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Authorization for release of i... Georgia Department of Behavioral Health & Developmental Disabilities Name of Individual/Consumer/Patient/Applicant Social Security Number AND/OR Date of Birth AUTHORIZATION FOR RELEASE OF INFORMATION

Nada39s fair credit compliance... Fair Credit Compliance POLICY & PROGRAM Table of Contents Overview of Fair Credit Policy & Compliance Program Templates 1 Instructions for Completing Fair Credit Policy and Compliance Program

Eastbay return print form RETURN AND EXCHANGE INSTRUCTIONS Thank you for your purchase . We appreciate the oppor tunity to provide you with high quality products and excellent customer ser vice . For your convenience , if

Philam life policy detail amen... POLICY DETAIL AMENDMENT FORM 15F-18F Net Lima Building, 5th Avenue corner 26th Street, Bonifacio Global City, Taguig 1634 Agent Code NOTE: POLICY NUMBER Fill out 0 with block letters. Put Q on the

Nycha pet registration form Reset NYCHA 040. 505A Rev. 8/06 NEW YORK CITY HOUSING AUTHORITY DOG AND CAT VETERINARIAN CERTIFICATION TENANT OF RECORD FOR OFFICE USE ONLY PET TRACKING STREET ADDRESS ACCOUNT 9 digit NOTE TO TENANT After you submit the Dog and Cat Registration form to NYCHA bring your pet to a veterinarian for examination and ask the veterinarian to complete this form. You must return the completed form to your management of ce no later than 90 days after form is given to tenant. You will not have to submit a new Veterinarian form again unless you get a new pet. However you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certi cate. PET DESCRIPTION PET TYPE PET S DATE OF BIRTH BREED DOG DESCRIPTION e*g* color markings CAT CURRENT WEIGHT EXPECTED WEIGHT WHEN FULLY-GROWN LBS* HEALTH REQUIREMENTS NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE DOG LICENSE NUMBER A dog must be licensed and must wear its license tag when in public SPAYED OR NEUTERED NO YES Dogs and cats must be spayed or neutered RABIES VACCINATION CURRENT YES TAG VETERINARIAN CERTIFICATION I the undersigned veterinarian examined the above described pet and certify that the information given is accurate. You will not have to submit a new Veterinarian form again unless you get a new pet. However you are required by the New York City Department of Health and Mental Hygiene to have your dog or cat revaccinated upon expiration of the vaccination certi cate. PET DESCRIPTION PET TYPE PET S DATE OF BIRTH BREED DOG DESCRIPTION e*g* color markings CAT CURRENT WEIGHT EXPECTED WEIGHT WHEN FULLY-GROWN LBS* HEALTH REQUIREMENTS NYC DEPARTMENT OF HEALTH AND MENTAL HYGIENE DOG LICENSE NUMBER A dog must be licensed and must wear its license tag when in public SPAYED OR NEUTERED NO YES Dogs and cats must be spayed or neutered RABIES VACCINATION CURRENT YES TAG VETERINARIAN CERTIFICATION I the undersigned veterinarian examined the above described pet and certify that the information given is accurate.

Baptist funeral policy form Harmony Baptist Church Funeral Policy and Guide 1310 Harmony Church Rd. Monroe GA 30655 770-267-5717 770-267-8238 fax kim harmonybaptist. The pastor must approve all funeral arrangements at Harmony Baptist and its cemetery. Decisions concerning areas outside the scope of this funeral policy shall be decided at the discretion of the pastor. For all other individuals additional fees will be assessed. Those who have been members of Harmony but now are considered made payable to Harmony Baptist Church on or prior to the day of the funeral. Normally honorariums for the pastor pianist or musicians are paid following the service or through the funeral director. active member defined on page 5 The following fees apply Active Member Non-Member Page 4 Use of Sanctuary Use of Fellowship Hall Pastor Pianist/Organist Soloist Sound System Operator No fee Honorarium For the purposes of this policy active members are defined as those members of Harmony Baptist Church who regularly attend church services and contribute to the church as they generally provide regular financial and personal support for the church. net www. harmonybaptist. net Rev* Brant Callaway Pastor Rev* Brian Fillingim Min* of Education Rev* William Kilgore Min* of Music Page 1 Funeral Policies and Practices Monroe GA Funeral Services Even for Christians the death of a loved one is a difficult experience. We grieve the loss of one who has been close but we do not sorrow as those who have no hope 1 Thessalonians 4 13. It is our desire and privilege to minister to the families of our congregation in their time of need* It is through the Word of God that we have hope at the time of the death of a loved one Romans 15 4. This policy is provided to assist our families in planning and providing a Christian funeral* Although funeral services may be held in funeral homes the best place for conducting a funeral service upon the death of a Christian is in the sanctuary of the church to which he or she belonged* By having the service at the church all who attend will be reminded of our hope and assurance in Jesus Christ. Therefore all members of Harmony are encouraged to use the church building for funeral services. The sanctuary is also offered for the funeral services of Christians whose membership is in another church. There can be alternative methods for the conducting of services at the time of death. These could include a private graveside service for family members as soon after death as possible and/or a public service of worship a memorial service conducted at the church later. However funeral worship services will only be conducted in the church sanctuary. The pastor is available to go with the family to the funeral home to assist in making arrangements if desired* The pastor will be happy to meet with the family to plan any funeral worship arrangements. Date and Time of Funerals Dates and times for funerals at Harmony are to be arranged in consultation with the pastor based on availability and the preferences of the deceased s family.

Texas standard homeowners poli... DEC - 1 TEXAS HOMEOWNERS POLICY DECLARATIONS PAGE NAMED INSURED POLICY NO. EFFECTIVE DATE: EXPIRATION DATE: AT 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE RESIDENCE PREMISES/DWELLING PREMISES

Policy schedule cum certificat... -- TWO WHEELER VEHICLE PACKAGE POLICY Certificate Cum Policy Schedule For CLAIMS Call 1800-209-8888 Toll free from all phones For RENEWALS Visit www. icicilombard. com or call 1800-209-8888 DE T A IL S OF T H E P OL IC Y H O L DE R POLICY DETAILS I ns u r e d N a m e Policy Issuing Office Z e ni t h H o u s e K e s ha v Mumbai - 400034 Insured Address R ao K h a d ye M ar g M a ha l a xm i From 00 00 25-Aug-2010 to 24-Aug-2011 midnight Pe r i o d o f I ns ur a nc e Contact No s E Policy Issued On 25-Aug-2010 00 00 C ov er N ot e N o W-2011959 R T O L o ca t i o n m ail A d d r e s s TAMILNADU-CHENNAI Hypothecated to C at e g or y V E H IC L E D E T A IL S M ake M od el T yp e o f b o d y CC M fg. Y e a r HONDA MOTORCYCLE U NIC OR N Saloon Registration Number Chassis Number E ng ine N um be r V e hi c l e I D V in Rs. Si d e C a r 46785 ME4KCO93H98085953 KCO9E1087405 Additional Acc N o n - E l e ct r i ca l Acc* in Rs. Elec/ Electronic Seating capacity CNG / L P G Unit in Rs. T o t al V a lu e SC H E D UL E O F P R E M I U M I N R S. Ow n Da m ag e A Basic Own Damage T ot al Sub Total Additions Less Su b T o t a l D e d u ct i o n s B o n u s P e rc e n t 2 0 Total Own Damage Premium Total package Premium A B Service Tax Incl Edu. Cess And Higher Edu. Cess Liability B 640. 00 Basic Third Party Liability 640. 00 PA Cover for Owner-Driver of Rs. 1 00 000 0. 0 0 T o t a l Add 0. 00 Unnamed PA cover for 2 persons of Rs. 140. 00 each 128. 00 - 128. 00 Sub Total Additions 51 2. 0 0 T o t a l L i a b i l i t y P r e m i u m 300. 00 50. 00 140. 00 1 002. 00 1 1 06. 00 Total Premium Payable in Rs. Geographical Area India Compulsory deductibles Rs. 50 LIMITS OF LIABILITY a Under Section II - 1 i of the policy - Death of or bodily injury Such amount as is necessary to meet there requirements of the motor vehicles Act. 1988. b Under Section II - 1 i of the policy - Damage to Third Party Property Rs 100 000 PA Cover for Owner-Driver under section III-CSI Rs 100 000 Voluntary Deductible Rs. 0 LIMITATIONS AS TO USE The policy covers use of the vehicle for any purpose other than Hire or reward Carriage of goods other than samples or personal luggage Organized racing Pace making Speed testing Reliability trials Any purpose in connection with Motor Trade. DRIVER S CLAUSES Any person including the insured Provided that a person driving holds an effective Driving License at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective Learner s License may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules 1989. IMPORTANT NOTICE The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule. Any payment made by the company by reason of wider terms appearing in the certificate in order to comply with the Motor Vehicle Act 1988 is recoverable from the insured* See the clause headed AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY.

Amc generic warranty policy gu... AMC GENERIC WARRANTY POLICY GUIDE The AMC Board of Directors and the CWEDA Board of Directors have both agreed that the following generic warranty agreement could be used as a guideline for developing

Sexual abuse and molestation p... SEXUALABUSEANDMOLESTATIONPOLICY FORHOTELS(SAMPLE) DISCLAIMER VenturePrograms,Inc.explicitlydisclaimsallwarranties,expressorimplied,includinganywarrantyof merchantabilityorfitnessforaparticularpurpose.Thosewhoutilizethissamplesexualabuseandmolestation

Globe life and accident reques... Part 1 Globe Life And Accident Insurance Company Policy Number Request for Policy Change Globe Life And Accident Insurance Company Print first, middle, and last names of Primary Insured Requested

Application for garage policy... APPLICATION FOR GARAGE POLICY Policy Period Desired: From Business Trade Name: Insured: Mailing Address: To City: County: State: Zip Code: Phone ( ) Internet Address (If any): Years in Business: Years

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