City of aspen address
[PDF File]VERIFICATION OF VEHICLE IDENTIFICATION NUMBER
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Address City State ZIP Code I certify, under penalty of perjury in the second degree, that I have completed a physical inspection of the vehicle/manufactured home described above and the information is true and correct to the best of my knowledge. Printed First and Last Name of Inspector Date
[PDF File]Form I-693, Report of Medical Examination and Vaccination ...
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City/Town/Village of Birth. F. USCIS Online Account Number (if any) Part 2. Applicant's Statement, Contact Information, Certification, and Signature. NOTE: Read the . Penalties . section of the Form I-693 Instructions before completing this section. You must submit Form I-693 in a sealed envelope to USCIS as directed in the Form I-693 ...
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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() - 20. LEAVE ADDRESS. 21. RATION STATUS (Enlisted) COMMUTED RATIONS (COMRATS) Meal Pass No. Entitled to EDF meals except during. periods of leave I CERTIFY THAT I HAVE SUFFICIENT FUNDS TO COVER THE COST OF ROUND TRIP TRAVEL.
[PDF File]Form 941 for 2017: Employer’s QUARTERLY Federal Tax Return
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Address. City State. EIN Phone. ZIP code. Page . 2. Form . 941 (Rev. 1-2017) Form 941-V, Payment Voucher. Purpose of Form. Complete Form 941-V if you're making a payment with Form 941. We will use the completed voucher to credit your payment more promptly and accurately, and to …
[PDF File]Request for Social Security Earnings Information
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Address State City ZIP Code 4. I am the individual to whom the record pertains (or a person authorized to sign on behalf of that individual). I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by …
[PDF File]Form SSA-89 (02-2018) Discontinue Previous Editions Page 1 ...
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Company Address: I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent, if applicable, for the purpose I identified. The name and address of the Company's Agent is: I am the individual to whom the Social Security number was issued or the parent or legal guardian of a
[PDF File]Parking Privileges Application
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Physical Address City State ZIP Mailing Address (if different from above) City State ZIP I certify, under penalty of perjury, that I have read and understand the Persons with Disabilities plate and placard application and usage requirements and that I am responsible for the use in conformity with Colorado Revised Statutes 42-3-204 and 42-4-1208.
[PDF File]OCA Official Form No.: 960 AUTHORIZATION FOR RELEASE OF ...
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Patient Address I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: ... (212) 480-2493 or the New York City Commission of Human Rights at (212) 306-7450. These agencies are responsible for protecting my rights.
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit …
[PDF File]Physician's Order for Personal Care/Consumer Directed ...
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PHYSICIAN’S ORDER FOR PERSONAL CARE/CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES . INSTRUCTIONS . COMPLETE ALL ITEMS. (Attach additional sheets, if necessary). INCOMPLETE FORMS WILL BE RETURNED TO THE PHYSICIAN. INCOMPLETE OR MISSING INFORMATION MAY DELAY SERVICES TO THIS PATIENT. 1. Patient Identifying Information • …
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