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Form preview Whitney high school community... Volunteer Log Sheet Student Name: ___School:___ Grade: ___ School Year: ___Student Contact Phone Number: ___ a signature is required in each block Medicalize of AgencyDateStart Timed Teetotal # of
Form preview To download service contract b... BUCKY S LIMOUSINE SERVICE, LLC 1475 McDonald ST ONTO WI 54153 Phone (920) 834-4436 Fax (920) 834-9666 SERVICE CONTRACT Bucky s Limousine Service, LLC agrees to provide service as described herein
Form preview Vermont service contract provi... VERMONT SERVICE CONTRACT PROVIDER REGISTRATION AND CERTIFICATION JANUARY 1, TO DECEMBER 31, A. Registrant Identification Information: 1. Name (Must be exact name under which business is being conducted)
Form preview Service contract provider regi... 89 Main Street, Montpelier, VT 05620 3101 (p) 8028283301 | http://www.dfr.vermont.gov/Service Contract Provider Registration and Certification Return this form to: Department of Financial Regulation Attn:
Form preview Jalerran siberian huskies stud... Valerian Siberian Huskies Jess and John Moore 3361 Viola Rd. Clarion, PA 16214 Jessica cs online.net 8142272838 or 8142299123 www.SiberianHusky.wsStud Service Contract Owner of the Bitch Contact Information
Form preview State farm power of attorney f... State Farm Mutual Funds Power of Attorney POA /Trading Authority This form is used to notify SFVPMC of a POA situation in which you will hold discretionary authority over a securities account on behalf of the account owner. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. Please refer to Chapter 8 of the SFVPMC Compliance Manual for full details To aid us in identifying SFVPMC Registered Representatives RR holding POA please choose one of the following I am not affiliated with State Farm as an Agent Agent s Staff or Employee of State Farm I am a non-RR State Farm Agent non-RR Agent s Staff member or non-RR Employee of State Farm Alias I am a RR State Farm Agent RR Agent s Staff member or RR Employee of 3 Additional Information I am Power of Attorney for Name Account Number s If you are a Registered Representative of SFVPMC please complete the following My relationship to this individual is e.g. father sister friend 4 POA Signature Date Mail or fax form and copy of POA document to P. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts. If you have any questions or need additional information before completing this form please call 1-800-447-4930. 1 POA Information First Name MI Last Name Date of Birth mm/dd/yyyy Address Social Security Number City ZIP Code State 2 POA Affiliations With State Farm SFVPMC must be aware of any registered representative that is holding discretionary authority POA over a securities account in which the registered representative has authority to make independent decisions with respect to transactions in that customers account. SFVPMC has in place a review process and guidelines that registered representatives of SFVPMC must adhere to if they are holding discretionary authority over these accounts.
Form preview Census power of attorney sampl... SAMPLE FORMAT: Power of Attorney. POWER OF ATTORNEY. U.S. PRINCIPAL PARTY IN INTEREST/AUTHORIZED AGENT. Know all men by these presents, that , the
Form preview Power of attorney nys oca form DURABLE GENERAL POWER OF ATTORNEY NEW YORK STATUTORY SHORT FORM THE POWERS YOU GRANT BELOW CONTINUE TO BE EFFECTIVE SHOULD YOU BECOME DISABLED OR INCOMPETENT (CAUTION: THIS IS AN IMPORTANT DOCUMENT.
Form preview Special power of attorney mili... SPECIAL POWER OF ATTORNEY MILITARY AFFAIRS PREAMBLE This is a military Power of Attorney prepared pursuant to Title 10 United States Code Section 1044b and executed by a person authorized to receive legal assistance from the military service. Federal law exempts this power of attorney from any requirement of form substance formality or recording that is prescribed for powers of attorney by the laws of a state the District of Columbia or a territ...
Form preview Affidavit power of attorney fo... THAT as attorney-in-fact of the Principal and under and by virtue of the Power of Attorney I have this day executed this Affidavit. THAT at the time of executing this Affidavit I had no actual knowledge or actual notice of revocation or termination of the Power of Attorney by death or otherwise or notice of any facts indicating the same. THAT I agree to indemnify the Bank and hold it harmless from all costs claims demands suits expenses including reasonable attorney s fees judgments and liabilities whatsoever arising out of any action taken by me which is inconsistent with this Affidavit or the Power of Attorney. AFFIDAVIT AS TO POWER OF ATTORNEY BEING IN FULL FORCE STATE OF COUNTY OF ss. being duly sworn deposes and says THAT as principal the Principal who resides at did in writing under date of the Power of Attorney appoint me his/her true and lawful attorney and that annexed hereto and hereby made a part hereof is a true copy of the Power of Attorney. THAT I make this Affidavit for the purpose of inducing JPMorgan Chase Bank N.A. the Bank to accept delivery of this Affidavit as executed by me in my capacity of attorney-in-fact of the Principal with the full knowledge that the Bank in accepting the execution and delivery of this Affidavit and the Power of Attorney will rely upon this Affidavit. THAT I hereby represent that the Principal is now alive has not at any time revoked or repudiated the Power of Attorney and the Power of Attorney is still in full force and effect. This includes acts done by me both before and after the Bank has received notice of the death of the Principal or of the modification or termination of the Power of Attorney. If the Bank and I become involved in a lawsuit arising out of the Power of Attorney or my action under it we both waive a trial by jury. This includes acts done by me both before and after the Bank has received notice of the death of the Principal or of the modification or termination of the Power of Attorney. If the Bank and I become involved in a lawsuit arising out of the Power of Attorney or my action under it we both waive a trial by jury.

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