Professional legal forms

Standard form 24 Released 6/13/99. Applicant's Statement of Disability Civil Service Retirement System In Connection With Disability Retirement Under the Civil Service Retirement System or the Federal Employees' Retirement

Standard form 294 2001 TELEPHONE NUMBER NUMBER STANDARD FORM 294 REV. 9/2001 Prescribed by GSA-FAR 48 CFR 53. 219 a GENERAL INSTRUCTIONS 1. SUBCONTRACTING REPORT FOR INDIVIDUAL CONTRACTS See instructions on reverse OMB No* 9000-0006 Expires 04/30/2004 Public reporting burden for this collection of information is estimated to average 9 hours per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information* Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the FAR Secretariat MVP Acquisition Policy Division GSA Washington DC 20405. 3. DATE SUBMITTED 1. CORPORATION COMPANY OR SUBDIVISION COVERED a* COMPANY NAME b. STREET ADDRESS 4. REPORTING PERIOD FROM INCEPTION OF CONTRACT THRU YEAR c* CITY MAR 31 d. STATE e. ZIP CODE SEPT 30 5. TYPE OF REPORT 2. CONTRACTOR IDENTIFICATION NUMBER REGULAR FINAL REVISED 6. ADMINISTERING ACTIVITY Please check applicable box ARMY GSA NASA NAVY DOE OTHER FEDERAL AGENCY Specify AIR FORCE DEFENSE CONTRACT MANAGEMENT AGENCY 7. REPORT SUBMITTED AS Check one and provide appropriate number PRIME CONTRACT NUMBER SUBCONTRACT NUMBER 8. AGENCY OR CONTRACTOR AWARDING CONTRACT a* AGENCY S OR CONTRACTOR S NAME 9. DOLLARS AND PERCENTAGES IN THE FOLLOWING BLOCKS DO INCLUDE INDIRECT COSTS DO NOT INCLUDE INDIRECT COSTS SUBCONTRACT AWARDS TYPE 10a* 10b. SMALL BUSINESS CONCERNS Include SDB WOSB HBCU/MI HUBZone SB and VOSB Including Service-Disabled VOSB Dollar Amount and Percent of 10c LARGE BUSINESS CONCERNS Dollar Amount and Percent of 10c* 10c* TOTAL Sum of 10a and 10b. HUBZone SMALL BUSINESS HUBZone SB CONCERNS Dollar Amount and Percent of 10c* VETERAN-OWNED SMALL BUSINESS CONCERNS Includng Service-Disabled Veteran-Owned SB Concerns PERCENT HISTORICALLY BLACK COLLEGES AND UNIVERSITIES HBCU AND MINORITY INSTITUTIONS MI If applicable ACTUAL CUMULATIVE WHOLE DOLLARS WOMEN-OWNED SMALL BUSINESS WOSB CONCERNS SMALL DISADVANTAGED BUSINESS SDB CONCERNS Include HBCU/MI Dollar Amount and Percent of 10c* CURRENT GOAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS CONCERNS Dollar Amount and Percent 100. 0 17. REMARKS 18a* NAME OF INDIVIDUAL ADMINISTERING SUBCONTRACTING PLAN AREA CODE AUTHORIZED FOR LOCAL REPRODUCTION Previous edition is not usable 18b. This report is not required from small businesses. commercial plan has been approved nor from large businesses in the Department of Defense DOD Test Program for Negotiation of Comprehensive Subcontracting Plans. The Summary Subcontract Report SF 295 is required for contractors operating under one of these two conditions and should be submitted to the Government in accordance with the instructions on that form* 3. This form collects subcontract award data from prime contractors/subcontractors that a hold one or more contracts over 500 000 over 1 000 000 for construction of a public facility and b are required to report subcontracts awarded to Small Business SB Small Disadvantaged Business SDB Women-Owned Small Business WOSB HUBZone Small Business HUBZone SB Veteran-Owned Small Business VOSB and Service-Disabled Veteran-Owned Small Business concerns under a subcontracting plan* For the Department of Defense DOD the National Aeronautics and Space Administration NASA and the Coast Guard this form also collects subcontract award data for Historically Black Colleges and Universities HBCUs and Minority Institutions MIs.

Standard confirm form STANDARD FORM TO CONFIRM ACCOUNT. BALANCE INFORMATION WITH FI. NANCIAL INSTITUTIONS. CHINO BASIN DESALTER AUTHORITY

Nc form contract NOTE If alternative 2 applies then do not insert 0 N/A or leave blank. existing loan s secured by a deed of trust on the Property in accordance with the attached Loan Assumption Addendum. Page 1 of 5 STANDARD FORM 2-T Buyer Initials Seller Initials 5. PROPERTY DISCLOSURE Buyer has received a signed copy of the N.C. Residential Property Disclosure Statement prior to the signing of this Offer to Purchase and Contract. OFFER TO PURCHASE AND CONTRACT as Buyer hereby offers to purchase and as Seller upon acceptance of said offer agrees to sell and convey all of that plot piece or parcel of land described below together with all improvements located thereon and such fixtures and personal property as are listed below collectively referred to as the Property upon the following terms and conditions 1. 2. FIXTURES The following items if any are included in the purchase price free of liens any built-in appliances light fixtures ceiling fans attached floor coverings blinds shades drapery rods and curtain rods brackets and all related hardware window and door screens storm windows combination doors awnings antennas satellite dishes and receivers burglar/fire/smoke alarms pool and spa equipment solar energy systems attached fireplace screens gas logs fireplace inserts electric garage door openers with controls outdoor plants and trees other than in movable containers basketball goals storage sheds mailboxes wall and/or door mirrors and any other items attached or affixed to the Property EXCEPT the following items 3. PERSONAL PROPERTY The following personal property is included in the purchase price 4. PURCHASE PRICE The purchase price is and shall be paid as follows bank check certified check other to be deposited and held in escrow by Escrow Agent until the sale is closed at which time it will be credited to Buyer or until this contract is otherwise terminated. In the event 1 this offer is not accepted or 2 any of the conditions hereto are not satisfied then all earnest monies shall be refunded to Buyer. In the event of breach of this contract by Seller upon Buyer s request all such breach. In the event this offer is accepted and Buyer breaches this contract then all earnest monies shall be forfeited upon Seller s request but receipt of such forfeited earnest monies shall not affect any other remedies available to Seller for such breach. PERSONAL PROPERTY The following personal property is included in the purchase price 4. PURCHASE PRICE The purchase price is and shall be paid as follows bank check certified check other to be deposited and held in escrow by Escrow Agent until the sale is closed at which time it will be credited to Buyer or until this contract is otherwise terminated. In the event 1 this offer is not accepted or 2 any of the conditions hereto are not satisfied then all earnest monies shall be refunded to Buyer. In the event of breach of this contract by Seller upon Buyer s request all such breach. In the event this offer is accepted and Buyer breaches this contract then all earnest monies shall be forfeited upon Seller s request but receipt of such forfeited earnest monies shall not affect any other remedies available to Seller for such breach. NOTE In the event of a dispute between Seller and Buyer over the return or forfeiture of earnest money held in escrow by a broker the broker is required by state law to retain said earnest money in the broker s trust or escrow account until a written release from the parties consenting to its disposition has been obtained or until disbursement is ordered by a court of competent jurisdiction. Effective Date as set forth in paragraph 23. REAL PROPERTY Located in the City of County of State of North Carolina being known as and more particularly described as Street Address Zip Legal Description All A portion of the property in Deed Reference Book Page No. County. NOTE Prior to signing this Offer to Purchase and Contract Buyer is advised to review Restrictive Covenants if any which may limit the use of the Property and to read the Declaration of Restrictive Covenants By-Laws articles of Incorporation Rules and Regulations and other governing documents of the owners association and/or the subdivision if applicable. 2. FIXTURES The following items if any are included in the purchase price free of liens any built-in appliances light fixtures ceiling fans attached floor coverings blinds shades drapery rods and curtain rods brackets and all related hardware window and door screens storm windows combination doors awnings antennas satellite dishes and receivers burglar/fire/smoke alarms pool and spa equipment solar energy systems attached fireplace screens gas logs fireplace inserts electric garage door openers with controls outdoor plants and trees other than in movable containers basketball goals storage sheds mailboxes wall and/or door mirrors and any other items attached or affixed to the Property EXCEPT the following items 3. PROPERTY INSPECTION APPRAISAL INVESTIGATION Choose ONLY ONE of the following Alternatives ALTERNATIVE 1 a Property Inspection Unless otherwise stated herein Buyer shall have the option of inspecting or obtaining at Buyer s expense inspections to determine the condition of the Property. Unless otherwise stated herein it is a condition of this contract that i the built-in appliances electrical system plumbing system heating and cooling systems roof coverings including flashing and gutters doors and windows exterior surfaces structural components including foundations columns chimneys floors walls ceilings and roofs porches and decks fireplaces and flues crawl space and attic ventilation systems if any water and sewer systems public and private shall be performing the function for which intended and shall not be in need of immediate repair ii there shall be no unusual drainage conditions or evidence of excessive moisture adversely affecting the structure s and iii there shall be no friable asbestos or existing environmental contamination. Any inspections shall be completed and written notice of necessary repairs shall be given to Seller on or before. Seller shall provide written notice to Buyer of Seller s response within days of Buyer s notice. Buyer is advised to have any inspections made prior to incurring expenses for Closing and in sufficient time to permit any required repairs to be completed by Closing. b Wood-Destroying Insects Unless otherwise stated herein Buyer shall have the option of obtaining at Buyer s expense a report from a licensed pest control operator on a standard form in accordance with the regulations of the North Carolina Structural Pest Control Committee stating that as to all structures except there was no visible evidence of wood-destroying insects and containing no indication of visible damage there from. The report must be obtained in sufficient time so as to permit treatment if any and repairs if any to be completed prior to Closing. All treatment required shall be paid for by Seller and completed prior to Closing unless otherwise agreed upon in writing by the parties. Unless otherwise stated herein it is a condition of this contract that i the built-in appliances electrical system plumbing system heating and cooling systems roof coverings including flashing and gutters doors and windows exterior surfaces structural components including foundations columns chimneys floors walls ceilings and roofs porches and decks fireplaces and flues crawl space and attic ventilation systems if any water and sewer systems public and private shall be performing the function for which intended and shall not be in need of immediate repair ii there shall be no unusual drainage conditions or evidence of excessive moisture adversely affecting the structure s and iii there shall be no friable asbestos or existing environmental contamination. Any inspections shall be completed and written notice of necessary repairs shall be given to Seller on or before. Seller shall provide written notice to Buyer of Seller s response within days of Buyer s notice. Buyer is advised to have any inspections made prior to incurring expenses for Closing and in sufficient time to permit any required repairs to be completed by Closing. b Wood-Destroying Insects Unless otherwise stated herein Buyer shall have the option of obtaining at Buyer s expense a report from a licensed pest control operator on a standard form in accordance with the regulations of the North Carolina Structural Pest Control Committee stating that as to all structures except there was no visible evidence of wood-destroying insects and containing no indication of visible damage there from. The report must be obtained in sufficient time so as to permit treatment if any and repairs if any to be completed prior to Closing. All treatment required shall be paid for by Seller and completed prior to Closing unless otherwise agreed upon in writing by the parties. The Buyer is advised that the inspection report described in this paragraph may not always reveal either structural damage or damage caused by agents or organisms other than wooddestroying insects.

Form 2a8 t SELLER POSSESSION AFTER CLOSING AGREEMENT THIS AGREEMENT IS AN ADDENDUM TO THE OFFER TO PURCHASE AND CONTRACT WARNINGS TO BUYERS AND SELLERS: THIS FORM SHOULD NOT BE USED FOR OCCUPANCY OF MORE THAN

Texas commission on fire prote... Date Received Texas Commission on Fire Protection Fire Service Standards & Certification Division P.O. Box 2286, Austin, Texas 78768-2286 (512) 936-3838 FAX (512) 936-3808 Date Approved Approved

Minnesota department of labor... Reset 443 Lafayette Road N. St. Paul, MN 55155 (651) 284-5005 Telecommunication Device for the Deaf (651) 297-4198 Fax (651) 284-5740 All dates must be entered in mm/dd/yyyy Minnesota Department of

Haywood foundation reference l... Wells Fargo Private Client Service P. O. Box 597 Helena MT 59624 Due November 15th APPLICATION FOR THE HEYWOOD FOUNDATION SHEEP AWARD 500 CASH AWARD Directions Complete this form and send it accompanied by the three reference letters requested 1. Please list your references below Name Address County Extension Agent Occupation 4-H CLUB LEADER Signed Signed 4-H Applicant Parent or Guardian Date APPLICATION INSTRUCTIONS HEYWOOD FOUNDATION Purpose To...

Mi standards order form state... Michigan Standards for Ensuring Excellent Educators The standards in this document, approved by the Michigan State Board of Education, represent the best thinking of thousands of Michigan educators.

Texas standardized credentiali... Texas Standardized Credentialing Application Please type or print Section I Personal Information Name Last First Other Name Used Maiden/Other Middle Years Associated with Former Name yyyy - yyyy Jr. Sr. etc* Social Security Number Gender Male HOME Mailing Address Date of Birth mm/dd/yyyy City ZIP Code Home Telephone Number Citizenship Place of Birth State If not American Citizen Status and Visa Number Are you eligible to work in the United States Are you currently on active military duty or on military reserve US Military Service/Public Health Yes No Dates of Service From mm-dd-yyyy To mm-dd-yyyy Last Location Practice Location Information SE N/A Female Branch of Service Type of Professional Primary Care Type of Service Provided Specialty Care O N Email Address D Tax ID Number and Associated Individual Group Number and Name for this location Correspondence Office Address - Street Telephone Number Do you want this site listed in the Directory Fax Number No If No what is your expected start date Other Office Address - Street Primary Office Email Address T Group/Corporate Name as It Appears on W-9 if Different from Group Name/Practice Name Number Physician Nurse Physical Therapist Counselor U Group Name/Practice Name to Appear in the Directory If you have additional offices please submit an attachment containing the above information and check this box License and Other Identification Numbers License Information Include all license s and certifications in all States where you are currently or have previously been licensed State s of Original Date of Issue License/Certificate Number Registration practice in this state License Expiration Date Other DPS/DEA specify Texas Department of Insurance/Proposed to be Effective July 1 2002. HMO01 PROPOSED 1 of 13 UPIN National Provider Identifier when available Are you a participating Medicare Provider International Medical Graduates Are you certified by the Educational Council for Foreign Medical Graduates ECFMG Education If yes ECFMG Number ECFMG Issue Date School Issuing Professional Degree Medical Dental Chiropractic etc* Degree Attendance Dates Address es State/Country If you attended additional schools please submit attachment containing the above information and check this box Post-graduate Education Start Date month/year Fellowship Teaching Appointment Institution End Date Was program successfully completed Program Director Zip Code Internship Residency Current Program Director if known If you completed additional training please submit attachment containing the above information and check this box Other Graduate Level Education for Which a Degree Was Obtained Type of Program Psychology Public Health Business etc* Degree Obtained BS MS PhD etc* Date of Graduation month/year Professional/Specialty Information Primary Specialty Initial Certification Date Board Certified Name of Certifying Board Recertification Date s if applicable Expiration Date if applicable Do you wish to be listed in the directory under this specialty HMO PPO POS If not Board certified indicate any of the following that apply I have taken exam results pending for I am intending to sit for the Boards on I am not planning to take Boards Secondary Specialty board date 2 of 13 Additional Specialty Hospital Affiliations Do you have hospital privileges If you do not admit patients what admitting arrangements do you have Provide Additional Areas of Professional Practice Interest or Focus HIV/AIDS etc* If you have privileges please answer the section below.

Exhibit k departamento de haci... Government of Puerto Rico Department of the Treasury PUBLICATION 10-03 INFORMATIVE RETURNS COMPACT DISC (CD) REPORTING REQUIREMENTS FOR TAX YEAR 2010 Analysis and Programming Division December, 2010

Short form return ocr 2005 hac... Resident of Puerto Rico at the end of the year? Tax exempt income from the Lottery of Puerto Rico? Income from ...

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