follow-up health care costs will be provided if the free exam is not performed within the first five 5 days. The Society provides the first vaccinations however the second shots are the adopter s responsibility. In case of illness diagnosed by a veterinarian within the allowed period said animal may be returned for a full refund or replacement within ten days. Return/refund only allowed proved that all items such as license certificate tags etc* are also returned* If the free exam is not performed within the allotted time period and illness is found kennel cough etc* all treatment costs will be the adopter s responsibility.

Generic dog adoption applicati... DOG ADOPTION APPLICATION Name: Address: Home Phone Cell Phone City: Work Phone Date: Zip: Thank you for considering the adoption of a shelter animal! Before you decide to adopt a pet, please consider

Mn common grant application fo... For a list of grantmakers that accept the Minnesota Common Grant Application Form or to download the Form visit MCF s Web site at www. Minnesota Common Grant Application Form Revised December 2000 Dear Nonprofit Colleague We are pleased to introduce an updated version of the Minnesota Common Grant Application form. Minnesota grantmakers developed this form to make the grantseeking process simpler and more efficient for nonprofits. For ease of use and to eliminate unnecessary duplication of work you may reproduce any part of the form you find helpful including the COVER SHEET and BUDGET forms. Keep in mind that every grantmaker has different guidelines and priorities as well as different deadlines and timetables. Before submitting this application to a potential funder it is very important that you check to see whether your project or program matches their published interests. Any funder that has agreed to accept this form may request additional information as needed* STRATEGIES FOR SUCCESSFUL GRANTSEEKING 1. Do your research to determine whether the foundations and corporations goals and objectives for grantmaking are consistent with your type of grant request. 2. After you do the research find out the preferred method of contact for the grantmaker and contact the grantmaker to secure their specific grantmaking guidelines. Many grantmakers generally like to have initial contact with you before receiving a written proposal* 3. Include a cover letter with each proposal that introduces your organization and your proposal and makes a strategic link between your proposal and the funder s mission and grantmaking interests. 4. Type and single-space all proposals. 5. Answer all the questions in the order listed* 6. Submit the number of copies each grantmaker requests according to their guidelines. 7. Do not include any materials other than those specifically requested at this time. RESOURCES Call write or check the Website of each grantmaker to obtain a copy of their funding guidelines for a list of Minnesota grantmaker sites visit MCF s Web site at www. mcf*org select Links of Interest. Use MCF s Guide to Minnesota Grantmakers and other directories listing foundations interests and processes. Visit a Foundation Center Collection Library in Minneapolis St* Paul Fargo Duluth Rochester or Marshall-SW State. mcf*org/mcf/grant/applicat. htm Grant Application Cover Sheet Date of application Application submitted to Organization Information Name of organization Legal name if different Address City State Zip Employer Identification Number EIN Phone Fax Web site Name of top paid staff Title E-mail Name of contact person regarding this application Is your organization an IRS 501 c 3 not-for-profit If no is your organization a public agency/unit of government Yes No If no check with funder for details on using fiscal agents and list name and address of fiscal agent Fiscal agent s EIN number Proposal Information Please give a 2-3 sentence summary of request Population served Geographic area served Funds are being requested for check one Note Please be sure funder provides the type of support you are requesting.

Dubai blank visa form EMBASSY OF THE KYRGYZ REPUBLIC affix the photo here 2360 Massachusetts Ave, Washington, DC 20016 Tel: (202) 338-5141 / (202 ) 742 6602; Fax: 202 742 6501 E-mail: Consul kyrgyzembassy.org VISA APPLICATION

Wisconsin common grant applica... WISCONSIN COMMON GRANT APPLICATION FORM (Revised March 2006) The Common Grant Application (CGA) can be used for all types of proposals: special projects, capital and general operating support. Please

Fndf form First Nations Development Fund Grant Program PROJECT APPLICATION PROJECT INFORMATION First Nation: Project Contact Person: Mr. Mrs. Ms. Phone Number: Work Fax Home Email: If First Nations Development

Ovs application form 2010 Ovs. ny. gov Read Compensation before filling out this form. Please print. Answer all questions. It is a crime to file a false claim Victim Assistance Program Use Only OVS VAP ID Program Name/Phone Advocate Name/Email Tell us about the victim. Last Name First Name MI Social Security Date of Birth Check here if you do not have one. New York State Office of Victim Services Claim Application and Instructions 1 Columbia Circle Suite 200 Albany NY 12203-6383 518 457-8727 55 Hanson Place Room 1000 Brooklyn NY 11217-1523 718 923-4325 65 Court Street Room 308 Buffalo NY 14202-3406 716 847-7992 How to Apply for Compensation Who can apply for compensation Do I need a lawyer to file a claim to OVS Innocent victims of crime certain relatives dependents and the guardian can apply to OVS other resources. Call us at 1-800-247-8035 Or visit our website www. ovs. ny. gov It s best to fill out the form completely or it may take longer to process your claim. Who can sign the claim Generally the victim must sign the claim. However if the victim is under 18 or is physically or mentally incapable of signing then the legal guardian the person receiving the benefits must fill out section 2 of the claim and sign the claim. If the victim died the person asking for benefits must fill out section 2 of the claim and sign the claim. Do I have to fill out the attached HIPAA form Yes. Fill out one HIPAA form for each service provider. You can photocopy a blank form to make extra copies. Tell us your new address and phone number. Also let us know if your email address changes. What if I have questions or need help filing a claim We can help you find a victim assistance program near you. Call us at 1-800-247-8035 Or visit our website www. ovs. ny. gov It s best to fill out the form completely or it may take longer to process your claim. Who can sign the claim Generally the victim must sign the claim. However if the victim is under 18 or is physically or mentally incapable of signing then the legal guardian the person receiving the benefits must fill out section 2 of the claim and sign the claim. If the victim died the person asking for benefits must fill out section 2 of the claim and sign the claim. Do I have to fill out the attached HIPAA form Yes. No* But if you hire a lawyer to help you with this claim and it is awarded you can ask OVS to reimburse up to 1 000 of the legal fees. What kinds of expenses can I get compensated for OVS offers compensation related to personal injury death and loss of essential personal property. The specific expenses OVS may cover include Medical pharmacy and counseling expenses Loss of Essential Personal Property up to 500 including 100 for cash Burial or Funeral Expenses up to 6 000 Lost Wages or Lost Support up to 30 000 Parents or guardians of hospitalized minor children may be eligible for this benefit. Transportation court/medical Occupational/Vocational Rehabilitation Security and Shelter Crime scene clean-up up to 2 500 Good Samaritan property losses up to 5 000 How do I ask for compensation Send us your completed OVS application along with copies of Police reports Medical bills Correspondence with insurance companies or benefits plan saying if they will cover your loss Insurance cards Receipts for essential personal property Death certificate and funeral contract Victim s birth certificate What if I don t have some of the papers OVS needs What if my property was lost damaged or destroyed because of the crime If you are under 18 60 or over disabled or were injured you may apply for benefits to replace your essential personal property or cash that was not covered by any other resource.

Standard application form for... Standard Application Form for Agricultural Permit Transfer of Ownership or Operation Please Type or Print Section 1 FACILITY INFORMATION DATE A TRANSFER OF OWNERSHIP PERMIT NUMBER FARM NAME COUNTY

Sweden visa application form p... Photo Application for Schengen Visa This application form is free For official use only Date of application: Visa application number: 5. Place of birth 6. Country of birth 8.Sex 9. Marital status

Sample of a filled schengen ap... This document has no legal effect and cannot be basis for a visa application in any accredited Embassy or Consulate Stamp embassy or consulate Application for Schengen Visa Photo This application

Passport forms I ' ' DEPARTMENT: HOME AFFAIRS FOR OFFICIAL USE ONLY z .,J REPUBLIC OF SOUTH AFRICA BLOCK fr . gI%, N UMNYANGO

47sp form Application for migration to Australia by a partner Form 47SP Life in Australia Australian values The Australian Government encourages people to gain an understanding of Australia, its people and

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