Examples of Agent’s Address in a sentence
Insert other relevant statements below) SIGNATURE AND ACKNOWLEDGMENT Agent’s Name Printed Agent’s Address Agent’s Telephone NumberThis document was acknowledged before me on , (Date)by (Name of Agent) (Seal, if any) Signature of NotaryMy commission expires: Subchapter 4.
The agent is to provide the following information, then forward the Application to the Arkansas W orkers’ Compensation Commission at the address below:Agent’s Name Agent’s Address (City) (State) (Zip Code)Agent’s SignatureIf answers to ALL questions above are “no”, submit Form A to the Coverage/Compliance Section, Arkansas Workers’ Compensation, P.O. Box 950, Little Rock, Arkansas 72203-0950 or deliver to 324 Spring St., Little Rock, Arkansas 72201.
Approved as to form: Principal:City Attorney By: Surety: By: Agent’s Name: Agent’s Address: Form No. SPEC-100A Revised: 09/11/2014Department of Labor and Industries Prevailing Wage(360) 902-5335www.lni.wa.gov/TradesLicensing/PrevWage• This form must be typed or printed in ink.
Principal: Enter Vendor Legal Name By: Surety: By: Agent’s Name: Agent’s Address: PAYMENT BONDTO THE CITY OF TACOMA Resolution No.
Postal Code Name of Owner’s Agent (if any) at the Show) Agent’s Address City Prov.