Address Telephone Number. City, State, Zip Code Signature Account # -Office use only UNITED STATES DEPARTMENT OF AGRICULTURE Farmers Home Administration RIGHT OF WAY EASEMENT (General Type Easement) KNOW ALL MEN BY THESE PRESENTS, that , (hereinafter called "Grantors"), in consideration of one dollar ($1.00) and other good and valuable consideration paid by Culleoka Water Supply Corp, (hereinafter called "Grantee"), the receipt and sufficiency of which is hereby acknowledged, does hereby grant, bargain, sell, transfer, and convey to said Grantee, its successors, and assigns, a perpetual easement with the right to erect, construct, install, and lay and thereafter use, operate, inspect, repair, maintain, replace, and remove water distribution lines and appurtenances over and across acres of land, more particularly described in instrument recorded in Prop. ID _, Geo ID , Deed Records, Collin County, Texas, together with the right of ingress and egress over Grantor's adjacent lands for the purpose for which the above-mentioned rights are granted. The easement hereby granted shall not exceed 15' in width, and Grantee is hereby authorized to designate the course of the easement herein conveyed except that when the pipeline(s) is installed, the easement herein granted shall be limited to a strip of land 15' in width the center line thereof being the pipeline as installed. In the event the easement hereby granted abuts on a public road and the county or state hereafter widens or relocates the public road so as to require the relocation of this water line as installed, Grantor further grants to Grantee an additional easement over and across the land described above for the purpose of laterally relocating said water line as may be necessary to clear the road improvements, which easement hereby granted shall be limited to a strip of land 15' in width the center line thereof being the pipeline as relocated. The consideration recited herein shall constitute payment in full for all damages sustained by Grantors by reason of the installation of the structures referred to herein and the Grantee will maintain such easement in a state of good repair and efficiency so that no unreasonable damages will result from its use to Grantor's premises. This agreement together with other provisions of this grant shall constitute a covenant running with the land for the benefit of the Grantee, its successors, and assigns. The Grantors covenant that they are the owners of the above-described land and that said l...
Address Telephone Number. 1. Legal Xxxx - A legal xxxx is used by residents who cannot sign because of infirmity or illiteracy but not due to legal incompetency. Resident must draw an "X" or other preferred xxxx where the signature should be. The xxxx must be signed and dated by two witnesses who observe Resident make the xxxx. If Resident is physically unable to hold the pen, Facility may ask Resident if he/she consents to the Agreement's terms. If Resident consents to the terms, Facility may execute the xxxx on behalf of Resident. The xxxx must be signed and dated by two witnesses who observe Facility personnel make the xxxx. The xxxx need not be notarized.
Address Telephone Number. City, State, Zip Code Signature
Address Telephone Number. Do you want your house on your property demolished? Notary Is there another structure that you want removed? Property owner must fill out this form at the Community Development Department, 000 XXX Xxxx., Xxxxxx.
Address Telephone Number. I authorize the provider and my pharmacy to cooperate fully with any city, state, or federal law enforcement agency, including the state’s Board of Pharmacy, in the investigation of any possible misuse, sale, or other diversion of my pain medicine. Controlled substances (pain, sleep, muscle relaxants, stimulants, anti-depressants) are tracked by the Drug Monitoring Program (PDMP). Pharmacies and Providers DO track your usage of controlled substances through obtaining an online report, which annotates providers who have prescribed, and pharmacies that have dispensed these medications. I authorize my provider to provide a copy of this Agreement to my pharmacy. I agree to waive any applicable privilege or right of privacy or confidentiality with respect to these authorizations. I agree that I will submit to a blood or urine test if requested by my provider to determine my compliance with my prescribed medication. I understand that I am financially responsible for this testing. I agree that I will use my medicine at a rate no greater than the prescribed rate and that use of my medicine at a greater rate will result in my being without medication for a period of time. Refills will not be approved prior to your refill date on your prescription. I will bring all unused pain, anxiety, ADD, sleep aid medicine to every office visit. If I sign a pain contract from another provider, I will notify my primary care provider, which will then void this agreement. I agree to follow these guidelines that have been fully explained to me. All of my questions and concerns regarding treatment have been adequately answered. A copy of this document has been given to me. This Agreement is entered into on this day of . Patient Signature Patient Date of Birth Physician Signature Date Signed
Address Telephone Number. I, , agree to take part in the Superior Court Diversion Program (Program) and be monitored by the court. I understand that if I fulfill the terms of this Participant Agreement (Agreement), the Department of Attorney General will not file a charge(s) against me and/or pursue the charges that are currently pending. Furthermore, if I successfully complete the Program, I will be eligible to have my case dismissed and sealed. I understand that if I do not fulfill the terms and conditions of this Agreement, I will be terminated from the Program and my case will proceed through the normal course of felony charging and prosecution. An absolute requirement for this Agreement is that I must avoid committing a crime during the term of my participation in the Program. I understand that if at any time during that period, there is probable cause as determined by the court to believe that I have committed any criminal offense that is not the subject of this Agreement, the court may use its discretion to revoke this Agreement and terminate my participation on the Program. I understand that if, at any time during my participation in the program, it is discovered that I have a criminal record anywhere beyond that included in the discovery materials or previously disclosed by me to the Department of Attorney General, or that I have other pending matters that I knew or should have known about that ultimately result in criminal charges, the court reserves the right to revoke this Agreement. I understand that I am obligated to report any police contact that results in arrest or citation to my case manager as soon as possible. Police contact does not mean the Agreement will be automatically terminated. However, failure to notify my case manager of police contact will be deemed a violation of the Agreement and may result in termination from the Program. I further agree that this Agreement tolls any applicable civil and/or criminal statute of limitations. SUPERIOR COURT I understand that it is my responsibility to fulfill any and all conditions of this Agreement. While my case manager will help me fulfill my obligations, it is my responsibility to complete all requirements and provide any documentation that is requested. I understand and agree that my case will be held open until . I also understand that the anticipated length of my participation in the program may be decreased or extended by stipulation of all the parties. I understand that there may be periodic meetings between ...
Address Telephone Number. Xxxxx X. Xxxxxxxxx 00000 Xxxx Xxxxx Xx., Xxxxx 000, Xxx Xxxxx, XX 00000 xxx@xxxxx.xxx (000) 000-0000 Xxxxx X. Xxxxxxxxxx 00000 Xxxx Xxxxx Xx., Xxxxx 000, Xxx Xxxxx, XX 00000 xxx@xxxxx.xxx (000) 000-0000 If you need more space for any response, please attach additional sheets of paper. Please be sure to indicate your name and the number of the item being responded to on each such additional sheet of paper, and to sign each such additional sheet of paper before attaching it to this Investor Questionnaire. Please note that you may be asked to answer additional questions depending on your responses to the above questions. The undersigned recognizes that the Company is relying on the truth and accuracy of such information so that it may rely on certain exemptions from registration contained in the Act and the securities laws of certain states. By signing below, the undersigned consents to the disclosure of the information contained herein and the inclusion of such information in the Registration Statement, any amendments thereto and the related prospectus. The undersigned understands that such information will be relied upon by the Company in connection with the preparation or amendment of the Registration Statement and the related prospectus. THE UNDERSIGNED AGREES TO INFORM THE COMPANY IMMEDIATELY OF ANY CHANGES IN THE FOREGOING INFORMATION.
Address Telephone Number. City, State, Zip Code Signature Culleoka Water Supply Corp
Address Telephone Number. City, State, Zip Code Signature Solid Waste and Recycling Form for Bridgewater/Branch Village Residential Community Princeton, TX Customer Name: Address of Property: Move in Date: Standard: 95-gallon trash cart and 95-gallon recycling cart. Important Information • Culleoka Water Supply Corporation does not handle waste services. Your waste service provider is CWD (Community Waste Disposal). Questions or concerns: (000) 000-0000. • Waste Customer Service email is xxxxxxx@xxxxxxxxxxxxxxxxxxxxxx.xxx. • Trash and Recycle collection day is Friday of each week. All collection carts should be curbside by 7:00am each Friday. • Culleoka Water Supply Corporation will act as a third-party billing agent for CWD. For billing questions call: (000) 000-0000. Signature of Applicant Date
Address Telephone Number. Texas FCCLA Region/State Officer Social Media Code of Conduct Texas FCCLA Region/State officers are representatives of FCCLA and must use social media responsibly and abide by this Social Media Code of Conduct in both their role as an officer and in their personal use. Region/State officers are responsible for monitoring and regulating all content posted to or tagged on their social media accounts. It is recommended that privacy and/ or tagging permission settings be implemented for all personal social media accounts. FCCLA Region/State Officers are expected to set an example for other members and should create and maintain a social media image that is positive, ethical, professional, and kind. Social media should never be used to air your grievances. Be aware that if you post your attendance or participation in an activity that you are endorsing that activity or product. “Social media” refers to all websites and applications that enable users to create and share content or to participate in social networking, whether or not it is associated or affiliated with the organization, as well as any other form of electronic communication. These include, but are not limited to Facebook, Instagram, Twitter, Snapchat, YouTube, TikTok, LinkedIn, blogs, vlogs, and other online threads. Texas FCCLA Region/State Officer Social Media Code of Conduct Please review the details of the agreement and sign and date acknowledging you understand the expectations as a region/state officer of Texas FCCLA. I, , agree to follow all the guidelines of Texas Family, Career and Community Leaders of America (FCCLA) with regard to social media use. I will not publish, post, share, like, or release content containing or involving: • Information that is confidential or not for public consumption • An individual’s private information (your own or someone else’s) • Commentary, content, or images that are inappropriate, defamatory, proprietary, harassing, libelous, volatile, potentially inflammatory, contain vulgar or inappropriate language, and/or that can or do create a hostile environment • Guns, weapons, alcohol, smoking, vaping, violence, protests, sexual content, nudity, and/or any illegal activity that reveals myself or anyone else participating in questionable activities • Pictures or statuses that reveal public displays of affection (PDA) • Politics, religion, and/or other controversial topics which may alienate individual members or misrepresent the views of FCCLA as a whole o Texas ...
