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Form preview Affidavit form b E-VERIFY AFFIDAVIT FORM B Private Employer of Compliance Pursuant to O. C. G.A. 36-60-6 d By executing this affidavit the undersigned private employer verifies that it is exempt from compliance with O. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs fewer than 100 employees and therefore is not required to register with/or utilize the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state Signature of Authorized Officer or Agent Printed name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs fewer than 100 employees and therefore is not required to register with/or utilize the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. C. G*A. 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state Signature of Authorized Officer or Agent Printed name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201. C. G*A. 36-60-6 stating affirmatively that the individual firm or corporation employs fewer than 100 employees and therefore is not required to register with/or utilize the federal work authorization program commonly known as E-Verify or any subsequent replacement program in accordance with the applicable provisions and deadlines established in O. C. G*A. 13-10-90. Signature of Exempt Private Employer Printed Name of Exempt Private Employer I hereby declare under penalty of perjury that the foregoing is true and correct. Executed on 201 in city state Signature of Authorized Officer or Agent Printed name and Title of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 201.
Form preview Hire houston first application... Hire Houston First Application and Affidavit Thank you for your interest in the Hire Houston First initiative. Businesses interested in becoming eligible to participate in the Hire Houston First initiative must complete this application and sign the attached affidavit. It is the policy of the City of Houston as defined in Chapter 15 Article XI to use the City s spending powers in a manner that promotes fiscal responsibility and maximizes the effectiveness of local tax dollars by ensuring a portion of citizens tax dollars remain in the local economy for economic benefit of the citizens by utilizing all available legal opportunities to contract with city and/or local businesses. Only businesses that meet the requirements will be eligible to participate in the Hire Houston First initiative. A completed HHF application is NOT evidence of designation under the Hire Houston First initiative. An applicant s eligibility must be confirmed in writing by the Office of Business Opportunity Definitions A. City Business means a business with a principal place of business within city limits. B. Local Area means the Houston-Sugar Land-Baytown metropolitan statistical area as defined by the Office of Management and Budget within the Executive Office of the President of the United States and includes the counties of Harris Fort Bend Montgomery Brazoria Galveston Chambers Waller Liberty Austin and San Jacinto. C. Local Business means a business with a principal place of business in the local area* D. Principal Place of Business means the business must be either 1 headquartered in the incorporated limits of the city or the local area as applicable or 2 have an established place or places of business in the incorporated limits of the city or the local area from which 20 or more of the entity s workforce are regularly based and from which a substantial role in the entity s performance of a commercially useful function or a substantial part of its operations is conducted* A location utilized solely as a post office box mail drop or telephone message center or any combination thereof with no other substantial work function shall not be construed as a Principal Place of Business. E* Headquartered means the location where an entity s leadership directs controls and coordinates the entity s activities. Please complete the following form/affidavit and submit it to the Office of Business Opportunity Houston Business Solutions Center located at 611 Walker Lobby Level and Houston TX 77002 832 393-0954. Applications may be submitted via e-mail to houstonBSC houstontx. gov or faxed to 832. 393. 0650. Incomplete applications and affidavits will not be processed* Please answer all questions. / Application Date Company is applying as Check at least one City Business CB with a principal place of business within the city limits from which a substantial role in the entity s performance of a commercially useful function or a substantial part of its operations is conducted as defined in Chapter 15 Article XI.
Form preview The home depot inc insurance a... Dept. THE HOME DEPOT, INC. INSURANCE APPROVAL REQUEST FORM Supplier Name: Supplier Telephone: Supplier Number Supplier Contact Name: Supplier Fax: Agent/Broker: Agent/Broker Telephone: Supplier Email:
Form preview City of houston annual update... http://www.houstontx.gov/obo/index.html. Submit Completed Application Package to: City of Houston. Office of Business Opportunity. 611 Walker, 7th Floor.
Form preview Affidavit general form ONTARIO Court File Number Name of court Form 14A Affidavit general dated at Court office address Applicant s Full legal name address for service street number municipality postal code telephone fax numbers and e-mail address if any. Sworn/Affirmed before me at municipality in province state or country Signature on date FLR 14A March 1 2010 Commissioner for taking affidavits Type or print name below if signature is illegible. D clar sous serment/Affirm solennellement devant moi en/ /au province tat ou pays le er FLR 14A 1 mars 2010 Commissaire aux affidavits Dactylographiez le nom ou crivez-le en caract res d imprimerie ci-dessous si la signature est illisible. Lawyer s name address street number municipality postal code telephone fax numbers and e-mail address if any. Respondent s My name is full legal name I live in municipality province and I swear/affirm that the following is true Set out the statements of fact in consecutively numbered paragraphs. Where possible each numbered paragraph should consist of one complete sentence and be limited to a particular statement of fact. If you learned a fact from someone else you must give that person s name and state that you believe that fact to be true. 1. I am not the same as the person s listed in rows of the attached Associated Family and Child Protection Cases report. Associated Criminal Cases report. 2. To the best of my knowledge listed in rows is not the same child as the child 3. I make this affidavit in good faith and for no improper purpose. Put a line through any blank space left on this page. This form is to be signed in front of a lawyer justice of the peace notary public or commissioner for taking affidavits. Fran ais au verso Num ro de dossier du greffe Nom du tribunal Formule 14A Affidavit formule g n rale dat du situ e au Adresse du greffe Requ rant e s Nom et pr nom officiels et adresse aux fins de signification num ro et adresse lectronique le cas ch ant. Nom et adresse de l avocat e num ro et rue municipalit code postal num ros de t l phone et de t l copieur et adresse lectronique le cas ch ant. Intim e s Je m appelle nom et pr nom officiels J habite municipalit et province et je d clare sous serment/j affirme solennellement que les renseignements suivants sont v ridiques num rez les d clarations de fait sous forme de paragraphes num rot s cons cutivement. Si possible chaque paragraphe devrait consister en une seule phrase et se limiter une d claration de fait particuli re. Si vous avez appris le fait d une autre personne vous devez donner son nom et indiquer que vous tenez ce fait pour v ridique. 1. Je ne suis pas la m me personne aux rang es du que celle s qui est sont indiqu e s rapport ci-joint sur les causes connexes en mati re de protection de la famille et de l enfance. 2. Au mieux de ma connaissance qui est indiqu aux rang es n est pas le m me enfant que celui protection de la famille et de l enfance. 3. Je fais cet affidavit de bonne foi et des fins convenables. Tracez une ligne horizontale en travers de tout espace laiss en blanc sur la pr sente page.
Form preview Financial affidavit 2013 2019... List of Attachments - Check off which forms and documents you are attaching to your Financial Affidavit. Certification of Copies - You must give a copy of your Financial Affidavit with all attachments to the other side. G. Specific Instructions for Numbered Sections of the Financial Affidavit Form or if there are restraining orders you do not have to give your address. Clear Form THE STATE OF NEW HAMPSHIRE JUDICIAL BRANCH http //www. courts. state. nh. us Court Name Case Name Case Number if known FINANCIAL AFFIDAVIT 1. Any asset of substantial value that you either gave away or sold for less than fair market value within 6 months of the date of the Financial Affidavit. E. Duty to Update - You must fill out and file a new Financial Affidavit for every hearing. F. Use of Forms - You may use the Financial Affidavit and Monthly Expenses forms provided by the Court or your own forms as long as the format and content are identical to the Court version. You may design other attachments as you see fit. Financial Federal Income Tax Loan Payments Other Debts Savings IRA Other Retirement Plans 9. Other Expenses TOTAL MONTHLY EXPENSES General Instructions for Completing the Financial Affidavit Form NHJB-2065-F A. I have reasonably estimated the fair market value of each asset and C. I understand that I have a duty to update the information provided in this financial affidavit for each court hearing and Court with any change of address in writing. General Information Name Street Address Town/City State Zip Mailing Address if different Date of Birth Social Security Number Highest Grade or Degree Completed Date of Marriage Date of Separation or Divorce 4. Monthly Income - Miscellaneous AFDC TANF and Food Stamps Other Public Assistance Children s Income Child Support 2. Children born to or adopted by the Parties Full Name DOB and SSN 2a* Number of people currently living in household including self 3. Employment Information Name Address and Phone Number of Employer Base Pay from Salary Wages Overtime and Shift Differential Commissions Tips Bonuses Part-time Employment Self-employment Unemployment and Veteran s Benefits Disability Workers Compensation Pension and Retirement Benefits Interest and Dividends Trust and Other Investment Income Rental Income and Business Profits All other sources Total Section 5 Monthly Income Job Skills 7. Monthly Expenses Court Ordered Support for Others State Income Taxes Mandatory Pension Health Insurance for Parties Children Day Care for Parties Children Date and Place of Last Employment Additional Information Top of Page 8. Additional Assets - If you have an interest in any property which is held solely by or jointly with any other person or entity and which has not already been disclosed or if you are owed money from any source please explain 9. Tax Return Information Year of last return filed Single or joint return My Total W-2s and 1099s If Self-employed check here and attach copy of most recent IRS Schedule C. 10. Insurance Life Company Type and Face Amount Beneficiaries Health Type Description of Coverage Dental 11.
Form preview Mn affidavit 2013 2019 form SUITE 165 ST. PAUL MN 55101-5165 Phone 651 297-2126 TTY 651 282-6555 Website dvs. dps. mn.gov AFFIDAVIT TO CORRECT THE OWNERSHIP RECORD OF A MOTOR VEHICLE PLEASE READ INSTRUCTIONS BELOW BEFORE COMPLETING FORM The appropriate parties must complete all sections of this form and the following Titled vehicle The seller s and correct buyer s must also complete the transfer and application on the certificate of title. TO THE BEST OF MY KNOWLEDGE THIS VEHICLE HAS HAS NOT CHECK ONE SUSTAINED DAMAGE IN EXCESS OF 80 PERCENT ACTUAL CASH VALUE. ASSIGNMENT I/WE CERTIFY THAT THIS VEHICLE IS FREE FROM ALL SECURITY INTERESTS. I/WE WARRANT TITLE AND ASSIGN THE REGISTRATION TAX AND VEHICLE TO THE PERSON S NAMED ABOVE. I/WE DID PURCHASE THE ABOVE DESCRIBED VEHICLE SUBJECT TO LIENS SHOW AND NO OTHERS Date of Purchase D SELLER MUST COMPLETE I/WE CERTIFY THAT ALL INFOMRATION ABOVE IS CORRECT Seller s Signature PS2025-E1 07/13. MINNESOTA DEPARTMENT OF PUBLIC SAFETY Print Form DRIVER AND VEHICLE SERVICES DIVISION 445 MINNESOTA ST. Non-titled vehicle A motor vehicle application PS2000 must be completed and signed by the correct buyer. Note To qualify for a refund cancellation of a vehicle sale must be submitted within 90 days of the initial sale date. VEHICLE DESCRIPTION MUST BE COMPLETED IN ALL CASES A Year VEHICLE IDENTIFICATION NUMBER 10 11 12 13 14 Make Model Plate Number Title Number B INCORRECT BUYER S MUST COMPLETE Incorrect Buyer s Name/Names last first and middle Date s of Birth Signature s INCORRECT BUYER S MUST SIGN X On provide date LIEN RELEASE FOR INCORRECT BUYER S - Must be Notarized Secured Party s Name Subscribed and sworn to before me this day of 20 State City Zip Code The secured Party named no longer claims a security interest in the vehicle above. Notary Public County Signature and Title of Authorized Agent Date of Release My Commission Expires Note If a lien is noted on the certificate of title a lien release is required for the incorrect buyer The correct buyer must complete the lien information in section C below. C Buyer s Name/Names last first and middle Street Address IS THIS VEHICLE SUBJECT TO SECURITY AGREEMENT S YES NO Date of Loan First Secured Party Print Name ODOMETER DISCLOSURE STATEMENT. I/WE CERTIFY THAT THE ODOMETER NOW READS NO TENTHS MILES AND TO THE BEST OF MY KNOWLEDGE THE ODOMETER MILEAGE IS ACTUAL MILEAGE WARNING ODOMETER DISCREPNCY MECHANICAL LIMITS IF YES COMPLETE SECTION BELOW FOR ADDITIONAL SECURED PARTIES ATTACH COMPLETED FORM PS2017 DAMAGE DISCLOSURE STATEMENT. Non-titled vehicle A motor vehicle application PS2000 must be completed and signed by the correct buyer. Note To qualify for a refund cancellation of a vehicle sale must be submitted within 90 days of the initial sale date. Note To qualify for a refund cancellation of a vehicle sale must be submitted within 90 days of the initial sale date. VEHICLE DESCRIPTION MUST BE COMPLETED IN ALL CASES A Year VEHICLE IDENTIFICATION NUMBER 10 11 12 13 14 Make Model Plate Number Title Number B INCORRECT BUYER S MUST COMPLETE Incorrect Buyer s Name/Names last first and middle Date s of Birth Signature s INCORRECT BUYER S MUST SIGN X On provide date LIEN RELEASE FOR INCORRECT BUYER S - Must be Notarized Secured Party s Name Subscribed and sworn to before me this day of 20 State City Zip Code The secured Party named no longer claims a security interest in the vehicle above.
Form preview Sc form affidavit 2014 STATE OF SOUTH CAROLINA 1350 DEPARTMENT OF REVENUE NONRESIDENT SHAREHOLDER OR PARTNER AFFIDAVIT AND AGREEMENT INCOME TAX WITHHOLDING I-309 (Rev. 7/23/14) 3313 The undersigned taxpayer on oath, being
Form preview Affidavit of domicile merrill... Affidavit of Domicile Merrill Lynch Account Number All the fields provided below are required. I, being duly sworn, depose and state as follows: Affiant (Your Name. If a Corporate Fiduciary, Show
Form preview Affidavit alteration form AFFIDAVIT OF ALTERATION Assignment of Title On this day of 20 comes who being duly sworn deposes and says that on or about the day of 20 he altered the assignment of State for the following reason s Deponent further states that such alteration was not made with intent to defraud or with intent to evade the laws of the State of Arkansas governing the registration of motor vehicles. Further the deponent sayeth not. Signature of Affiant Subscribed and Sworn to before me this day Notary Public My Commission expires This department reserves the right to consider each application individually on its merits and hereby gives notice that your affidavit does not necessarily mean that a certificate of title will be issued thereon* ADC CDK 404 10-308.
Form preview Arkansas affidavit repossessio... AFFIDAVIT OF REPOSSESSION OF MOTOR VEHICLE I, We, do hereby solemnly swear to affirm that the following described vehicle was repossessed from, pursuant to the terms of a Conditional Sales Contract,
Form preview Dr 2153 form DR 2153 11/13/07 COLORADO DEPARTMENT OF REVENUE DIVISION OF MOTOR VEHICLES INVESTIGATIONS UNIT 1881 PIERCE STREET ROOM 136 LAKEWOOD COLORADO 80214 303 205-8383 AFFIDAVIT OF COLORADO DRIVER S LICENSE OR ID THEFT Take DO NOT MAIL OR FAX this completed notarized form with a police report to a driver s license office to apply for a license or ID with a new number PIN. VICTIM IDENTIFICATION Note Knowingly submitting false information on this form could subject you to criminal prosecution for perjury. FULL LEGAL NAME First Middle Last Jr. Sr. III NAME IF DIFFERENT FROM ABOVE WHEN THE EVENTS DESCRIBED IN THIS AFFIDAVIT TOOK PLACE Date of Birth Social Security Number CURRENT ADDRESS Address Driver s license or Identification card number PIN City State ZIP Code Beginning date of residence at this address Month Year ADDRESS IF DIFFERENT FROM ABOVE WHEN THE EVENTS DESCRIBED IN THIS AFFIDAVIT TOOK PLACE Current Daytime Telephone Number Beginning and End date of residence at this address From Month To Current Evening Telephone Number HOW THE FRAUD OCCURRED Check all that apply for items 1-6 1. I did not authorize anyone to use my name or personal information to seek the money credit loans goods or services described in this report. 2. I did not receive any benefit money goods or services as a result of the events described in this report. 3. My identification documents for example credit cards birth certificate driver s license Social Security card etc* were stolen lost on or about month/day/year 4. To the best of my knowledge and belief the following person s used my information for example my name address date of birth existing account numbers Social Security number mother s maiden name etc* or identification documents to get money credit loans goods or services without my knowledge or authorization Name Address if known Phone Number s Additional Information 5. I do not know who used my information or identification documents to get money credit loans goods or services without my knowledge or authorization* 6. Additional comments For example description of the fraud which documents or information were used or how the identity thief gained access to your information* VICTIM S LAW ENFORCEMENT ACTIONS 7. My signature below indicates that I am willing to assist in the prosecution of the person s who committed this fraud. the investigation and prosecution of the persons who committed this fraud. 9. check all that apply I have reported the events described in this affidavit to the police or other law enforcement agency. The police did did not write a report. Please complete the following Agency Number 1 Officer/Agency personnel taking report Report number if any Date of report E-mail address if any Please indicate the supporting documentation you are able to provide. Attach copies NOT originals to the affidavit. A copy of the report filed with the police or sheriff s department is attached* SIGNATURE I declare under penalty of perjury that the information I have provided in this affidavit is true and correct to the best of my knowledge.

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