PLEASE COMPLETE THE FOLLOWING INFORMATION. Full name and address of the holder of the Shares (hereinafter: the “Shareholder”) Name(s): _________________________________________________________________________________________________ Street/House: ______________________________________________________________________________________________ Town/City: ________________________________________________________________________________________________ Postcode: _________________________________________________________________________________________________ County/State: ______________________________________________________________________________________________ Country: _________________________________________________________________________________________________ Please state the number of Shares that you wish to tender: _________________________________________________________ Please state the registered number(s) of the Shares that you wish to tender: ______________________________________________ Please insert your bank account details for the payment of the Offer Price per Share: Bank Account Number: _______________________________________________________________________________________ SWIFT address: _____________________________________________________________________________________________ Please sign for acceptance ____________________________________________________________________________________ At: _______________on____/_____/2010 This form will serve as a deed of transfer (akte xxx xxxxxxxx) with respect to Shares that are evidenced by a registration in the Company’s Dutch shareholders’ register referenced herein. Please also consult the Offer to Purchase for a full explanation of the Offer.
PLEASE COMPLETE THE FOLLOWING INFORMATION. XXXXXX, XX 00000 (000)000-0000 xxxx@xxxxxxxxxx.xxx BILLING NAME LAST FIRST M.I SERVICE ADDRESS MAILING ADDRESS (if different) CITY STATE ZIP CODE DATE OF BIRTH DRIVER’S LIC. NO. EMPLOYER WORK PHONE HOME PHONE CELL PHONE SPOUSE’S NAME CELL PHONE_ NAME OF NEAREST RELATIVE NOT LIVING WITH YOU_ PHONE _ REQUESTED START DATE FOR SERVICES 1ST TIME SERVICE WITH US? _ IF NOT, WHAT ADDRESS? SIGNED UP FOR ALERTS: TEXT MESSAGE, PH. NUMBER & CARRIER and/or EMAIL _ (Initial only if purchasing new membership-meter) RESIDENTIAL (OR) COMMERCIAL WATER METER MEMBERSHIP FEES WILL VARY FROM ($800.00 - $1200.00) DEPENDING ON TYPE OF METER AND LOCATION OF METER WITHIN WATER DISTRICT THIS CHARGE IS NONREFUNDABLE. INITIAL BILLS ARE SENT OUT ON THE 1ST OF EVERY MONTH. BILLS ARE DUE BY THE 19TH TO AVOID LATE CHARGES. BILLS THAT ARE NOT PAID BY THE 25TH WILL BE DISCONNECTED ON THAT DAY. WE DO NOT SEND OUT DISCONNECT NOTICES. IF YOUR SERVICES ARE DISCONNECTED, A RECONNECT FEE PLUS THE AMOUNT OF YOUR XXXX, WILL NEED TO BE PAID BEFORE THE SERVICE IS RECONNECTED. I HEREBY APPLY FOR UTILITY SERVICE AT THE ABOVE ADDRESS AND AGREE TO USE AND PAY THEREFORE IN ACCORDANCE WITH THE RATES, RULES AND REGULATIONS LEGALLY IN EFFECT FOR SOUTHWEST XXXXX XXXXXX WATER DISTRICT. I WILL BE RESPONSIBLE FOR ALL THE WATER BILLS DUE TO THE SOUTHWEST XXXXX XXXXXX WATER DISTRICT INCURRED AT THE ABOVE ADDRESS.
PLEASE COMPLETE THE FOLLOWING INFORMATION. The Main Guest Name: Address (for DD Refund): Email: Tel/Cell: Number and Names of Guests You must disclose the exact number and names of the Guests (including all children) who will be occupying the Property between the above dates. This is subject to the maximum number set out below. You must immediately notify us, by phone or in writing, if the number of guests changes. Please fill in the attached GUEST LIST. If you arrive with additional people not on the Guest list, they will not be permitted to enter Xxxxxx Xxxxxxx.The Main Guest agrees to leave the property in the same condition as found. Any missing items or damage will be charged. (See attached DAMAGES & LOSSES) Daily Cleaning and Cooking services for up to 3 meals a day are included. Air-conditioning used beyond 12 hours out of every 24 hours per room will be billed separately. Other service requests will be billed separately. The Main Guest confirms (s)he has read and agreed to the “Marina Chacala Code of Conduct Rules.” Owner and Marina Chacala condominium assumes no liability for property loss or damage, nor liability for accidents, injury or death on the property or within the Marina Chacala compound. The Main Guest is responsible for the Property and all the other Guests during occupancy of the Property. COMPLETE GUEST LIST Maximun # of Guests: 12 (including children) Arrival: . Departure: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
PLEASE COMPLETE THE FOLLOWING INFORMATION. It is my understanding that will be participating in a fitness evaluation and exercise program. This patient is permitted to participate in the following activities. (Please check all that apply.)
PLEASE COMPLETE THE FOLLOWING INFORMATION a) What evidence was provided to confirm that the above listed jobs were retained and/or provided and that the project achieved the job creation/retention goals noted in Exhibit A of the Committee Resolution?
PLEASE COMPLETE THE FOLLOWING INFORMATION. EvEnt DatE(S) LaSt namE: lllllllllllllll EvEnt namE XxXX(S)/aCtivity(iES) EntERED actions, inactions or negligence, and also from the actions, inactions or negligence of others. I understand and voluntarily assume these risks.
PLEASE COMPLETE THE FOLLOWING INFORMATION. EMPLOYEE NAME SCHOOL/DEPARTMENT I have read and agree to abide by the Staff Network and Internet Use and Safety Policy and Guidelines. I understand that any violation of the terms and conditions set forth in the Policy is inappropriate and may constitute a criminal offense. As a user of the Board’s computers/network and the Internet, I agree to communicate over the Internet and networks in an appropriate manner honoring all relevant laws, restrictions and guidelines. EMPLOYEE SIGNATURE DATE 7540.04 F1
PLEASE COMPLETE THE FOLLOWING INFORMATION. EvEnt DatE(S) lllllllllllllll EvEnt namE XxXX(S)/aCtivity(iES) EntERED LaSt namE: extreme test of a person’s physical and mental limits and may involve the risk of serious injury or death, economic loss, property damage or loss that may result from my own actions, inactions or negligence, and also from the actions, inactions or negligence of others. I understand and voluntarily assume these risks.
PLEASE COMPLETE THE FOLLOWING INFORMATION. EvEnt DatE(S) LaSt namE: lllllllllllllll EvEnt namE XxXX(S)/aCtivity(iES) EntERED aDDRESS: llllllllllllllllll FiRSt namE: lllllllllllllll m.i.l StatE: ll Zip CODE: lllll City: llllllllllllllllllll phOnE numbER: lll lll llll l DatE OF biRth ll ll llll WOlRlS ClatlEglORly (lJunlior,lCitlizenl, Clitizeln Cllydlesdlale,letcl.) ll conditions. I fully understand that participating in the Event is an extreme test of a person’s physical and mental limits and may involve the risk of serious injury or death, economic loss, property damage or loss that may result from my own actions, inactions or negligence, and also from the actions, inactions or negligence of others. I understand and voluntarily assume these risks.
PLEASE COMPLETE THE FOLLOWING INFORMATION. If you prefer to complete this form electronically, it is available for downloading at xxx.xxxxxxxxxxx.xxx. Property address Property identification number (PID) Name(s) of property owner(s) Cell phone and email of property owner Cell phone and email of 2nd property owner (if any) CITY STAFF COMPLETES THIS INFORMATION: Building Permit Number # Date of Occupancy Permit or Final Inspection Date: Landscaping Completion Deadline (12 months after occupancy permit or final inspection date) A Date: Deadline to pay Landscaping Security Amount in cashier's or certified check if landscaping is not completed by the deadline (10 days after A) B Date: Landscaping Security Amount (city code section 510, code 18700) C $ ACKNOWLEDGEMENTS: The undersigned acknowledge and agree to the above terms and conditions. The undersigned further acknowledge that there will be an opportunity to speak at a public hearing noticed and held by the city council prior to the city certifying any amount to Hennepin County to be collected with property taxes. Property Owner Signature: 2nd Property Owner Signature: CITY OF GREENWOOD: Zoning Administrator’s Signature: Zoning Administrator’s Name (print): Landscaping Security Agreement | Form Updated 12.30.23
