Signature and Certification. Sign in ink, in the space provided. This is your promise to pay. Review your Application/Promissory Note to make sure you have correctly completed all items. Alaska Commission on Postsecondary Education P.O. Box 110505 Juneau, Alaska 99811-0505 Customer Service Center Toll Free: (000) 000-0000 In Juneau: (000) 000-0000 TDD: (000) 000-0000 Alaska Supplemental Education Loan (ASEL) Application and Promissory Note Fax: (000) 000-0000 xxxx.xxxxxx.xxx DO NOT COMPLETE: Xxxxxxxx, retain this copy for your records The Alaska Commission on Postsecondary Education (ACPE) services the education loans owned by the Alaska Student Loan Corporation (ASLC).
Signature and Certification. REQUIRED The adult household member who fills out the application must sign below. If Part 4 is completed, the adult signing the form must also list the last four digits of his/her Social Security Number (SSN) or check the box if no SSN. See Privacy Act Statement on the back of this page. If you have listed a case number in Part 2 or are applying on behalf of a xxxxxx child, or have checked the box that your child(ren) will not qualify for Free/Reduced- Price meals, the last four digits of the SSN is not needed. “I certify (promise) that all information on this application is true and that all income is reported. I understand that this information is given in connection with the receipt of Federal funds, and that CACFP officials may verify (check) the information. I am aware that if I purposely give false information, the participant/center may lose meal benefits, and I may be prosecuted under applicable State and Federal laws.” Signature of Adult Today’s Date X Print Name of Adult Signing Social Security Number (SSN) (last four digits) XXX-XX- Check if no SSN Address City/State/Zip Code Daytime Phone OSPI CNS (Rev. 1/19) Page 1 of 2 White Native Hawaiian or Pacific Islander Multi-Racial Black or African American Asian Not Hispanic or Latino We are required to ask for information about your children’s race and ethnicity. This information is important and helps to make sure we are fully serving our community. Responding to this section is optional and does not affect your children’s eligibility for receiving meals during care.
Signature and Certification. Sign in ink, in the space provided. This is your promise to pay. Review your Application/Promissory Note to make sure you have correctly completed all items. Alaska Commission on Postsecondary Education P.O. Box 110505 Juneau, Alaska 99811-0505 Customer Service Center Toll Free: (000) 000-0000 In Juneau: (000) 000-0000 TDD: (000) 000-0000 Fax: (000) 000-0000
Signature and Certification. All baseline monitoring reports must be signed and certified in accordance with Section 7 of this Division.
Signature and Certification. All baseline monitoring reports must be signed and certified in accordance with §18-326 of this Part. [A.O.] (Ord. 422, 10/12/1994; as amended by A.O.
Signature and Certification. ✔ I certify that I have established an IRA with the TCW Funds, Inc. of which U.S. Bank, NA, is the Custodian. I agree to contact my present Custodian from whom I am transferring to determine if specific documentation or a signature guarantee is required. I understand that I am responsible for determining my eligibility for all transfers or direct rollovers. I agree to hold the Custodian harmless against any and all situations arising from an ineligible transfer or direct rollover. I acknowledge that the Custodian or its agent cannot provide legal advice and I agree to consult with my own tax professional for advice. I authorize U.S. Bancorp Fund Services, LLC, to act on my behalf in contacting the current custodian or plan administrator to facilitate the transfer of assets. X Signature of Owner (or Guardian if IRA owner is a minor) Date (MM/DD/YYYY) Signature Guarantee* (for transfers from another Custodian) IMPORTANT: Please contact your current Custodian to determine if a signature guarantee* is required. * A signature guarantee may be obtained from any eligible guarantor institution, as defined by the Securities and Exchange Commission. These institutions include banks, saving associations, credit unions, and brokerage firms. The words “SIGNATURE GUARANTEED” must be stamped or typed near your signature. The guarantee must appear with the printed name, title, and signature of an officer and the name of the guarantor institution. Please note that a Notary Public Seal or Stamp is not acceptable.
Signature and Certification. I have read and understand the certifications and requirements set out in this Agreement. I hereby verify that the statements made herein are true and correct to the best of my knowledge, information and belief. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities, and I am making this statement under penalty of perjury. I further understand that if I fail to meet the obligations herein the Commonwealth may take other actions against me including but not limited to referral to criminal justice authorities, and/or suspension or debarment under 62 Pa.C.S. §531. Signature (Must be an original ink signature) Date ____________________________________
Signature and Certification. The signing of this document by authorized officials forms a binding commitment between LPC and SFC. The parties are obligated to perform in accordance with the terms and conditions identified in this MOU. All Appendices attached hereto are hereby incorporated into this MOU and made a part hereof. Authorized Treasury Official Title Date Authorized Treasury Official Title Date (41 CFR 102-73.155 (p)) (41 CFR 102-73.80) Xxxxxxx Xxxxxxx Vice Chancellor, Date Business Services ATTACHMENT A – Las Positas College Campus Map & Room Diagram Bldg. 2400 – Multi-Disciplinary Building Room 2401- Reading Room San Francisco Regional Financial Center 0000 00xx Xxxxxx, Xxxxx X, Xxxxxxxxxx XX 00000 000-000-0000 Attachment B SFC COOP Employee List for Las Positas Security . a. Xxxxxx Xxxxxxx, Director Work Phone 000-000-0000 Cell Phone 000-000-0000
Signature and Certification. The undersigned certifies to MFA that it has read and understands all of its obligations under the Section 504 requirements. The undersigned acknowledges that this certification will be relied upon by MFA in its review and approval of proposal for funding and any misrepresentation of information or failure to comply with any conditions proposed in this certification could result in penalties, including the disbarment of applicant from participation in MFA administered programs for a period of time. Name of Funded Program: Organization Name: Agency Director Signature Date MFA Program Manager Signature Date Section 504 Checklist Used for monitoring purposes of compliance with Section 504 of the Rehabilitation Act of 1973. Recipient Name: Date Prepared: Address: Telephone:
Signature and Certification. I understand and agree that:
