Witness Statement. 7. Copy of policy report(in case of legal case)
Witness Statement. 8. Before leaving the doctor’s office, obtain the Physician’s Release/Work Status and the Job Analysis/Work Recommendations Report from the clinic/hospital doctor after each doctor’s visit via email or fax to Xxxxxxxx XxXxxxx at 000-000-0000.
Witness Statement. I hereby swear that on the 13th day of June in the year 2003 before me, the undersigned, personally appeared Xxxxxxx Xxxxx, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the person on behalf of which the individual acted, executed the instrument. Witness my hand this l3th day of June, 2003. Xxxxxxx Xxxxxx-Xxxxxxxx COUNTY OF NEW YORK ) ) ss STATE OF NEW YORK ) On the 13th day of June in the year 2003 before me, the undersigned, personally appeared Xxxxxx Xxxxxxx, Xxxxxx Xxxxx Xxxxxxxxxx, Moms Seton, and Xxxxx Xxxxxx, personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in their capacities, and that by their signatures on the instrument, the person on behalf of which the individuals acted, executed the instrument. Witness my hand and notarial seal this 13th day of June, 2003. Notary Public
Witness Statement. I hereby swear that on the 13th day of June in the year 2003 before me, the undersigned, personally appeared Xxxxxxx Xxxxx, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the person on behalf of which the individual acted, executed the instrument. Witness my hand this l3th day of June, 2003. /s/ Xxxxxxx Xxxxxx-Xxxxxxxx Xxxxxxx Xxxxxx-Xxxxxxxx SCHEDULE 1.01 SECURITY DOCUMENTS Statutory Mortgage Deeds means, collectively, the following statutory mortgages:
Witness Statement. The witness cannot be the partner involved in the treatment I have personally verified the identity of patient with the following identification document (please check one of the choices below). Patient signed this consent in my presence. Patient 1’s health insurance card Patient 1’s driver’s licence Patient 1’s passport number OR I know patient 1 personally Name of witness Address Signed on the day of the month of , in the year at (city). Signature of witness
Witness Statement. You may make a witness statement under the following grounds, which apply to you.
Witness Statement. You may make a witness statement under the following grounds, which apply to you: Note: If your penalty charge relates to a London Borough Parking Contravention you may make a witness statement under ONE of the following grounds: ● You paid the penalty charge notice in full within 28 days. You must provide details of the date payment was made, the method of payment i.e. cash, cheque etc and who the payment was made to. Please note you may be asked to provide proof of payment upon request. ● You did not receive the penalty charge notice. ● You made representations about the penalty charge notice to the Local Authority but did not receive a reply within 28 days (rejection notice). ● You appealed to the Parking and Traffic Appeals Service against the Local Authority’s decision to reject your representation within 28 days, but you had no response to your appeal. Proceedings for contempt of court may be brought against you if you make or cause to be made a false statement in a witness statement verified by a statement of truth without an honest belief in its truth You must file the witness statement by the date shown on the Order for recovery. Once completed send to the Traffic Enforcement Centre at: Northampton County Court Bulk Centre St Katherine’s House, 00 – 00 Xx Xxxxxxxxx’x Xxxxxx Xxxxxxxxxxx NN1 2LH or email: xxxxxxxxxxxxxxx.xxx@xxxxxxxx-xxxxxxx.xxx.xxx.xx Transport for London (The Enforcement Authority) Penalty charge notice Traffic Management Act 2004 Liability for the penalty charge lies with you, the owner/hirer/keeper To Vehicle registration mark: Penalty charge notice: Date of this notice: Transport for London believes that a penalty charge is payable with respect to the above vehicle for the following alleged parking contravention: Contravention location: on at The alleged contravention was seen and recorded by camera operator number who was observing real time pictures from an approved device at the time stated and has been recorded on digital storage media DO NOT IGNORE THIS NOTICE THIS NOTICE ALSO SERVES AS A NOTICE TO OWNER This Penalty Charge Notice is served by post on the basis of a record produced by an approved device. Please see overleaf for more details of how to pay or what to do if you think this Penalty Charge is not payable. The full amount of the penalty charge is £ . The penalty charge must be paid before the end of 28 days beginning with the date on which this notice is served or the person on whom this notice is served may make...
Witness Statement. I declare that the Registrant who signed this document is personally known to me, that he/she signed or acknowledged this document in my presence, and that he/she appears to be of sound mind and under no duress or undue influence. Signature: Print Name: (Witness #1) DATED: / / Signature: Print Name:
Witness Statement. This form was signed by ...................................................................................... on the........................................day of .............................................................20 before me (print full name).............................................................................................. Signed......................................................................................................................... Office of witness*….……………………………………………………………………. Address of witness.…………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… * In England and Wales this form must be witnessed by an officer of the Children and Family Court Advisory and Support Service (Cafcass) or, where the child is ordinarily resident in Wales, by a Welsh family proceedings officer.
Witness Statement. The witness cannot be the partner involved in the treatment I have personally verified the identity of patient 1 with the following identification document (please check one of the choices below). Patient 1 signed this consent in my presence. Patient 1’s health insurance card Patient 1’s driver’s licence Patient 1’s passport number OR I know patient 1 personally Name of witness Address Signed on the day of the month of , in the year at (city). Signature of witness I am the partner of , and I consent to the treatment described above, including all options chosen. Signed on the day of the month of , in the year at (city). Signature of patient 2
