Application Fee Schedule Please check the appropriate box below. See also Additional Information starting on page 6.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Application Fee Schedule Please check the appropriate box below. See also Additional Information starting on page 6."

Transcription

1 DRIVING SCHOOL LICENSE APPLICATION N. APPLICATION DMV USE ONLY N. LICENSE Received Fee Amunt Expiratin Fee Amunt PART 1 Schl Infrmatin: l READ VEHICLE AND TRAFFIC LAW SECTION 394 AND DMV COMMISSIONER S REGULATIONS PART 76 BEFORE FILLING IN THIS FORM. l Print clearly r type. Name f Driving Schl Address f Main Office Business Phne N. (Area Cde) Fax Number (Area Cde) Address f Branch Office Business Phne N. (Area Cde) First Fax Number (Area Cde) Cntact Infrmatin - What is the name, phne number and address f the individual we shuld send infrmatin t? If the schl has a website, please prvide the website address. Yu must submit a Persnal Histry (frm MV-521.1) fr this individual. Address Driving Schl Website Address Hme Phne N. (Area Cde) Fax Number (Area Cde) Applicatin Fee Schedule Please check the apprpriate bx belw. See als Additinal Infrmatin starting n page 6. All fees are payable t The Cmmissiner f Mtr Vehicles Original license applicatin* $ (nn-refundable) Branch license applicatin* N fee Change f wnership* $ (nn-refundable) Add Partner(s) r Persn(s) t business N fee Change f address N fee Change f business name N fee Incrprating N fee * If yur applicatin fr an riginal license r change f wnership is apprved, yu must pay a license fee f nt mre than $100 fr a twyear license. If yur applicatin fr a branch license is apprved, the fee is $1.50 per year. The fees are payable t Cmmissiner f Mtr Vehicles, in the frm f a check ( starter checks cannt be accepted) r mney rder. PART 2 Check type f wnership (ne wnership type per applicatin) and include paperwrk described belw: Individual with assumed name [sle prprietr r ding business as (DBA) name] Ø Enclse a cpy f the certified business certificate certified by the Cunty Clerk s ffice. Partnership with assumed name [ ding business as (DBA) name] Ø Enclse a cpy f the Certified Business Certificate fr Partners certified by the Cunty Clerk s ffice. The partnership papers must cntain all partners names and the DBA name. Crpratin (Inc., Crp., Ltd.) Ø Enclse a cpy f the filing receipt issued frm the NYS Department f State: (518) r Ø If crpratin is a DBA, yu must als cmplete Crpratin with assumed name. Crpratin with assumed name [ ding business as (DBA) name] Ø Print crpratin name belw and enclse a cpy f the Certificate f Assumed Name issued by the NYS Department f State: (518) r Crpratin Name Limited Liability Cmpany (LLC) Ø Enclse a cpy f the filing receipt issued by the NYS Department f State: (518) r If yu need assistance, call the Bureau f Driver Training Prgrams at Frms are available at PAGE 1 OF 7

2 PART 3 Business Name PLACE OF BUSINESS: DO YOU { Own (cmplete Sectin A) Lease (cmplete Sectins A and B) Sublease (cmplete Sectins A, B and C) Print name and lcatin f business, and business address, belw: Business Address Business Street Address (physical lcatin) City State ZIP Business Phne N. (Area Cde) Cunty A. All applicants must cmplete this sectin. Name f Prperty Owner/Landlrd Owner Mailing Address (Include Number and Street) Phne N. (Area Cde) City State ZIP Number f Years r Mnths Owned? Is this prperty zned fr the business type(s) yu are applying fr? YES NO PLEASE NOTE: Whether yu wn r are leasing yur business prperty, it is yur respnsibility t be in cmpliance with all state and lcal laws and regulatins, while being cnsidered fr a license and while cnducting yur business. Yu must prvide a cpy f the Certificate f Occupancy fr all business lcatins. If yu d nt prvide this infrmatin with yur applicatin, the applicatin will be denied. B. If yu are leasing, cmplete this sectin. Print the Name the Lease is in (Lessee Name) Phne N. (Area Cde) Business Address Expiratin / / C. If yu are subleasing, cmplete this sectin and attach written apprval frm the landlrd. Print the Name the Sublease is in (Sublessee Name) Phne N. (Area Cde) Business Address Expiratin / / PART 4 Ownership infrmatin (cmplete the sectin that applies): A. INDIVIDUAL OWNERSHIP: If wner is an ut-f-state resident, attach gvernment FEIN (Federal Emplyer Identificatin Number) issued ID r recent fficial cpy f driver recrd. B. PARTNERSHIP: Cmplete ne sectin fr each partner; if mre than three, attach additinal pages. If partner is an ut-f-state resident, attach gvernment issued ID r recent fficial cpy f driver recrd PAGE 2 OF 7

3 C. CORPORATION r LIMITED LIABILITY COMPANY: Fr Inc., Crp., LLC, r Ltd., list crprate fficers (President, Secretary and Treasurer are required). List stckhlders and percentage f stck. Fr LLC, list all managing members. Attach additinal pages if needed. Attach a cpy f each listed persn s driver license. (If any listed persn is an ut-f-state resident, attach cpy f gvernment issued ID r recent fficial cpy f driver recrd. 1. Percentage f Stck 2. Percentage f Stck 3. Percentage f Stck D. Qualified Instructr T be licensed, a driving schl must emply at least ne instructr wh has a currently valid Driving Schl Instructr Certificate (frm MV-524) and at least 1,000 hurs f behind-the-wheel instructin. In the space belw, prvide the infrmatin pertaining t this instructr; als attach prf f the 1,000 hurs f instructin. First MI Instructr s Certificate Number Ttal N. f Hurs Teaching In-Car Instructin E. Pwer f Attrney - Give the fllwing infrmatin abut all persns wh have pwer f attrney fr yur driving schl. Please include a cpy f the Pwer f Attrney frm with yur applicatin. If additinal space is needed, attach additinal page(s). First MI F. Questins CHECK ONE If yu answer Yes t any questin(s), please prvide explanatin and detail n page 4 r attach additinal pages. YES 1. Have any f the wners, partners, crprate fficers, managing members, managers r majr stckhlders ever perated a driving schl? NO 2. Have any f the wners, partners, crprate fficers, managing members, managers r majr stckhlders ever been cnvicted f a felny r crime invlving vilence, dishnesty, deceit, indecency, degeneracy r mral turpitude? Will yu be ffering the Prelicensing Curse? If Yes, cmplete an Authrized Signature List (frm MV-278.6) and Request fr Classrm Premises Check fr Prelicensing Curse (frm MV-279) Will yur schl ffer Private Service Bureau services? If YES, attach a draft cpy f yur PSB receipt shwing all services and prices Des r will yur schl ffer a Pint Insurance Reductin Prgram (PIRP)? If yes, list the spnsr s name and attach a list f all classrm lcatins used fr PIRP classes: 6. What type(s) f vehicle(s) will yu use fr instructin? Aut Bus Mtrcycle Tractr-Trailer Truck G. Services Offered - Attach a list f services yu will prvide and the prices fr these services. Yu must include the fee and duratin f each lessn. PAGE 3 OF 7

4 PART 5 Tell us abut yur business and assciates: A. Have yu r any persn named in this applicatin ever had a financial interest in a DMV-regulated business that had its license, registratin r certificatin denied, suspended r revked in New Yrk State? This includes an interest as wner, partner, crprate fficer, managing member r stckhlder hlding mre than twenty percent f the stck, and includes matters nw n appeal. NO YES If YES : Specify name and address f the persn(s), business type, date and actin taken against the business. B. Are yu, r is anyne named in this applicatin, scheduled fr a hearing that may result in the suspensin, revcatin r denial f a DMV-issued business license r apprval fr a DMV-apprved curse (such as PIRP, Mtrcycle Safety Prgram Beginner Rider Curse, PSB, etc.)? NO YES If YES : Specify name and address f the persn(s), business type, date and reasn fr hearing. C. Have yu r any persn named in this applicatin been cnvicted f, r frfeited bail fr, any misdemeanr r felny at any time? NO YES If YES : Name f Birth Cnvictin Penalty Curt Attach cpy f Certificate f Cnvictin, and explain nature f ffense (Further explanatin may be attached.) D. Des anyne else have a financial interest in yur business that is nt disclsed n this applicatin? N Yes If YES : Name E. D yu have any emplyees? YES NO If YES : prvide yur Federal Emplyer Identificatin Number, and attach a cpy f prf f Wrker s Cmpensatin (frm C r U-26.3) and Disability Benefits Insurance (frm DB-120.1) cverage frm the NYS Insurance Fund: r (212) If NO : yu can submit either prf f wrker s cmpensatin and disability benefits (as abve) r a Certificatin f Attestatin f Exemptin (frm CE-200) available at PART 6 Attach additinal pages if necessary Additinal Infrmatin (please identify the sectin name and/r questin number related t the additinal infrmatin yu are prviding). PAGE 4 OF 7

5 PART 7 Certificatin (all applicants must cmplete this sectin): As a cnditin fr the issuance and the cntinued validity f a driving schl license, the individuals signing this applicatin agree t the fllwing cnditins: u t cmply with all f the prvisins f the New Yrk State Vehicle and Traffic Law and the Cmmissiner s Rules and Regulatins relating t driving schls and Private Service Bureaus. u u t cmply with all state laws and regulatins, and all municipal rdinances and regulatins relating t public health and public safety fr the schl and business facility. t emply (r therwise make use f) nly instructrs wh have been prperly certified by the State f New Yrk t instruct at the applicant s schl. The persn(s) signing this applicatin states that he r she is an wner, partner, fficer, r managing member f the business named n this applicatin, and that all infrmatin prvided in this applicatin is true. T knwingly make a false statement in this applicatin is a misdemeanr punishable under Sectin f the Penal cde, and may result in the revcatin f yur driving schl license. Making a false statement in this applicatin r in any prf r statements in writing in cnnectin with it, r deceiving r substituting in cnnectin with this applicatin is a misdemeanr under Sectin 392 f the Vehicle and Traffic Law, and may als result in the revcatin r suspensin f yur driving schl license. Applicatin Prepared by Print Name Signature NOTE: If yu are applying fr a license t pen a driving schl r a branch ffice, r t change yur wnership r address, this applicatin package is the first part f a tw-part prcess. After yur applicatin and supprting dcuments are received and accepted (see page 2 f frm MV-299.2), a Mtr Vehicles License Examiner will visit yur driving schl/branch premises t cnduct an inspectin. Yu must meet all requirements t be apprved. l Have yu cmpleted ALL SECTIONS that apply t yur business? l Have yu signed the applicatin? l Have yu included yur check (NO STARTER CHECKS) r mney rder fr the applicatin fees, made payable t Cmmissiner f Mtr Vehicles? Send this frm and all papers required t cmplete yur applicatin package t: NYS Department f Mtr Vehicles Bureau f Driver Training Prgrams Certificatin & Oversight Unit 6 Empire State Plaza Albany NY (518) PAGE 5 OF 7

6 ADDITIONAL INFORMATION: PART 1 Nn-refundable applicatin fee: Only applicatins fr an ORIGINAL r CHANGE OF OWNERSHIP require an applicatin fee. The fee is fifty dllars ($50) and must be paid in the frm f a check (n starter checks can be accepted) r mney rder, made payable t Cmmissiner f Mtr Vehicles. PART 4 Ownership infrmatin Tell us yur business structure (hw yu set up the business t perate yur drivers schl). The dcumentatin yu include with yur applicatin will depend n yur business structure. See the list belw fr the dcumentatin yu must include with yur applicatin: Sle Prprietr: Certified cpy f the Business Certificate by the Cunty Clerk s Office Partnership: Certified cpy f the Business Certificate fr Partners by the Cunty Clerk s Office Crpratin: Certified cpy f the Certificate f Incrpratin Filing Receipt (issued by Department f State) If the crpratin is a dba with anther name, then the applicant must als submit the certificate f assumed name (issued by Department f State). Schl Infrmatin Minutes f the crpratin meeting that identify: When the meeting was held Wh was in attendance l Minutes must be signed by all fficials f the crpratin and l Minutes must be ntarized OR have a crprate seal The purpse f the frmatin f the crpratin (t cnduct the business f the driver s schl in accrdance with VTL 394) Lcatin f the place f business Crprate fficers (CEO, President, VP, Secretary, Treasurer, Crprate Officers) Distributin f shares (including ttal number f shares) f the crpratin and t whm they are distributed. NOTE: All shares d nt have t be distributed, but at least ne fficer must wn a minimum f 20% f the ttal shares distributed. l Persn wh is respnsible fr the peratin must have at least 20% f the shares l NOTE: The filing receipt identifies the number f shares. L.L.C. (Limited Liability Cmpany): Certified cpy f the Certificate f Incrpratin (issued by Department f State) Minutes f the cmpany meeting that identify: When the meeting was held Wh was in attendance (i.e. the members) l Minutes must be signed by all members f the cmpany and l Minutes must be ntarized OR have crprate seal The purpse f the frmatin f the cmpany t cnduct the business f the driver s schl in accrdance with VTL 394 Lcatin f the place f business Members f the L.L.C., and their respective titles PART 5 Tell us abut yur business and assciates Emplyee Benefits Cverage: Yu must shw prf that yu have either: Wrker s Cmpensatin (frm C r U-26.3) and Disability Benefits Insurance (frm DB-120.1) OR Certificate f Attestatin f Exemptin frm NYS Wrk s Cmpensatin and/r Disability Benefits Cverage (frm CE-200), fund at Persnal Histry (frm MV-521.1): Yu must prvide this fr all staff except instructrs. Required Instructr Verificatin: Yu must have at least ne certified instructr. Frm MV-523 Applicatin fr Driving Schl Instructr Certificate (and all supprting dcuments and fees). At least ne instructr must have a minimum f 1,000 hurs behind-the-wheel teaching experience. A ntarized statement is required t verify this experience. If a ntarized statement is nt available, we ll review any persnal statement with supprting dcumentatin. PAGE 6 OF 7

7 PART 6 Place f Business Prf f lcatin fr business: Yur driving schl must have a physical ffice (which DMV will inspect befre a license is issued). As part f the applicatin, yu must include prf f yur ffice lcatin by including a cpy f a deed r lease r sublease. Yu must als include a cpy f the certificate f ccupancy. NOTE: if this is a sub-lease, yu must submit a cpy f the rental lease issued t the tenant and a written statement frm the landlrd, which acknwledges the apprval f the presence f a driving schl at the lcatin. General Infrmatin Required Driving Schl Recrds. A driving schl is required t keep recrds f business and custmers. With yur applicatin yu must submit a draft cpy f: Student Recrd Card Business Receipt and/r Cntract(s) the schl will use - ptinal Private Service Bureau (PSB) receipt if the business intends t perate a PSB - ptinal List f Driving Schl Vehicles (frm MV-527). All vehicles used fr training r rad testing must be reprted. Even if the schl has n vehicles, the MV-527 is required and must indicate n vehicles. Prelicensing Curse (ptinal): A driving schl which prvides the DMV Prelicensing Curse must have an apprved classrm and qualified classrm-endrsed instructr. Include Premises Check (frm MV-279) and Prf f Lcatin f classrm (if at a different lcatin), cnsisting f a deed r lease r sublease NOTE: if this is a sub-lease, yu must submit a cpy f the rental lease issued t the tenant and a written statement frm the landlrd, which acknwledges the apprval f the presence f a driving schl at the lcatin. Authrized Signature List (frm MV-278.6) Applicatin fr Access t DMV Internet Rad Test Scheduling System (frm MV-522.1) (ptinal). All driver license testing with DMV is scheduled using an autmated scheduling system. Driving schls can apply fr an accunt that allws them t schedule appintments fr their custmers. MV-521 (9/15) PAGE 7 OF 7

Information Bulletin PT 204/09.15

Information Bulletin PT 204/09.15 Infrmatin Bulletin PT 204/09.15 Operatr Accreditatin fr Limusine Services What is peratr accreditatin? The Transprt Operatins (Passenger Transprt) Act 1994 requires peratrs f public passenger services

More information

Skrill Merchant Services Application Form

Skrill Merchant Services Application Form Skrill Merchant Services Applicatin Frm Skrill Merchant Services Applicatin Frm (the Applicatin ) shuld be signed by r n behalf f the Merchant. It is very imprtant that the Merchant has read the Applicatin

More information

c) Be a permanent resident of the United States and the State of Florida. (A resident is

c) Be a permanent resident of the United States and the State of Florida. (A resident is THIRTEENTH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY (Revised 1/9/06) PROCEDURES FOR PROCESS SERVER CERTIFICATION Cmpleted Applicatins are Sub.iect t Apprpriate Public Recrds Disclsure Law Applicatins

More information

All applicants and listed vendors must submit a criminal background check valid

All applicants and listed vendors must submit a criminal background check valid AMENDMENT TO APPLICATION Receipt # Receipt # Date Submitted Date Submitted Amunt paid Amunt paid COMMERCIAL VENDOR APPLICATION PEDDLING, SOLICITING, SPECIAL EVENT VENDOR, VENDOR AT ATHLETIC EVENT Chapter

More information

Loan Application for Pre- Approval

Loan Application for Pre- Approval Lan Applicatin fr Pre- Apprval Get pre-apprved fr yur hme lan financing tday by cmpleting this applicatin. Please cmplete the entire applicatin and return with the dcumentatin requested n the attached

More information

Sonny s Franchise Company 201 North New York Avenue 3rd floor Winter Park, FL 32789

Sonny s Franchise Company 201 North New York Avenue 3rd floor Winter Park, FL 32789 Snny s Franchise Cmpany 201 Nrth New Yrk Avenue 3rd flr Winter Park, FL 32789 Phne: (407) 660-8888 Fax: (407) 660-1285 Email: sates@snnysbbq.cm Name Address PRELIMINARY FRANCHISE APPLICATION Befre filling

More information

o o Thank you for choosing Clover Park Technical College! We look forward to welcoming you to CPTC soon!

o o Thank you for choosing Clover Park Technical College! We look forward to welcoming you to CPTC soon! Thank yu fr requesting the CPTC Internatinal Admissin Applicatin Packet! T cmplete yur admissin, please fill ut the fllwing frms and submit with the dcuments belw: FORMS Internatinal Educatin Admissins

More information

BridgeValley Community and Technical College Financial Aid Office 2015-2016 Maximum Hour Financial Aid Suspension Appeal Process

BridgeValley Community and Technical College Financial Aid Office 2015-2016 Maximum Hour Financial Aid Suspension Appeal Process BridgeValley Cmmunity and Technical Cllege Financial Aid Office 2015-2016 Maximum Hur Financial Aid Suspensin Appeal Prcess T receive financial aid administered by BridgeValley Cmmunity and Technical Cllege,

More information

FORM ADV (Paper Version) UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT FORM BY EXEMPT REPORTING ADVISERS

FORM ADV (Paper Version) UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT FORM BY EXEMPT REPORTING ADVISERS APPENDIX A FORM ADV (Paper Versin) UNIFORM APPLICATION FOR INVESTMENT ADVISER REGISTRATION AND REPORT FORM BY EXEMPT REPORTING ADVISERS Frm ADV: General Instructins Read these instructins carefully befre

More information

Frequently Asked Questions About I-9 Compliance

Frequently Asked Questions About I-9 Compliance Frequently Asked Questins Abut I-9 Cmpliance What is required t verify wrk authrizatin? The basic requirement t verify wrk authrizatin is the Frm I-9. This frm is available n the HR website: http://www.fit.edu/hr/dcuments/frms/i-9.pdf

More information

SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A

SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A SOMERS POINT MUNICIPAL CODE SECTION 202 LICENSE APPLICATION FORM A ** APPLICANT INFORMATION ** NOTE: IF APPLICANT IS AN ORGANIZATION EXEMPT UNDER SECTION 202-22, OR IS APPLYING FOR A LICENSE AS A TRANSIENT

More information

Errors & Omissions Insurance for Title, Escrow Agents and Abstractors. Endorsed by the American Land Title Association

Errors & Omissions Insurance for Title, Escrow Agents and Abstractors. Endorsed by the American Land Title Association Errrs & Omissins Insurance fr Title, Escrw Agents and Abstractrs Endrsed by the American Land Title Assciatin The Insurance Cmpany: Title Industry Assurance Cmpany, a Risk Retentin Grup TIAC issued its

More information

TITLE CHANGE REQUEST CHECKLIST AND INSTRUCTIONS

TITLE CHANGE REQUEST CHECKLIST AND INSTRUCTIONS CHECKLIST AND INSTRUCTIONS Thank yu fr allwing Interval Servicing t assist yu with yur title change request. We want yur transactin t be prcessed smthly and efficiently. Please be sure t review this checklist

More information

New Hampshire. Address: New Hampshire Real Estate Commission 64 South Street Concord, NH 03301-3670

New Hampshire. Address: New Hampshire Real Estate Commission 64 South Street Concord, NH 03301-3670 New Hampshire Gverning Agency New Hampshire Real Estate Cmmissin Website: http://www.nh.gv/nhrec/ Address: New Hampshire Real Estate Cmmissin 64 Suth Street Cncrd, NH 03301-3670 Telephne N.: (603) 271-2701

More information

RESIDENTIAL BUILDING PERMIT APPLICATION

RESIDENTIAL BUILDING PERMIT APPLICATION Butler Twnship 290 Suth Duffy Rad Butler, PA 16001 724/287-7465 Fax: 724/282-2142 RESIDENTIAL BUILDING PERMIT APPLICATION Name f Applicant Name f Owner Phne Fax Phne Fax Name f Cntractr/C. Name f Architect

More information

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM WB-DEC

UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM WB-DEC UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washingtn, D.C. 20549 FORM WB-DEC DECLARATION OF ORIGINAL INFORMATION SUBMITTED PURSUANT TO SECTION 21F OF THE SECURITIES EXCHANGE ACT OF 1934 A. SUBMITTER

More information

Skrill Merchant Services Application Form

Skrill Merchant Services Application Form Skrill Merchant Services Applicatin Frm Skrill Merchant Services Applicatin Frm (the Applicatin ) shuld be signed by r n behalf f the Merchant. It is very imprtant that the Merchant has read the Applicatin

More information

LAW ENFORCEMENT TECHNOLOGY CREDIT BY EXAMINATION FACT SHEET Texas

LAW ENFORCEMENT TECHNOLOGY CREDIT BY EXAMINATION FACT SHEET Texas LAW ENFORCEMENT TECHNOLOGY CREDIT BY EXAMINATION FACT SHEET Texas Ri Salad Cllege, a Maricpa Cunty Cmmunity Cllege in Tempe, Arizna, is prud t annunce its Credit by Examinatin prgram in Law Enfrcement

More information

Where to send the application: The Agency reviews applications and makes decisions for Exemptions for:

Where to send the application: The Agency reviews applications and makes decisions for Exemptions for: BACKGROUND SCREENING Applicatin fr Exemptin AUTHORITY: In accrdance with sectin 435.07, Flrida Statutes, persns disqualified frm emplyment may be granted an exemptin frm disqualificatin. The granting f

More information

FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Approved by the DOLA Executive Director July 1, 2014

FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Approved by the DOLA Executive Director July 1, 2014 FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Apprved by the DOLA Executive Directr July 1, 2014 Prgram Overview: As f July 1, 2014, the Department f Lcal

More information

CONSTRUCTION INDUSTRIES & MANUFACTURED HOUSING DIVISION

CONSTRUCTION INDUSTRIES & MANUFACTURED HOUSING DIVISION New Mexic Regulatin and Licensing Department 2550 Cerrills Rad Santa Fe, NM 87505 Ph (505) 476-4700 Fax (505) 476-4685 INSTRUCTIONS FOR FILING A COMPLAINT Thank yu fr cntacting The New Mexic Regulatin

More information

Workers Compensation Employee Packet

Workers Compensation Employee Packet Wrkers Cmpensatin Emplyee Packet Cmplete the fllwing frms and return t Meagan Vrhies, Claims Crdinatr via fax (817) 735-0127, email at Meagan.Vrhies@untsystem.edu r in persn at Human Resurce Services (EAD-280).

More information

Bond Authorization Requested

Bond Authorization Requested District r Charter Schl Cntact Persn: Address 1: Address 2: City: Zip Cde: Telephne: Email Address: Bnd Authrizatin Requested The maximum bnd authrizatin that may be requested per district r charter schl

More information

Application for 477 Services

Application for 477 Services An Indian Rerganizatin Act Village Under Act f Cngress June 15 th, 1935 32 Chilkat Ave. Klukwan, Alaska 99827 HC60 Bx 2207 Haines, Alaska 99827 Phne: 907-767-5505 Fax: 907-767-5408 klukwan@chilkat-nsn.gv

More information

INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR CERTIFICATE OF EXEMPTION FROM LICENSURE AS A HEALTH CARE CLINIC

INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR CERTIFICATE OF EXEMPTION FROM LICENSURE AS A HEALTH CARE CLINIC INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR CERTIFICATE OF EXEMPTION FROM LICENSURE AS A HEALTH CARE CLINIC REFERENCES: CHAPTER 400, PART X, F.S. (2006) AND FAC 59A-33.006. As prvided in s. 400.9935

More information

Account Switch Kit. Locations. HACKLEBURG PO DRAWER A 34888 US HWY 43 HACKLEBURG, AL 35564 Phone: (205)395-1944 Fax: (205)935-3349

Account Switch Kit. Locations. HACKLEBURG PO DRAWER A 34888 US HWY 43 HACKLEBURG, AL 35564 Phone: (205)395-1944 Fax: (205)935-3349 Member FDIC "Hmetwn Banking... Accunt Switch Kit... Mving Made Easy" Lcatins HAMILTON PO BO 189 1281 MILITARY ST S HAMILTON, AL 35570 Phne: (205)921-9400 Fax: (205)921-9708 HACKLEBURG PO DRAWER A 34888

More information

Merchant Processes and Procedures

Merchant Processes and Procedures Merchant Prcesses and Prcedures Table f Cntents EXHIBIT C 1. MERCHANT INTRODUCTION TO T-CHEK 3 1.1 Wh is T-Chek Systems? 3 1.2 Hw t Cntact T-Chek Systems 3 1.3 Hw t Recgnize T-Chek Frms f Payment 3 1.3.1

More information

OCEAN REEF PUBLIC SAFETY WELCOME CENTER BUSINESS REQUIREMENTS AND REGULATIONS PACKAGE

OCEAN REEF PUBLIC SAFETY WELCOME CENTER BUSINESS REQUIREMENTS AND REGULATIONS PACKAGE OCEAN REEF PUBLIC SAFETY WELCOME CENTER BUSINESS REQUIREMENTS AND REGULATIONS PACKAGE The Package includes: Business Requirements t Register Cntractrs Rules Prices O.R.C.A. I.D. Cards Requirements Day

More information

Third Party Originator Application

Third Party Originator Application Third Party Originatr Applicatin Applicant Infrmatin Third Party Name: Primary Address: City: State: Zip Cde: Primary Cntact: Telephne Number: Email Address: Fax Number: Website Address: Branch Lcatins

More information

NEWFIELD CENTRAL SCHOOL HEALTH INSURANCE

NEWFIELD CENTRAL SCHOOL HEALTH INSURANCE Health/Rx & Dental/Visin Benefits Enrllment/Change rm Please Print Please Cmplete ALL Applicable Sectins Emplyee Infrmatin: Emplyee Benefit Office Use Only H/Rx: WC E Dental: WC A Visin: WC D am Indv am

More information

STUDENT VETERAN BENEFIT CHECKLIST For POST 9/11 GI BILL AND SELECTIVE RESERVE EDUCATIONAL PROGRAMS 1606 & 1607

STUDENT VETERAN BENEFIT CHECKLIST For POST 9/11 GI BILL AND SELECTIVE RESERVE EDUCATIONAL PROGRAMS 1606 & 1607 Financial Aid, Schlarships, Veterans and Fster Yuth Prgrams 6201 Winnetka Avenue, Wdland Hills CA 91371-0002 Veterans: (818) 710-3316 ext 3316 FAX: (818) 704-8221 www.piercecllege.edu/ffices/financial_aid/veterans.asp

More information

Kuck Immigration Partners. Source of Funds. -Worksheet and Document Checklist-

Kuck Immigration Partners. Source of Funds. -Worksheet and Document Checklist- Kuck Immigratin Partners Surce f Funds -Wrksheet and Dcument Checklist- 1 Table f Cntents General Rules... 3 Investrs Net Wrth Wrksheet:... 4 Dcumentatin:... 5 Identificatin and Bigraphic Dcuments... 5

More information

Agency Fund (Non-Student Org X-Fund) Guidelines Last Revision: 12/7/2009

Agency Fund (Non-Student Org X-Fund) Guidelines Last Revision: 12/7/2009 Agency Fund (Nn-Student Org X-Fund) Guidelines Last Revisin: 12/7/2009 Definitin f Agency Fund: An Agency Fund cnsists f funds held by Eastern Michigan University as custdian r fiscal agent fr thers, such

More information

Payment Options Check Payable to Account Holder* Electronic Funds Transfer (ACH) $5.00 Maintain IRA with The Bancorp (contact us for options)

Payment Options Check Payable to Account Holder* Electronic Funds Transfer (ACH) $5.00 Maintain IRA with The Bancorp (contact us for options) Dear Custmer: Thank yu fr cntacting Custmer Care regarding the clsure f yur Individual Retirement Accunt (IRA). In rder t prcess yur request, please cmplete the enclsed Request fr Distributin frm. Yu may

More information

Massage Therapist Licensure Application

Massage Therapist Licensure Application Flrida Bard f Massage Therapy PO Bx 6330 Tallahassee, FL 32314-6330 Web: www.flridasmassagetherapy.gv Email: inf@flridasmassagetherapy.gv Massage Therapist Licensure Applicatin Fees must be paid in the

More information

Clinch-Powell Rural Small Business Loan Fund Fact Sheet

Clinch-Powell Rural Small Business Loan Fund Fact Sheet Clinch-Pwell Rural Small Business Lan Fund Fact Sheet Eligible Areas: Grainger, Claibrne, Hancck, Hawkins, Unin, Jeffersn, Greene, Ccke, Campbell and rural areas f Hamblen and Knx cunties in Tennessee.

More information

Corporations Q&A. Shareholders. 2006 Edward R. Alexander, Jr.

Corporations Q&A. Shareholders. 2006 Edward R. Alexander, Jr. Crpratins Q&A. What is a crpratin and why frm ne? A crpratin is a business entity that is separate and distinct frm its wners. It can enter cntracts, sue and be sued withut invlving its wners (the sharehlders).

More information

COMMERCIAL LOAN APPLICATION PACKAGE

COMMERCIAL LOAN APPLICATION PACKAGE COMMERCIAL LOAN APPLICATION PACKAGE COMMERCIAL LOAN REQUEST FORM Infrmatin Checklist The fllwing checklist will help yu gather the necessary infrmatin fr the initial evaluatin f yur cmmercial lan request.

More information

PUBLIC CHARTER SCHOOLS. Entity Type. This document addresses the following topics related to Tennessee Public Charter Schools. Additional Information:

PUBLIC CHARTER SCHOOLS. Entity Type. This document addresses the following topics related to Tennessee Public Charter Schools. Additional Information: Jan 2015 PUBLIC CHARTER SCHOOLS STATE OF TENNESSEE COMPTROLLER OF THE TREASURY DEPARTMENT OF AUDIT DIVISION OF LOCAL GOVERNMENT AUDIT Entity Type Fr accunting, financial reprting, and auditing purpses,

More information

MASSAGE THERAPY LICENSE

MASSAGE THERAPY LICENSE Guidelines fr MASSAGE THERAPY LICENSE City f Mrhead 500 Center Avenue, PO Bx 779 Mrhead, MN 56560-0799 Phne: 218.299.5304 Fax: 218.299.5306 cityclerk@ci.mrhead.mn.us Mrhead City Cde, 2-6C: Massage Enterprise

More information

LOUISIANA TECH UNIVERSITY Division of Student Financial Aid Post Office Box 7925 Ruston, LA 71272

LOUISIANA TECH UNIVERSITY Division of Student Financial Aid Post Office Box 7925 Ruston, LA 71272 LOUISIANA TECH UNIVERSITY Divisin f Student Financial Aid Pst Office Bx 7925 Rustn, LA 71272 Dear Financial Aid Applicant, Accrding t yur 2011-2012 Student Aid Reprt (SAR), yu did nt include any parental

More information

Transportation Allowance Program

Transportation Allowance Program Transprtatin Allwance Prgram Respnsibilities, Prcedures and Guidelines I. INTRODUCTION This manual describes respnsibilities, prcedures and guidelines (including vehicle specificatins and reimbursable

More information

CONTRACTOR REGISTRATION FAQ

CONTRACTOR REGISTRATION FAQ Department f Buildings & Inspectins Cincinnati, Ohi 45202 www.cincinnati-h.gv CONTRACTOR REGISTRATION FAQ CMC Sectin 1106-21: Rules and Regulatins - The chief building fficial is authrized t establish

More information

DIVISION OF INFORMATION TECHNOLOGY

DIVISION OF INFORMATION TECHNOLOGY DIVISION OF INFORMATION TECHNOLOGY Cellphne/Tablet Repairs Overview Flrida Internatinal University s Divisin f Infrmatin Technlgy is seeking submissins frm prpsed Licensees wh are interested in perating

More information

o I hereby request a total SURRENDER of my contract/certificate (please enclose).

o I hereby request a total SURRENDER of my contract/certificate (please enclose). Distributin Request Frm Prtective Life Insurance Cmpany (PLICO/"the Cmpany") Prtective Life and Annuity Insurance Cmpany (PLAIC/"the Cmpany") Cntract Owner Custmer Service Office: Cntract Annuitant P.O.

More information

FINANCIAL OPTIONS. 2. For non-insured patients, payment is due on the day of service.

FINANCIAL OPTIONS. 2. For non-insured patients, payment is due on the day of service. FINANCIAL OPTIONS 1. Fr thse patients wh carry dental insurance, all c-payments are due n date f service. We will file yur claim as a service t yu, and will d ur very best t maximize yur benefits. We accept

More information

YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES

YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES Please fill ut cmpletely and send back t 216.475.1579 r vendrpackets@garick.cm YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES We must receive: 4 pages f Vendr packet

More information

IDENTIFICATION FORM 3: TRUSTS, TRUSTEES & SMSFs

IDENTIFICATION FORM 3: TRUSTS, TRUSTEES & SMSFs IDENTIFICATION FORM 3: TRUSTS, TRUSTEES & SMSFs GUIDE TO COMPLETING THIS FORM Cmplete the fllwing in BLOCK LETTERS: Sectin 1 (all parts) all trusts. AND select and cmplete ne f the fllwing sectins fr ONLY

More information

FAFSA / DREAM ACT COMPLETION PROGRAM AGREEMENT

FAFSA / DREAM ACT COMPLETION PROGRAM AGREEMENT FAFSA / DREAM ACT COMPLETION PROGRAM AGREEMENT If using US Pstal Service, please return t: Califrnia Student Aid Cmmissin Prgram Administratin & Services Divisin ATTN: Institutinal Supprt P.O. Bx 419028

More information

CAMS CERTIFICATION APPLICATION

CAMS CERTIFICATION APPLICATION CAMS CERTIFICATION APPLICATION PLEASE ONLY FILL IN STEPS 1 AND 6 STEP 1 Cntact Infrmatin Prefix (Mr. Mrs. Ms.) First Name Middle Initial Last Name Title Cmpany Industry Mailing Address 1 (N P. O. Bxes,

More information

CORPORATE CREDIT CARD POLICY

CORPORATE CREDIT CARD POLICY TITLE: POLICY OWNERS: DATE INSTITUTED: May 1, 2008 CURRENT VERSION: Ver. 1.6 REVISION DATE: July 1, 2015 Crprate Credit Card Plicy Melissa Cluse, Vice President & Cntrller Cindy Klein, Accunts Payable

More information

Wire Transfer Request

Wire Transfer Request Wire Transfer Request Requirements and Instructins OFFICE OF DISBURSEMENTS Categry: Dcument Name: Payment Prcessing Wire Transfer Request - Requirements and Instructins Respnsible Department: Office f

More information

University of Texas at Tyler 2015-2016 Special Circumstances Request Independent Student

University of Texas at Tyler 2015-2016 Special Circumstances Request Independent Student University f Texas at Tyler 2015-2016 Special Circumstances Request Independent Student Student Name: ID#: Sectin I. In accrdance with Federal regulatins, student and spuse 2014 incme is used t determine

More information

Frequently Asked Questions about the Faith A. Fields Nursing Scholarship Loan

Frequently Asked Questions about the Faith A. Fields Nursing Scholarship Loan ARKANSAS STATE BOARD OF NURSING 1123 S. University Avenue, Suite 800, University Twer Building, Little Rck, AR 72204 Phne: (501) 686-2700 Fax: (501) 686-2714 www.arsbn.rg Frequently Asked Questins abut

More information

Hampton Roads Orthopaedics & Sports Medicine. Notice of Privacy Practices

Hampton Roads Orthopaedics & Sports Medicine. Notice of Privacy Practices This is being prvided t yu as a requirement f the privacy regulatins issued under the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). This ntice describes hw HROSM may use and disclse

More information

Affiliate Service Agreement

Affiliate Service Agreement Affiliate Service Agreement A. Harringtn Limusine Service (HLS) is searching fr an Affiliate Partner in yur area t better serve HLS s clients. Please cmplete this fillable PDF frm in its entirety. In rder

More information

Dear Flexible Spending Account (FSA) Enrollee:

Dear Flexible Spending Account (FSA) Enrollee: Dear Flexible Spending Accunt (FSA) Enrllee: Welcme t yur FSA Plan! Yu nw have 24x7 access t all yur FSA needs n the web. T access yur accunt simply lgn t www.fsa4me.cm. Yur user name is yur first initial,

More information

NHVAS Mass Management Spot Check Checklist

NHVAS Mass Management Spot Check Checklist Legal Entity Name f NHVAS Operatr: DTMR Representative: Lcatin: NHVAS Mass Management Spt Check Checklist Spt Check Date: Spt Check Number: DMS Number: 540/ The fllwing surces f evidence have been identified

More information

NSW FAIR TRADING. Real Estate Fraud Prevention Guidelines

NSW FAIR TRADING. Real Estate Fraud Prevention Guidelines NSW FAIR TRADING Real Estate Fraud Preventin Guidelines Real Estate Fraud Preventin Guidelines Cntents 1. Intrductin..... 2 2. Backgrund.. 2 3. The Law.. 2 4. Cmmissiner s Guidance.... 3 5. Prescribed

More information

2015-16 Independent Verification Worksheet for HSC Students

2015-16 Independent Verification Worksheet for HSC Students 15IVHP 2015-16 Independent Verificatin Wrksheet fr HSC Students Yur applicatin was selected fr review in a prcess called verificatin. In this prcess, Temple University will be cmparing infrmatin frm yur

More information

IMT Standards. Standard number A000014. GoA IMT Standards. Effective Date: 2010-09-30 Scheduled Review: 2011-03-30 Last Reviewed: Type: Technical

IMT Standards. Standard number A000014. GoA IMT Standards. Effective Date: 2010-09-30 Scheduled Review: 2011-03-30 Last Reviewed: Type: Technical IMT Standards IMT Standards Oversight Cmmittee Gvernment f Alberta Effective Date: 2010-09-30 Scheduled Review: 2011-03-30 Last Reviewed: Type: Technical Standard number A000014 Electrnic Signature Metadata

More information

Texas Hold Em Poker Tournament licence application fee: $20.00 (non-refundable) A 25.00 administration fee will be charged for N.S.F. cheques.

Texas Hold Em Poker Tournament licence application fee: $20.00 (non-refundable) A 25.00 administration fee will be charged for N.S.F. cheques. Texas Hld Em Pker Turnament Applicatin The Saskatchewan Liqur and Gaming Authrity may issue a licence pursuant t subsectin 207 (1)(b) f the Criminal Cde f Canada, authrizing charitable r religius rganizatins

More information

FAQs about Registration & Licensing in Dubai

FAQs about Registration & Licensing in Dubai FAQs abut Registratin & Licensing in Dubai Trade Names 1. Is it required t register a trade name in rder t apply fr an initial apprval? N, a trade name may be bked fr ne year renewable perid, against payment

More information

Mortgage Loan Servicing Escrow Department

Mortgage Loan Servicing Escrow Department Mrtgage Lan Servicing Escrw Department BBVA Cmpass Escrw Department P.O. Bx 830953 Hazard Insurance Claim Prcess We are srry t hear that yu have experience damage t yur prperty. As a valued custmer, ur

More information

Office Use Only Account # Approved By:

Office Use Only Account # Approved By: Office Use Only Accunt # Apprved By: Dealer Applicatin Please cmplete and submit this applicatin alng with a cpy f yur (EIN) Federal Tax Id Number certificate befre placing yur 1 st rder. We will review

More information

TYPE OF OFFENSE(S) AND SECTION NUMBER(S) LIST OFFENSE(S), CASE NUMBER(S) AND DATE(S) CASE NUMBER(S) AND DATE(S)

TYPE OF OFFENSE(S) AND SECTION NUMBER(S) LIST OFFENSE(S), CASE NUMBER(S) AND DATE(S) CASE NUMBER(S) AND DATE(S) SUPERIOR COURT OF CALIFORNIA Reserved fr Clerk s File Stamp COUNTY: PLAINTIFF: PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT: DUI ADVISEMENT OF RIGHTS, WAIVER, AND PLEA FORM (Vehicle Cde 23152) CASE NUMBER:

More information

o o 2) Program Rewards

o o 2) Program Rewards 1) T qualify fr the American Red Crss High Schl Leadership Prgram (referred t as Prgram), each student (referred t as Member) is asked t cmplete the fllwing requirements: a. Cmplete an nline prfile at

More information

VENDOR REGISTRATION AND DISCLOSURE STATEMENT AND SMALL, WOMEN-, AND MINORITY-OWNED BUSINESS CERTIFICATION APPLICATION

VENDOR REGISTRATION AND DISCLOSURE STATEMENT AND SMALL, WOMEN-, AND MINORITY-OWNED BUSINESS CERTIFICATION APPLICATION WV-1A New Update REV. 09/18/15 STATE OF WEST VIRGINIA - PURCHASING DIVISION VENDOR REGISTRATION AND DISCLOSURE STATEMENT AND SMALL, WOMEN-, AND MINORITY-OWNED BUSINESS CERTIFICATION APPLICATION Befre a

More information

Name: (Last) (First) (Middle) Other names used since the age of 18 (maiden name, aliases): Residence Address: City Zip Code (PO Boxes not accepted)

Name: (Last) (First) (Middle) Other names used since the age of 18 (maiden name, aliases): Residence Address: City Zip Code (PO Boxes not accepted) Nrth Carlina Department f Insurance Bail Bndsman/Bail Bnd Runner License Applicatin Please check nly ne type f license: Prfessinal Bail Bndsman -$263.00 Surety Bndsman -$263.00 Bail Bnd Runner -$183.00

More information

IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS

IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS MEDICAL PROVIDER NETWORK (MPN) NOTIFICATION If yu are injured at wrk, Califrnia Law requires yur emplyer t prvide and pay

More information

THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM

THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM 1. Prgram Adptin The City University f New Yrk (the "University") develped this Identity Theft Preventin Prgram (the "Prgram") pursuant

More information

NAIC Replacement Requirements For Certain Life Insurance Policies And Annuity Contracts

NAIC Replacement Requirements For Certain Life Insurance Policies And Annuity Contracts NAIC Replacement Requirements Fr Certain Life Insurance Plicies And Annuity Cntracts Duties f Prducers If a transactin invlves a replacement, the prducer must leave with the applicant, at the time an applicatin

More information

East Mecklenburg High School Trade Contractor Pre qualification

East Mecklenburg High School Trade Contractor Pre qualification East Mecklenburg High Schl Trade Cntractr Pre qualificatin In filling ut this pre qualificatin statement please carefully read and fllw all instructins. If yu have any questins please cntact Andy Aldridge

More information

UNITED KINGDOM VISA STEP-BY-STEP GUIDE

UNITED KINGDOM VISA STEP-BY-STEP GUIDE United Kingdm Visa TRAVEL VISA PRO Call us fr assistance Tll-free: (866) 378-1722 Fax: (866) 511-7599 www.travelvisapr.cm UNITED KINGDOM VISA STEP-BY-STEP GUIDE Citizens f United States f America d nt

More information

Tree Permit Process Intake: (A) (B) (C) (D) (A combination of checklists may be applicable depending on the scope of work) Review:

Tree Permit Process Intake: (A) (B) (C) (D) (A combination of checklists may be applicable depending on the scope of work) Review: Tree Permit Prcess Intake: 1. Applicants may btain the Tree Permit Applicatins frm the Envirnmental Resurces Divisin in the Planning and Zning Department lcated at 444 SW 2 nd Avenue, 3 rd Flr, Miami,

More information

Special Tax Notice Regarding 403(b) (TSA) Distributions

Special Tax Notice Regarding 403(b) (TSA) Distributions Special Tax Ntice Regarding 403(b) (TSA) Distributins P.O. Bx 7893 Madisn, WI 53707-7893 1-800-279-4030 Fax: (608) 237-2529 The IRS requires us t prvide yu with a cpy f the Explanatin f Direct Rllver,

More information

We will record and prepare documents based off the information presented

We will record and prepare documents based off the information presented Dear Client: We appreciate the pprtunity f wrking with yu regarding yur Payrll needs. T ensure a cmplete understanding between us, we are setting frth the pertinent infrmatin abut the services that we

More information

Kentwood Police Department 4742 Walma Ave SE Kentwood, Michigan 49512 (616) 698-6580 http://www.ci.kentwood.mi.us REPORTING IDENTITY THEFT

Kentwood Police Department 4742 Walma Ave SE Kentwood, Michigan 49512 (616) 698-6580 http://www.ci.kentwood.mi.us REPORTING IDENTITY THEFT Kentwd Plice Department 4742 Walma Ave SE Kentwd, Michigan 49512 (616) 698-6580 http://www.ci.kentwd.mi.us REPORTING IDENTITY THEFT If yu are the victim f identity theft and ne f the fllwing cnditins are

More information

Other (please specify):

Other (please specify): Trusted Partner New Applicatin This frm shuld be used by Persns wh will make an ffer f emplyment, Emplyers, Cnnected Persns r EEA Cntractrs wh wish t apply fr Trusted Partner status fr the purpses f future

More information

Dear Brightleaf at the Park Owners,

Dear Brightleaf at the Park Owners, Dear Brightleaf at the Park Owners, Membership t the Brightleaf Club is nw included with all new cnstructin hmes being sld in Brightleaf at the Park. Many f the riginal wners have requested the ptin fr

More information

OPTIONAL PRACTICAL TRAINING INFORMATION

OPTIONAL PRACTICAL TRAINING INFORMATION Internatinal Services Office OPTIONAL PRACTICAL TRAINING INFORMATION Internatinal students, with an F-1 visa, wh have been lawfully enrlled full-time fr at least ne academic year and maintaining status

More information

WHAT YOU NEED TO KNOW ABOUT. Protecting your Privacy

WHAT YOU NEED TO KNOW ABOUT. Protecting your Privacy WHAT YOU NEED TO KNOW ABOUT Prtecting yur Privacy YOUR PRIVACY IS OUR PRIORITY Credit unins have a histry f respecting the privacy f ur members and custmers. Yur Bard f Directrs has adpted the Credit Unin

More information

Norwood Public Schools Internet & Cell Phone Use Agreement School Year 2015-16

Norwood Public Schools Internet & Cell Phone Use Agreement School Year 2015-16 Yu must read and agree t fllw the netwrk rules belw t use yur netwrk accunt r access the internet. Nrwd Public Schls makes available t students access t cmputers and the Internet. Students are expected

More information

ELECTRICAL EXAM KIT REV October 2012 FIELD SAFETY REPRESENTATIVE

ELECTRICAL EXAM KIT REV October 2012 FIELD SAFETY REPRESENTATIVE ELECTRICAL EXAM KIT REV Octber 2012 FIELD SAFETY REPRESENTATIVE A B C Includes inf fr; Electricians, Certified Master Electricians, Prfessinal Engineers & Applied Science Technlgists This dcument cntains

More information

Creating Vehicle Requests

Creating Vehicle Requests Overview Vehicle requisitins, including additins, replacements, dnatins and leases, are submitted, reviewed, and apprved using the State f Gergia Frms in VITAL Insights. The prcess has three levels f review

More information

PSI APPLICATION INSTRUCTIONS (PRE-POWERCLERK)

PSI APPLICATION INSTRUCTIONS (PRE-POWERCLERK) PSI APPLICATION INSTRUCTIONS (PRE-POWERCLERK) Prcess Summary Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Step 7 Step 8 Step 9 Step 10 Find Installer Size System Mail Applicatin Get Reservatin Building Permit

More information

Segal AmeriCorps Education Award Frequently Asked Questions

Segal AmeriCorps Education Award Frequently Asked Questions Segal AmeriCrps Educatin Award Frequently Asked Questins The Natinal Service Trust is a fund established by the Natinal and Cmmunity Service Act f 1993. It is used t pay fr AmeriCrps Educatin Awards and

More information

Service Request Form

Service Request Form New Prfessinal Services Order Frm Editable PDF Service Request Frm If yu have any questins while filling ut this frm, please cntact yur CDM, email Prfessinal Services at PS@swipeclck.cm, r call 888-223-3250

More information

INFORMATIONAL NOTICE MISCELLANEOUS TAX 2013-01. Issued: January 02, 2013

INFORMATIONAL NOTICE MISCELLANEOUS TAX 2013-01. Issued: January 02, 2013 INFORMATIONAL NOTICE MISCELLANEOUS TAX 2013-01 Issued: January 02, 2013 Pennsylvania Department f Revenue Guidelines fr Cllectin and Administrative Bank Attachment Required by Act 85 f 2012 Per the Tax

More information

PUBLIC TRANSPORTATION FLEET CHECKLIST

PUBLIC TRANSPORTATION FLEET CHECKLIST ONE INTERNATIONAL BLVD. SUITE 405 MAHWAH, NJ 07495 Phne (201)252-3030 - Fax (201)252-3031 PUBLIC TRANSPORTATION FLEET CHECKLIST Applicant Name: Prpsed Effective Date: Agency: Requested Qute Date: Prducer:

More information

Application Submission Checklist To Mutual of Omaha For Medicare Supplement Coverage NEW YORK

Application Submission Checklist To Mutual of Omaha For Medicare Supplement Coverage NEW YORK Mutual f Omaha Insurance Cmpany P.O. Bx 3608 Omaha, Nebraska 68103-3608 Applicatin Submissin Checklist T Mutual f Omaha Fr Medicare Supplement Cverage NEW YORK THIS APPLICATION MUST BE USED TO WRITE MUTUAL

More information

2. Visit the Admissions section of the TCC website http://www.tcc.edu/students/admissions/. Follow steps #1-3.

2. Visit the Admissions section of the TCC website http://www.tcc.edu/students/admissions/. Follow steps #1-3. Dear Early Childcare Educatr, We are pleased t infrm yu that GrwSmart is nw accepting applicatins fr teacher schlarships fr the upcming semester. Please share the fllwing infrmatin with yur clleagues and

More information

HIPAA Notice of Privacy Practices. Central Ohio Surgical Associates, Inc.

HIPAA Notice of Privacy Practices. Central Ohio Surgical Associates, Inc. HIPAA Ntice f Privacy Practices Central Ohi Surgical Assciates, Inc. THIS NOTICE OF PRIVACY PRACTICES (THE NOTICE ) DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

Owner Occupied Rehab Program

Owner Occupied Rehab Program Owner Occupied Rehab Prgram This prgram utilizes grant funds frm the Indiana Husing and Cmmunity Develpment Authrity t assist the hmewner with repairs such as: rf, gutters, bathrm renvatins, flrs, drs,

More information

CSAT Account Management

CSAT Account Management CSAT Accunt Management User Guide March 2011 Versin 2.1 U.S. Department f Hmeland Security 1 CSAT Accunt Management User Guide Table f Cntents 1. Overview... 1 1.1 CSAT User Rles... 1 1.2 When t Update

More information

50-STATE SURVEY: Money Transmitter Licensing Requirements Provided by: Thomas Brown, Lecturer, UC Berkeley Law School and Partner, Paul Hastings LLP

50-STATE SURVEY: Money Transmitter Licensing Requirements Provided by: Thomas Brown, Lecturer, UC Berkeley Law School and Partner, Paul Hastings LLP 50-STATE SURVEY: Mney Transmitter AL Ala. Cde 8-7- 1 et seq. (Sale f Checks Act) Ala. Admin. Cde r. 830-X-7-.01 Applicatin fr license (Ala. Cde 8-7-5, Ala. Admin. Cde r. 830-X-7-.01) Minimum Requirements:

More information

How do I verify my Luxbet Account?

How do I verify my Luxbet Account? All bkmakers in Australia are required by Federal law t verify each custmer's identity befre withdrawals can be made frm their respective betting accunts. Luxbet, as a Nrthern Territry Licensed Crprate

More information

Maryland General Service (MGS) Area 29 Treatment Facilities Committee (TFC) TFC Instructions

Maryland General Service (MGS) Area 29 Treatment Facilities Committee (TFC) TFC Instructions Maryland General Service (MGS) Area 29 Treatment Facilities Cmmittee (TFC) TFC Instructins Lve And Service Facility Presentatin t Patients We are frm Alchlics Annymus (AA), fr AA, and ur service is fr

More information

NYU Langone Medical Center NYU Hospitals Center NYU School of Medicine

NYU Langone Medical Center NYU Hospitals Center NYU School of Medicine Title: Identity Theft Prgram Effective Date: July 2009 NYU Langne Medical Center NYU Hspitals Center NYU Schl f Medicine POLICY It is the plicy f the NYU Langne Medical Center t educate and train staff

More information

WORKPLACE INJURY/ILLNESS/INCIDENT INVESTIGATION & REPORTING POLICY (BC VERSION)

WORKPLACE INJURY/ILLNESS/INCIDENT INVESTIGATION & REPORTING POLICY (BC VERSION) WORKPLACE INJURY/ILLNESS/INCIDENT INVESTIGATION & REPORTING POLICY (BC VERSION) Intrductin: Hw t Use This Tl As d all ther jurisdictins, BC requires emplyers t investigate and reprt specific kinds f wrkplace

More information