Payment option 2 sworn statement form i. claimant information last first claimant name claimant id law firm ii. sworn statement by signing below, i am declaring under penalty of perjury that i purchased for personal or family use on or before...
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Nd probate code form 15 page 1 10/01/03 personal representative's verified statement to close the estate. (n.d.c.c. 30.1-21-03). name, address, and telephone no. of attorney space below for use of district court only probate no. attorney for: in...
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Republic of the philippines ) ) s. s. sworn statement as to the existence/non-existence of beneficial owners i, name of affiant , of legal age, filipino, and with office address at address , under oath, state that: 1. i am the duly elected and...
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Sworn statement in proof of loss (mobile home) name of insured: policy no. date of loss: amount claimed $ time of loss: m. description of insured mobile home or recreational vehicle year manufacturer model or type serial number lth wth acv at...
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Dentist aide program sworn statement of a history of varicella disease by my signature on this document, i , attest that print full legal name i have a personal history of varicella disease (chickenpox) or have varicella immunity. student...
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No. estate of , deceased in the county court at law no. of gregg county, texas sworn statement of service and expenses by attorney ad litem in heirship determination base ad litem fee form on this day personally appeared , (attorney ad litem)...
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Cause no. pr in the matter of the estate of deceased in county court at law no. 2 of wise county, texas sworn statement of services and expenses by attorney ad litem on this day personally appeared (attorney ad litem) known to me, who first being...
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Omb no. 1615-0097; expires 05/31/2011 department of homeland security u. s. citizenship and immigration services form g-646, sworn statement of refugee applying for admission into the united states penalties if you knowingly or willfully...
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Orlando police department your name (last, first middle): case no: statement (continued) sworn to and subscribed before me, this day of , 20 . i swear/affirm the above and/or attached statements are correct and true. signature: notary public law...
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Philadelphia bar association young lawyers division candidate personal statement form annual executive committee election ! (please type or print all information legibly) name of candidate: mailing address: office telephone: home telephone: office...
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Adult facilities model form department of social services division of licensing programs sworn disclosure statement to the applicant: section 63.2-1720 of the code of virginia requires that any person desiring work at a licensed assisted living...
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In the superior court for the state of alaska at in the matter of the estate of: person who died (decedent) date of birth: ) ) ) ) ) ) ) ) ) case no. sworn statement of personal representative to close informal estate 1. personal representative. i...
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State oil and gas board of alabama ogb-2c affidavit of ownership or control, underground injection control form ogb-2c, rev. 01/13 (file in triplicate) 01 permit number api number (to be filled in by board) state of alabama county of (county of...
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Sworn statement under section 287.133(3)(a), florida statutes, on public entity crimes (to be signed in the presence of a notary public or other officer authorized to administer oaths.) before me, the undersigned authority, personally appeared ,...
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Name of decedent (insured) policy # claim # sworn statement of no probate estate and indemnification agreement my name is , i am the (relationship to insured) of the decedent. i reside at (address) (telephone #). i have personal knowledge of the...
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