Professional legal forms

Firearm application medical fo... Republic of Guyana APPLICATION FOR JOINT FIREARM License (EXISTING License) INSTRUCTION: Please complete application in CAPITAL LETTERS. Failure to complete all sections will affect processing of

Medical form 11947292 SUN Downstate Medical Center Office of Financial Aid 450 Clarkson Avenue, Room 1-114 Brooklyn, NY 11203-2098 (718) 270-2488 Federal Work-Study Employment Request Form Supervisor's Name: (Please Print)

Standard form3107 2 Released 6/13/99. FERS Federal Employees Retirement System SPOUSE'S CONSENT TO SURVIVOR ELECTION Instructions: If you are married and you do not want a reduced annuity to provide a current spouse

Consent to exchange informatio... RCSC Form#3 CONSENT TO EXCHANGE INFORMATION-SWVTC RCSC I understand that different agencies provide different services and benefits. Each agency must have specific information in order to provide

Form 11 consent orders 2012 20... Application for Consent Orders Form 11 Please type or print clearly and mark X all boxes that apply. Attach extra pages if you need more space to answer any question/s. COURT USE ONLY Client ID Filed in Family Court of Western Australia File number Other specify Filed at Notice to the parties Each party to the application must sign an affidavit - for an applicant in accordance with Part I and for a respondent in accordance with Part K. The application must be filed promptly. The consent order may not be made if the application is not filed within 90 days of the date of the first affidavit see Parts I and K. Each copy of the draft consent order must be certified by the applicant or lawyer as a true copy. If an order or injunction is sought under Part VIIIAA or Part VIIIAB of the Family Law Act the third party must be named as a respondent to this application and must sign the draft consent order. The third party must also sign an affidavit in accordance with Part M of the form but is not required to complete any other Part. Part A About the parties APPLICANT What is your family name as used now RESPONDENT Given names Male Female What is your usual occupation What is your contact address address for service What is your contact address address for service in Australia If you give a lawyer s address the name of the law firm* include the name of the law firm* State Postcode Phone Fax DX Lawyer s code Email Please do not include email or fax addresses unless you are willing to receive documents from the Court and other parties in that way. Signature of applicant. Signature of respondent. When and in what country were you born DAY/MONTH/YEAR / COUNTRY Are you of Aboriginal and/or of Torres Strait Islander origin No Yes Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander You are not required to answer this question but it will greatly assist the Court if you do. The information sought is being collected to assist the Court in planning and delivering client services. It is possible that you may be contacted to participate in a review of a particular aspect of the Court s services although your right not to participate will be respected* The information you provide may be shared with researchers approved by the Court and may be included in publications in statistical form in a way that does not identify you. If there is more than one applicant or respondent attach an extra page with the details for Applicant 2 / Respondent 2 answering Items 1-5. A third party who will be bound by an order sought under Part VIIIAA or Part VIIIAB of the Family Law Act must be named as a respondent but need not complete any of this form except Part M. Part B About the relationship of the parties NOT APPLICABLE When did you begin living together DATE If married when and where did you get married TOWN/CITY When did you finally separate When and where did you get divorced Part C About other Court cases and orders IF YOU ARE SEEKING PARENTING ORDERS ANSWER ITEMS 10 TO 13.

Form application consent SHORT FORM APPLICATION FOR WRITTEN CONSENT TO ENGAGE IN THE BUSINESS OF INSURANCE PURSUANT TO 18 U.S.C. 1033 AND 1034 Submit Two Recent Identical Photos Notice to Applicant 18 U*S*C. 1033 prohibits certain activities by or affecting persons engaged or proposing to become engaged in the business of insurance e 1 A Any individual who has been convicted of any criminal felony involving dishonesty or a breach of trust or who has been convicted of an offense under this section and who willfully engages in the business of insurance whose activities affect interstate commerce or participates in such business shall be fined as provided in this title or imprisoned not more than 5 years or both. B interstate commerce and who willfully permits the participation described in subparagraph A shall be fined as provided in this title or imprisoned not more than 5 years or both. e 2 A person described in paragraph 1 A may engage in the business of insurance or participate in such business if such person has the written consent of any regulatory official authorized to regulate the insurer which consent specifically refers to this section* This Application will be reviewed by the chief insurance regulatory official in this state to determine whether the Applicant should be given written consent to engage in the business of insurance or You must answer every question on the Application* If a question does not apply indicate N/A in the space provided for the answer. Your answers are not limited to the space provided on the Application* Attach additional pages as needed* The Department of Insurance will not process incomplete Applications. Additional information may be requested* 1998 National Association of Insurance Commissioners PLEASE TYPE SECTION I - APPLICANT INFORMATION Full Name of Applicant Last Name First Name Middle Have you ever been known by or used another name including maiden name o yes o no If yes identify Home Address Street Address City State Zip Mailing Address P. O. Box or Street Address Home Telephone Number Work Telephone Number Social Security No* Have you ever used or been issued another social security number If so provide an explanation and previous/other social security number s Place and Date of Birth Answer all questions fully and completely. Failure to answer the questions fully will result in delays in the application process. You are not limited to the space below. Attach additional pages if needed. SECTION II - CRIMINAL HISTORY List any felony s for which you have been arrested charged indicted or convicted* Include details of any negotiated plea agreements and pleas of nolo contendre to an Information or indictment. Attach a full description of your acts involved in the aforementioned matters. Include dates of charge location and nature of offense. Attach additional pages if needed* Provide details of the conviction for which you are seeking written consent and the final disposition of these matter s including sentence dates of incarceration dates of probation/parole if you are currently under probation/parole include the name and phone number of person supervising your parole or probation restitution paid fines/costs ordered fines/costs paid and pardons granted* Include information as to whether or not your civil and political rights have been restored* Attach additional pages if needed* SECTION III - PRESENT/PROPOSED INSURANCE EMPLOYMENT Please specify the name and address of your current or proposed employer to which the requested exemption will apply.

Consent for radiation therapy... CONSENT FOR RADIATION THERAPY TO THE VAGINAL CUFF/CERVIX/UTERUS WITH INTRACAVITARY BRACHYTHERAPY PATIENT NAME: Print name) MR#: TO THE PATIENT: You have been given information about your condition

Parent revoke consent for spec... Print on District Letterhead REVOCATION OF SPECIAL EDUCATION CONSENT Parent: If you wish to exit your child from special education, please complete this form and submit it to the District Office.

Assurance of consent for home... Department of Student Services MONTGOMERY COUNTY PUBLIC SCHOOLS Rockville Maryland 20850 ASSURANCE OF CONSENT FOR HOME INSTRUCTION PURPOSE This form is used by the Montgomery County Public Schools in accordance with the State Board of Education regulation Title 13A Subtitle 10 Home Instruction Chapter 01 General Regulations.

32 parental consent under 18 o... MARQUETTE UNIVERSITY OFFICE OF RESIDENCE LIFE UNDER 18 OVERNIGHT GUEST FORM Marquette University Residence Life Form #32 PARENTAL/GUARDIAN CONSENT AND MEDICAL INFORMATION Marquette Student Information

Authorization health form AUTHORIZATION TO CONSENT TO HEALTH CARE FOR MINOR (North Carolina General Statutes 32A-34) I, of County, , am the custodial parent having legal custody of , born , . a minor child, age I authorize

Consent to name change of mino... IN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION Child(ren): Civil File No: Petitioner: And Respondent: CONSENT FORM The undersigned and are the (check one) parents guardians

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