Use of Form. Use this form to request disposition of United States Treasury Securities (Treasury Bills, Notes, Bonds, TIPS, Floating Rate Notes, Savings Bonds, and Savings Notes) and/or related payments belonging to a decedent’s estate, under either of the following circumstances: • The estate was formally administered through the court and has been closed. • The estate is being settled in accordance with State statute such as Summary Administration, Small Estates Acts, Texas Muniment of Title, Louisiana Judgment of Possession, etc., without the necessity of the court appointing an administrator, executor, or similar legal representative. ATTACHMENTS – If you need more space for any item, use a plain sheet of paper or make a photocopy of the relevant section, and attach to the form.
Use of Form. If you have been a victim of domestic violence, you or a family member on your behalf must complete and submit this certification form, or submit the information described below under “Alternate Documentation,” which may be provided in lieu of the certification form, within 14 business days of receiving the written request for this certification form by the owner or management agent. The certification form or alternate documentation must be returned to the person and the address specified in the written request for the certification form. If the requested certification form or the information that may be provided in lieu of the certification form is not received by the 14th business day or any extension of the date provided by the owner or management agent, none of the protections afforded to victims of domestic violence under the Section 8 project-based assistance program will apply. Distribution or issuance of this form does not serve as a written request for certification. Alternate Documentation: In lieu of this certification form (or in addition to it), the following documentation may be provided:
Use of Form. This form is for use only by members of the Cortland County Board of REALTORS®, Inc. only for placing of property listings in its Multiple Listing Service, or by other agents authorized under reciprocal agreements with the Cortland County Board of REALTORS® to place property listings in its Multiple Listing Service.
Use of Form. A family member must complete and submit this certification, or the information that may be provided in lieu of the certification, within 14 business days of receiving the written request for this certification by the PHA, owner or manager. The certification or alternate documentation must be returned to the person and address specified in the written request for the certification. If the family member has not provided the requested certification or the information that may be provided in lieu of the certification by the 14th business day or any extension of the date provided by the PHA, manager and owner, none of the protections afforded to victims of domestic violence, dating violence or stalking (collectively “domestic violence”) under the Section 8 or public housing programs apply. Note that a family member may provide, in lieu of this certification (or in addition to it):
Use of Form. If it has been determined that a subsidized guardianship is appropriate for the eligible child and the prospective guardian, the agency must negotiate and enter into a written, binding subsidized guardianship agreement with the prospective guardian. The agreement must be completed and signed by the agency and the prospective guardian, and the agency must provide a copy of the signed agreement to the prospective guardian before the court awards guardianship. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes]. The following agreement has been entered into by and between the county department or the Wisconsin Department of Children and Families, Division of Safety and Permanence (hereinafter called the "agency"), and Guardian 1 Full Name Guardian 2 Full Name (Hereinafter called the "guardian(s)"), for the purpose of facilitating the guardianship of Child’s Name (Xxxxxxxxxxx called the "child"), born on and to aid the guardian(s) in providing proper care for the child. (mm/dd/yyyy) This is the initial subsidized guardianship agreement. The guardian(s) agree that they intend to enter a guardianship for the child named above and have signed this document for the purposes of receiving subsidized guardianship payments and services for the child under Titles XIX and XX of the Social Security Act from the date indicated on the guardianship order. This is the initial subsidized guardianship agreement. The court has entered the final guardianship order for this child. The Department of Hearings and Appeals (DHA) has ordered the agency to provide subsidized guardianship payments and services for the child under Titles XIX and XX of the Social Security Act from the date indicated on the DHA order. A copy of the DHA order is attached to this agreement. This replaces the initial subsidized guardianship agreement. The establishment of the guardianship for the child named above has already occurred. The Division of Hearings and Appeals (DHA) has ordered the agency to provide a subsidized guardianship payment other than the amount indicated on the original Subsidized Guardianship Agreement from the date indicated on the DHA order. A copy of the DHA order is attached to this agreement.
Use of Form. This form is a comprehensive mutual nondisclosure agreement covering disclosures of confidential information, a concept defined in the agreement, by both parties in the context of discussions and negotiations relating to a possible business opportunity of mutual interest. When preparing such an agreement attention should be paid to defining the scope of the disclosures, both in terms of the purpose of the disclosures and the information that will be exchanged, The agreement includes a list of exceptions to ensure that the burdens on the parties do not become unreasonable, such as making it clear that the nondisclosure duties do not extend to information that the recipient can prove was in the public domain at the time it was disclosed; however, the availability of each of the exceptions turns on the ability of the receiving party to prove that the terms of the exception have been satisfied. The agreement makes it clear that disclosure is not intended to be a grant of rights to use the information and that no representations or warranties are being made by a party simply because disclosure has been made. Recipients are prohibited from reverse engineering any software programs that are disclosed and each party is required to return all materials upon request and refrain from making any copies or duplications of any confidential information.
Use of Form. Completion of this form is voluntary. The form may be used by child welfare agencies voluntarily placing an Indian child in a xxxxxx home or group home to comply with the requirements of the Wisconsin Chapter 48, the Children’s Code and with the federal Indian Child Welfare Act. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m), Wisconsin Statutes]. Note: Do not use this form if the child is less than 11 days old. See Wis. Stat. s. 48.028(5)(a). I hereby request the to place my child Department of Children and Families / County Department , born on , in a xxxxxx home, pursuant to (First MI Last, Suffix) (mm/dd/yyyy) s.48.63(1) Wis. Stats., group home, pursuant to s.48.63(1), Wis. Stats., group home, pursuant to s.48.625(1m), Wis. Stats., shelter home, pursuant to s. 48.63(1)(b) and s. 938.22, Placement dates are from to . (mm/dd/yyyy) (mm/dd/yyyy) Name and address of placement provider, if known: Name and address of parent or entity arranging the placement: I understand that by signing this document I grant placement and care responsibility of the child to the department listed above. I understand that the child’s placement in a licensed xxxxxx home may not exceed 180 days from the date of placement. I understand that the child’s placement in a group home under s.48.63(1), Wis. Stats., may not exceed 15 days from the date of placement. I understand that the child’s placement in a group home under s.48.625(1m), Wis. Stats., may not exceed 180 days from the date of placement, except if extended as allowed under s. 48.63(5). I understand that the child’s placement in a shelter care facility may not exceed 20 days. I understand that I may terminate this agreement at any time and that the child age 12 years of age or older may terminate this agreement relative to his or her placement. I understand that a permanency plan, pursuant to s.48.63(4) and 48.63(5)(c), Wis. Stats., will be prepared and I will be involved in the development of that plan. I agree to keep the department informed of any changes in my circumstances, including address, employment and earnings, marital status, health, access to health insurance and plans relative to the child. I understand that I may be held financially responsible for all, or a portion of, the placement costs that may incur during the child’s stay in the xxxxxx home, treatment xxxxxx home, or group home placement. I agree to cooperate with the de...
Use of Form. The Participant may change an earlier Beneficiary designation by a later execution of a Beneficiary designation form.
