Video surveillance recording release form name of school: location of video surveillance camera: name of individual seeking release of video surveillance recording: agency represented by individual: intended use of video taped information:...
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This unconditional waiver and release upon final payment form is for use by an individual or corporation who has been paid in full for all labor, services, equipment or material furnished to the sub-contractor or agent on the job of the contractor...
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Final waiver of lien name of project: location/address: city/state: in consideration of the sum of ($ ) and other valuable considerations, the undersigned does hereby waive, release and forever discharge any and all liens, claims or rights of...
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An attorney should be consulted prior to the execution and delivery of the form set forth herein. general releaseindividual to all interested parties know that , releasor in consideration of the sum of ($ ) received from , releasee, the adequacy...
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Hipaa privacy authorization form **authorization for use or disclosure of protected health information (required by the health insurance portability and accountability act, 45 c.f.r. parts 160 and 164)** **1.authorization** iauthorize...
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Mcallen independent school district af-11 individual inventory release form student name: club name: club sponsor: type of sale: date issued merchandise description sponsor signature activity fund forms updated august 2012 retail value amount...
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Prepared by, recording requested by and return to: name: company: address: city: state: zip: phone: fax: -above this line for official use only conditional waiver and release of lien upon progress payment- individual the undersigned lienor, in...
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This form is for the exclusive use of new york university and may not be disclosed or distributed to outside parties. new york university alien information collection form the information requested below is strictly confidential and will be used...
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Authorization for access by patient or disclosure of protected health information patient name: medical record #: date of birth: social security #: i hereby authorize the use or disclosure of the protected health information described below to be...
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Commonwealth of pennsylvania - public school employees' retirement system po box 125 harrisburg pa 17108-0125 toll-free: 1--773-7748 web address: .psers.state.pa.us psrs-1160 (02/2007) authorization for direct rollover psers health insurance...
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Form dt-individual double taxation treaty relief application for relief at source from united kingdom income tax and claim to repayment of united kingdom income tax for use by an individual resident of a country with which the uk has a double...
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