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To change the coverage that is... to change the coverage that is listed on your Declarations page you may use this form to do so. UNINSURED/UNDERINSURED MOTORISTS BODILY INJURY ...

Fsc declared form Self-Declaration regarding FSC-POL-01-004. (Policy for the Association of Organizations with FSC). The signing Organization is associated with the Forest ...

Archdiocese of galveston houst... Archdiocese of Galveston-Houston PETITION for a DECLARATION of NULLITY Due to LACK of CANONICAL FORM (Canon 1117) (This petition is to be completed only by the Case Sponsor.) This petition is used

32 2501 form Teletype TTY users may use the Washington Relay Service by calling 711. REV 32 2501 07/12/13 Print This Form Reset This Form. Washington State Department of Revenue Compliance Procedures Admin* PO Box 47473 Olympia WA 98504-7473 Declaration of Buyer and Seller Regarding Value of Used Vehicle Sold THIS FORM MUST BE COMPLETED ENTIRELY IN ORDER TO BE VALID Description of vehicle Make Model Year Vehicle Identification Number Seller s Name s please print Address City Phone State Zip Buyer s Name s please print Amount Paid Date of Sale / Describe condition of vehicle example needs new engine bodywork etc* Washington law Chapter 82. 12 RCW imposes a use tax on vehicles purchased from persons who are not required to collect the retail sales tax. The tax is due from the buyer on the value of the vehicle at the time of first use. RCW 82. 12. 010 7 a defines value of the article used for use tax purposes. Value means the amount paid or contracted to be paid for the vehicle. If the purchase price does not represent the true value of the vehicle acquired the value is to be determined as nearly as possible according to the retail selling price at place of use of similar vehicle s of like quality and character. The Department of Revenue may based on this statutory provision review and audit declarations of buyers and sellers regarding value of used vehicles sold with possible additional tax interest and penalties as a result* The following statements are made under the laws of the State of Washington* Indicate the city and state for place signed* I declare under penalty of perjury that the above amount is the total amount paid or contracted to be paid for the described vehicle. Seller s Signature Buyer s Signature Date Place Signed For tax assistance or to request this document in an alternate format please call 1-800-647-7706. Washington State Department of Revenue Compliance Procedures Admin* PO Box 47473 Olympia WA 98504-7473 Declaration of Buyer and Seller Regarding Value of Used Vehicle Sold THIS FORM MUST BE COMPLETED ENTIRELY IN ORDER TO BE VALID Description of vehicle Make Model Year Vehicle Identification Number Seller s Name s please print Address City Phone State Zip Buyer s Name s please print Amount Paid Date of Sale / Describe condition of vehicle example needs new engine bodywork etc* Washington law Chapter 82. 12 RCW imposes a use tax on vehicles purchased from persons who are not required to collect the retail sales tax. 12 RCW imposes a use tax on vehicles purchased from persons who are not required to collect the retail sales tax. The tax is due from the buyer on the value of the vehicle at the time of first use. RCW 82. 12. 010 7 a defines value of the article used for use tax purposes. The tax is due from the buyer on the value of the vehicle at the time of first use. RCW 82. 12. 010 7 a defines value of the article used for use tax purposes. Value means the amount paid or contracted to be paid for the vehicle. If the purchase price does not represent the true value of the vehicle acquired the value is to be determined as nearly as possible according to the retail selling price at place of use of similar vehicle s of like quality and character.

Florida living will declaratio... Declaration, made this day of ,20 I, willfully and voluntarily make known my desire that my dying not be artificially prolonged under the circumstances set forth below, and do hereby declare that,

Form 805 Rule 8.05 Financial Statement EXHIBIT 'A' IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI V. PLAINTIFF CAUSE NUMBER: DEFENDANT ************************************************************************************************************************

Nevada homestead declaration f... DECLARATION OF HOMESTEAD FOR RECORDING STAMP Assessor s Parcel Number APN or Assessor s Manufactured Home ID Number Recording Requested by and Mail to Name Address City/State/Zip DO NOT WRITE IN THIS AREA Check One Married filing jointly Widowed Single Person Multiple Single Persons Head of Family By Wife filing for joint benefit of both By Husband filing for joint benefit of both Other describe Regular Home Dwelling/Manufactured Home Condominium Unit Other Name on Title of Property do individually or severally certify and declare as follows is/are now residing on the land premises or manufactured home located in the city/town of more particularly described as follows set forth legal description and commonly known street address or manufactured home description I/We claim the land and premises hereinabove described together with the dwelling house thereon and its appurtenances or the described manufactured home as a Homestead. In witness Whereof I/we have hereunto set my hand/our hands this day of 20. Signature Print or type name here STATE OF NEVADA COUNTY OF This instrument was acknowledged before me on date Notary Seal Person s appearing before notary Signature of notarial officer CONSULT AN ATTORNEY IF YOU DOUBT THIS FORM FITS YOUR PURPOSE. NOTE Do not write in 1-inch margin. Rev.Feb 2010. Signature Print or type name here STATE OF NEVADA COUNTY OF This instrument was acknowledged before me on date Notary Seal Person s appearing before notary Signature of notarial officer CONSULT AN ATTORNEY IF YOU DOUBT THIS FORM FITS YOUR PURPOSE* NOTE Do not write in 1-inch margin* Rev*Feb 2010.

Declaration of mailing form SHORT TITLE CASE NUMBER DECLARATION OF MAILING INSTRUCTIONS Only a person who is age 18 years or older and not a party to this action can serve document copies by mail. Code Civ. Proc. 1013a. An unsigned copy of this Declaration of Mailing must be attached to and mailed with the copies. DATED LACIV 143 Rev. 09/08 LASC Approved 03-04 TYPE OR PRINT NAME OF PERSON WHO DID MAILING SIGNATURE OF PERSON WHO DID MAILING Print Save Code Civ. Proc. 1013 Clear. After the copies are deposited in the mail the person who mailed them must fill out and sign this form attached as the last page of the originals for filing. Code Civ* Proc* 1013 b. WARNING Falsifying this form can be a felony punishable by imprisonment in state prison* Pen* Code 118 126 1. I am employed in or a resident of the county in which this mailing occurred and not a party to this action* At the time of mailing I was at least 18 years of age or older 2. I am readily familiar with the practice at the residence or business address shown below for collection and processing of correspondence for mailing with the United States Postal Service which causes it to be sealed and deposited with said Postal Service with the postage prepaid the same day it is mailed or placed for collection and processing* 3. My residence business address and telephone number are as follows ADDRESS TELEPHONE NUMBER CITY STATE AND ZIP CODE I served the below document s on behalf of name of party personally sealing and mailing with postage prepaid placing for collection and mailing following ordinary by business practices true copies to the addressed as shown on the date and at the place shown in envelope s sealed or to be sealed in the ordinary course of business and addressed as follows DATE MAILED PLACE OF MAILING City and state 5. Exact title s of document s served I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. After the copies are deposited in the mail the person who mailed them must fill out and sign this form attached as the last page of the originals for filing. Code Civ* Proc* 1013 b. WARNING Falsifying this form can be a felony punishable by imprisonment in state prison* Pen* Code 118 126 1. Code Civ* Proc* 1013 b. WARNING Falsifying this form can be a felony punishable by imprisonment in state prison* Pen* Code 118 126 1. I am employed in or a resident of the county in which this mailing occurred and not a party to this action* At the time of mailing I was at least 18 years of age or older 2. I am employed in or a resident of the county in which this mailing occurred and not a party to this action* At the time of mailing I was at least 18 years of age or older 2. I am readily familiar with the practice at the residence or business address shown below for collection and processing of correspondence for mailing with the United States Postal Service which causes it to be sealed and deposited with said Postal Service with the postage prepaid the same day it is mailed or placed for collection and processing* 3.

Declaration of income form NEW YORK STATE DEPARTMENT OF HEALTH Office of Health Insurance Programs Self-Declaration of Income Name App. Reg/Case Social Security Number XXX-XXAddress STREET CITY STATE ZIP CODE Complete the information below only if you have no other way to document your income. All of the boxes below must be checked and all questions answered* Failure to complete this form may result in denial of your application* I get paid in cash. I do not get pay checks. I do not get pay stubs. I cannot get a letter from my employer. Explain why My cash income is How often weekly monthly etc* Current Employer Applicants/Recipients must read the following and sign below I certify that I have no other way to document my income and that all of the above information is true and correct. I understand that this information is to be used to determine eligibility for Public Health Insurance Programs. I understand that program officials may verify information on this form* I also understand that if I intentionally misrepresent my income I may have to repay benefits received and may be prosecuted under State law. Signature of Applicant Date Facilitated Enrollers must read the following and sign below obtain other possible sources of documentation* The information reported on this form was provided solely by the applicant/recipient and reflects the income the applicant reported to me. I did not modify the information in any way. I understand that if I intentionally falsified information on this form or if I assisted the applicant in falsifying any information I may lose my job and may be prosecuted under State law. All of the boxes below must be checked and all questions answered* Failure to complete this form may result in denial of your application* I get paid in cash. I do not get pay checks. I do not get pay stubs. I cannot get a letter from my employer. Explain why My cash income is How often weekly monthly etc* Current Employer Applicants/Recipients must read the following and sign below I certify that I have no other way to document my income and that all of the above information is true and correct. I do not get pay checks. I do not get pay stubs. I cannot get a letter from my employer. Explain why My cash income is How often weekly monthly etc* Current Employer Applicants/Recipients must read the following and sign below I certify that I have no other way to document my income and that all of the above information is true and correct. I understand that this information is to be used to determine eligibility for Public Health Insurance Programs. I understand that this information is to be used to determine eligibility for Public Health Insurance Programs. I understand that program officials may verify information on this form* I also understand that if I intentionally misrepresent my income I may have to repay benefits received and may be prosecuted under State law. I understand that program officials may verify information on this form* I also understand that if I intentionally misrepresent my income I may have to repay benefits received and may be prosecuted under State law. Signature of Applicant Date Facilitated Enrollers must read the following and sign below obtain other possible sources of documentation* The information reported on this form was provided solely by the applicant/recipient and reflects the income the applicant reported to me.

Download fillable of 306 adden... Addendum to Declaration for Federal Employment (OF 306) Indian Health Service Child Care & Indian Child Care Worker Positions Item 15a. Agency Specific Questions Name: Social Security Number:

Ex parte application and decla... Name, Address, and Telephone Number For court use only Superior Court of California County of San Francisco 400 McAllister St. San Francisco, CA 94102 Petitioner: Respondent: Application and Declaration

Indiana financial form FINANCIAL DECLARATION FORM STATE OF INDIANA CIRCUIT AND SUPERIOR COURTS OF PORTER COUNTY IN RE THE MARRIAGE OF Cause Number Petitioner And Respondent In accordance with Local Rule 18 of the Porter Superior Court and Indiana Trial Rules 26 33 34 35 and 37 the undersigned Petitioner or Respondent hereby submits the following VERIFIED FINANCIAL DISCLOSURE STATEMENT Dated I. Further this Financial Declaration Form is considered as a Request for Admissions to the recipient under Trial Rule 35 and should the recipient fail to fully prepare and exchange this statement then the Court may prohibit the party who did not properly complete the Financial the other party on the issues of income expenses assets and liabilities. Date Signature XVI. ATTORNEY S CERTIFICATION I have reviewed with my client the foregoing information including any valuations and attachments and sign this certificate consistent with my obligation under Trial Rule 11 of the Indiana Rules of Procedure. PRELIMINARY INFORMATION Husband Wife Address Soc* Sec* No* Badge/Payroll No* Occupation Employer Birth Date Date of Marriage Date of Physical Separation Date of Filing Children Name Age DOB SSN II. HEALTH INSURANCE INFORMATION Name and Address of health care insurance company Name all persons covered under plan s Weekly cost of total health insurance premium Weekly cost of health insurance premium for children only Name of the children s health care providers The names of the schools and grade level for each child are List any extraordinary health care concerns of any family member List any educational concerns of any family member III. INCOME INFORMATION A. EMPLOYMENT HISTORY Current Employer Telephone No* Length of Employment Job Description Gross Income Per week Bi-weekly Per month Yearly Net Income B. C. Dates of Employment INCOME SUMMARY 1. GROSS WEEKLY INCOME from Salary and wages including commissions bonuses allowances and over-time Note If paid monthly determine weekly income by dividing monthly income by 4. 3 Pensions Retirement Social Security Disability and unemployment insurance Public Assistance welfare AFDC payments etc* Food Stamps Child supports received for any child ren not both of the parties to this marriage Dividends and Interest Rents received All other sources specify TOTAL GROSS WEEKLY INCOME 2. ITEMIZED WEEKLY DEDUCTIONS from gross income State and Federal Income Taxes Medical Insurance Coverage Health Dental Eye Care Psychiatric Compensation per wk/mo/yr Union or other dues Retirement Pension fund Mandatory Optional Profit sharing Mandatory Optional 401 K Mandatory Optional SEP Mandatory Optional IRA Mandatory Optional Child Support withheld from pay not including this case Garnishments itemize on separate sheet Credit Union debts Direct Withdrawals Out of Paychecks Car Payments Life Insurance Disability Insurance Thrift plans Credit Union Savings Bonds Donations Other specify TOTAL WEEKLY DEDUCTIONS 3. WEEKLY DISPOSABLE INCOME A minus B Subtract Total Weekly Deduction from Total Weekly Gross Income IN ALL CASES INVOLVING CHILD SUPPORT Prepare and attach an Indiana Child Support Guideline Worksheet with documentation verifying your income or supplement with such a Worksheet within ten 10 days of the exchange of this Form* IV.

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