AFTER RECORDING RETURN TO. Borough Clerk Petersburg Alaska PO Box 329
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. 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: 33743 Project Name: Mid-Willamette Valley Intermodal Center Grant Agreement No. 33743 between the Linn Economic Development Group (“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. LINN ECONOMIC DEVELOPMENT GROUP By: Xxxxx Xxxxxxxx Title: Chairman State of Oregon: County of (Notary Stamp) 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. Oregon Health Authority Heath Systems Division 000 Xxxxxx Xx XX, X00 Xxxxx, XX 00000 SPACE ABOVE FOR RECORDER’S USE STATE OF OREGON OREGON HEALTH AUTHORITY DECLARATION OF RESTRICTIVE COVENANTS This Declaration of Restrictive Covenants (this “Declaration”) is made and entered into this day of [insert date when ready to sign] (the “Effective Date”) by and between Stabbin Wagon, an Oregon 501c3 Nonprofit Organization (“Declarant”) and the State of Oregon, acting by and through the Oregon Health Authority and its Health Systems Division (“OHA”) pursuant to ORS 430.275 and Oregon Laws 2021, chapter 626. OHA and Declarant may be referred to herein jointly as the “Parties” or individually as a “Party”.
AFTER RECORDING RETURN TO. Vacation Home Builders, Inc 000 Xxxxx Xxxxx Xxxxx Xxxxxxxxxx, Xxxxx 00000 INITIALED FOR IDENTIFICATION / OWNER BUILDER ADDENDUM “E” INSULATION ADDENDUM The Home will have insulation installed as follows:
AFTER RECORDING RETURN TO. Vacation Home Builders, Inc 000 Xxxxx Xxxxx Xxxxx Xxxxxxxxxx, Texas 77351 INITIALED FOR IDENTIFICATION / OWNER BUILDER ADDENDUM “D” INSULATION ADDENDUM The Home will have insulation installed as follows:
AFTER RECORDING RETURN TO. Xxxx Water Supply Corporation P.O. Box 4695 Tyler, TX 75712 Xxxx Water Supply Customer Information Sheet
