AFTER RECORDING RETURN TO. Xxxxxx County Planning Division 0000 Xxxxxxxxx Xx. NE, Salem OR 97305 MOBILE OFFICE REMOVAL AGREEMENT THIS COVENANT, Made this day of , 20 , by and between and the County of Xxxxxx, State of Oregon, in consideration of the land use approval by Xxxxxx County which order is incorporated in total herein by this reference, for the placement of a Mobile Office as a temporary use on property described as follows to-wit: (if space insufficient, continue description on reverse side) Do hereby promise and covenant as follows: I/We certify that I/we fully understand that the placement of a mobile office on the above described real property is temporary in nature as a farm-related office. This permit is valid until it is determined that the said office is no longer needed to assist in the operation of the agricultural enterprise and said mobile office will be removed 60 days thereafter. This covenant shall run with the land and is intended to and hereby shall bind my/our heirs, assigns, lessees, and successors. In Witness Whereof, the said Party has executed this instrument this day of 20 . Owner Owner STATE OF OREGON ) ) ss. Xxxxxx County ) This instrument was acknowledged before me this day of , 20 Notary Signature Notary Public for Oregon (OFFICIAL SEAL) Accepted:
AFTER RECORDING RETURN TO. Borough Clerk Petersburg Alaska PO Box 329
AFTER RECORDING RETURN TO. Notary Public in and for the State of Texas JCSUD PO BOX 1390 Xxxxxx, TX 76058 Easement ROW-VolPg&Instrument Caring – Heart Membership Application JCSUD and CareFlite have partnered together to allow all customers of the water system to become members of CareFlite for $1 per month. This includes all permanent family members of your household at no additional cost as listed below. Please return this completed form to Xxxxxxx County Special Utility District. First Name: Middle Initial: Last Name: Mailing Address: City: Zip Code: Phone # ( ) Date of Birth: □ Male □ Female Email Do you have health insurance? □ Yes □ No If you answered Yes to this question, please list your primary health insurance company: Other Family Members of Your Household: First Name: Middle Initial: Last Name: Date of Birth: □ Male □ Female First Name: Middle Initial: Last Name: Date of Birth: □ Male □ Female First Name: Middle Initial: Last Name: Date of Birth: _ □ Male □ Female First Name: Middle Initial: Last Name: Date of Birth: □ Male □ Female First Name: Middle Initial: Last Name: Date of Birth: □ Male □ Female (For additional household family members, please copy this page and attach to this application) By submitting this application, I agree (on my behalf and on behalf of my family) in consideration of the benefits provided to abide by the terms of the Caring-Heart Membership Program, which are shown on the back of this application. I request payment of authorized Medicare or other insurance benefits to me, or on my behalf, to be paid to CareFlite for any emergency services and supplies furnished to me or my household family members by CareFlite. I authorize any holder of any of my medical information or that of my household family members to release that information to CMS, its agents or carriers, or CareFlite in order to determine benefits payable on my behalf or on behalf of my family members, now and in the future. This agreement and authorization is executed on my own behalf and on behalf of the other members of my household, if they are minors or otherwise unable to sign. I understand that under Texas rule 157.11 if I or a household member is a Medicaid recipient, than I am not allowed to have them on this application. Therefore I am stating that I have not listed on this application anyone that is a Medicaid recipient. If a household family member subsequently becomes a recipient of Medicaid, I will notify CareFlite in writing of this change immediately. I warrant that a...
AFTER RECORDING RETURN TO. PLAINSCAPITAL BANK 0000 Xxxxxx Xxxxx Xxxx, Xxxxx 0000 Xxxxxx, XX 00000 Attention: Xxxx Xxxxxxx
AFTER RECORDING RETURN TO. Oregon Department of Transportation ATTN: Connect Oregon Program Manager 000 00xx Xxxxxx XX Xxxxx, XX 00000 SPACE ABOVE FOR RECORDER’S USE MEMORANDUM OF AGREEMENT AND ACKNOWLEDGEMENT OF ODOT ASSISTANCE [State Recording Authority: ORS 93.710 and ORS 205.130(2)] Agreement Number: 33744 Project Name: Treasure Valley Reload Center Grant Agreement No. 33744 between Malheur County Development Corporation (“Recipient”) and the State of Oregon, by and through its Department of Transportation (“ODOT”), was executed on [INSERT DATE] (the “Grant Agreement”). Pursuant to Exhibit B, Section IX, of the Grant Agreement, upon the recording of this Memorandum and its delivery to ODOT, Recipient will be eligible to receive certain Grant Funds for the Project described in Exhibit A to the Grant Agreement. Specifically, ODOT will disburse Grant Funds to reimburse certain costs that Recipient incurs constructing the Project on the property described in the attached Exhibit 1 (the “Project Property”). Recipient’s ownership, use, and disposition of the Project Property are subject to the terms of the Grant Agreement, a copy of which may be obtained from ODOT. [INSERT RECIPIENT NAME] By: (Name of person) Title: (Notary Stamp) State of Oregon: County of Signed or attested before me on by (Date) (Name of person) My commission expires on . STATE OF OREGON, DEPARTMENT OF TRANSPORTATION By: (Notary Stamp) Title: Active Transportation Section Manager State of Oregon: County of Signed or attested before me on by (Date) (Name of person) My commission expires on . EXHIBIT 1
AFTER RECORDING RETURN TO. Xxxxxxxx & Xxxxxxxx LLP Attn: _______________ 000 Xxxxx Xxxxxx Xxx Xxxx, XX 00000-0000 ADDRESS OF NEW OWNER AND
AFTER RECORDING RETURN TO. (Space reserved for recording data.) SPECIAL WARRANTY DEED THIS INDENTURE, made as of this _____ day of _______________, 201__, between , a (“Grantor”), having an address of , and , a (“Grantee”), having an address of .
AFTER RECORDING RETURN TO. [Insert where to return recorded document] ____________________[Space Above This Line For Recording Data]___________________ [insert identifying number for administrative tracking of mortgage] Compliance Mortgage THIS MORTGAGE (Security Instrument) is given on ______________ ____, 20_____. The Mortgagor is _______________________________________________ [Participant], a _______________________ [State of Organization of Participant] __________________ [Type of Entity of Participant] having an office at _________________________ [Street], _____________________ [City], _____________ [State] ____________ [Zip code] (Borrower). This Security Instrument is given to the United States Department of Housing and Urban Development, which is organized and existing under the laws of the United States, having its principal office at 000 Xxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, X.X., 00000 (Lender). Borrower owes Lender the principal sum of _____________________ and _____/100 Dollars (U.S. $ ____.__). This debt is evidenced by Borrower's note dated the same date as this Security Instrument (Note). Borrower promises to pay the principal balance of the Note, together with any interest thereon and all other sums which may or shall become due under this Security Instrument or the Note, no later than ______________ ____, 20_____ (Maturity Date), if (1) not otherwise satisfied in accordance with the provisions of this Security Instrument, or (2) there is an Event of Default (defined hereafter). [insert a date no later than a total of 540 calendar days plus, if the participant has been approved to operate a lease-purchase program, the number of calendar days within which the lessee must purchase the property or the participant must sell the property to another] The Maturity Date may be extended in the event of casualty or condemnation, pursuant to Section 12.1 of the Agreement. This Security Instrument secures (a) the repayment of the debt evidenced by the Note; (b) the performance of Borrower’s promises and agreements under the agreement, dated ______________ ____, 20_____, between Borrower and Lender ( Agreement), this Security Instrument, and the Note. For this purpose, Borrower hereby mortgages, warrants, grants, and conveys to Lender, with power of sale, the following described property located in _______________ County, ______ [State]: [Insert legal description of property], which has the address of _________________________ [Street], _____________________ [City], _____________ ...
AFTER RECORDING RETURN TO. City of Frisco Attention: Right of Way Manager 0000 Xxxxxx Xxxxxx Xxxxxxxxx Xxxxxx, Xxxxx 00000 ENCROACHMENT AND LICENSE AGREEMENT THIS ENCROACHMENT AND LICENSE AGREEMENT (“Agreement”) is made and entered into by and between the CITY OF FRISCO, TEXAS, a home-rule municipality (“City”), and , a (“Licensee”). City and Licensee are sometimes referred to collectively as the “parties” or individually as a “party.”
AFTER RECORDING RETURN TO. Attn: _____________ MAIL FUTURE TAX BILLS TO: __________________ __________________ __________________ ABOVE FOR RECORDER’S USE ONLY
