Sworn statement for use of this form, see ar 190-45; the proponent agency is pmg. authority: principal purpose: privacy act statement title 10, usc section 301; title 5, usc section 2951; e.o. 9397 social security number (ssn). to document...
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Connecticut department of public health 410 capitol avenue, ms#51 led hartford, ct 06134-0308 fax cover sheet date: december 30, 2005 time: to: directors of health chief sanitarians lead contacts lead consultant contractors phone: fax: from: alan...
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Exfor basics bnl-ncs-63380-2001/05-rev. informal report exfor basics a short guide to the nuclear reaction data exchange format victoria mclane national nuclear data center on behalf of the nuclear data center network may 2001 brookhaven national...
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Informal probate publication notice (mpc 551) instructions to petitioner: ? ? ? ? x publication must be completed within 30 days of the date of the informal order. complete the sample informal probate publication notice form (mpc 551) and arrange...
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Name mrn (patient identification) vcu health system mcv hospitals and physicians richmond, virginia 23298 mri safety checklist 1. have you had an mri? ..no yes did you have any difficulty related to the procedure? no yes if yes, please describe:...
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Agency file no.: (to be completed by eeo official) office of equal opportunity and diversity management division of complaints management and resolution phone: 301-496-1551 fax: 301-402-0994 pre-complaint intake form for aggrieved persons (ap)...
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Saltwater disposal report continuation - form 16a industrial commission of north dakota oil and gas division 600 east boulevard dept 405 bismarck, nd 58505-0840 sfn 5764 (03-2) please read instructions before filling out form. please submit the...
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Orbit fet college application form note: this form is not a proof of registration - you are registered at orbit fet college when you receive a proof of registration printout. administration dd / mm date issued previous student campus / site y n 1...
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State of wisconsin, circuit court, county for official use amended in the matter of the estate of application for informal administration case no. under oath, i state: 1. the decedent, with date of birth was domiciled in address of and date of...
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Chess scoresheet event round date (dd.mm.y) time control board section opening (eco code) white pairing (seed) no. rating black pairing (seed) no. rating white black white 1 26 2 27 3 28 4 29 5 30 6 31 7 32 8 33 9 34 10 35 11 36 12 37 13 38 14 39...
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Application form for registration of non-commercial society gambling act 2005 (lotteries) section a ? details of society applying for registration name of society address of office of society (must be within bracknell forest) (including postcode)...
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Tennessee department of revenue brand registration return for new brands alc 119 effective date account no. ssn or fein if this is an amended return, please check the box at right name: address: make your check payable to the tennessee department...
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