Michigan Department of Treasury 2766 (Rev. 05-16) L-4260 Property Transfer Affidavit This form is issued under authority of P.A. 415 of 1994. Filing is mandatory. This form must be filed whenever real estate or some types of personal property are transferred (even if you are not recording a deed).
description of operations / locations / vehicles (attach acord 101, additional remarks schedule, if more space is required) insr ltr type of insurance policy number policy eff (mm/dd/yyyy) policy exp (mm/dd/yyyy) limits wc statu-tory limits oth-er e.l. each accident e.l. disease - ea employee e.l. disease - policy limit $ $ $ any proprietor ...
Page 2 of 4 TP-584 (7/19) Part 3 – Explanation of exemption claimed on Part 1, line 1 (mark any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, New York State, or any of their instrumentalities, agencies,
149 Sales and Use Tax Exemption Certificate. Form 149 (Revised 11-2018) ... The purchaser’s state tax ID number can be found on the Missouri Retail License or out of state registration for retail sales. • Purchases of Taxable Services for resale: Purchasers for resale must have a Missouri retail license in order to claim resale of taxable ...
License Number Licensing State. E-Mail Address (if any) State or Province. Zip Code or Postal Code Male. Female. A-NOTE: Only medical doctors, doctors of osteopathy, or clinical psychologists licensed to practice in the United States (including the U.S. territories of Guam, Puerto Rico, and the Virgin Islands) are authorized to certify the form.
City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN).
1. Active License Information License Not Applicable. License Number Effective Date (mm/dd/yyyy) State Where Issued 2. Active Certification Information Please note: for physicians and non-physician practitioners with multiple certifications, report the active
MediCare enrollMent aPPliCation Clinics/group Practices and Certain other Suppliers CMS-855B See Page 1 to deterMine if you are CoMPleting the CorreCt aPPliCation. See Page 2 for inforMation on where to Mail thiS aPPliCation. See Page 35 to find a liSt of the SuPPorting doCuMentation that MuSt Be SuBMitted with thiS aPPliCation.
City, state, ZIP code . Signature Title. Date signed . Vendor’s license number, if any . Vendors of motor vehicles, titled watercraft and titled outboard motors may use this certi ﬁcate to purchase these items under the “resale” exception. Otherwise, purchaser must comply with …
Made by Page 1 of 21 Steele County Sheriff's Office Inmate Roster Printed on August 3, 2019 Inmate Booked Agency Hold Reasons Charges AHMED, ABDIQAADIR DAYIB 04/18/19 Rice County Sheriff's Holding for other Agency
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