CERTIFICATIONS AND SIGNATURES. This Contract must be signed by an authorized representative of Contractor. The undersigned certifies under penalty of perjury both individually and on behalf of Contractor that:
A. The undersigned is a duly authorized representative of Contractor, has been authorized by Contractor to make all representations, attestations, and certifications contained in this Contract and to execute this Contract on behalf of Contractor and that this Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms;
B. Contractor is not a contributing member of the Public Employees’ Retirement System and will be responsible for any federal or state taxes applicable to payment under this Contract. Contractor will not, by virtue of this Contract, be eligible for federal Social Security, employment insurance, workers’ compensation or the Public Employees’ Retirement System, except as a self-employed individual.
CERTIFICATIONS AND SIGNATURES. If the Depositor has indicated a Traditional IRA Rollover or Direct Rollover above, the Depositor certifies that the contribution does not include any employee contributions to any qualified plan (other than accumulated deductible employee contributions) or 403(b) arrangement; that any assets transferred in kind by the Depositor are the same assets received by the Depositor in the distribution being rolled over; if the distribution is from another Traditional IRA, that the Depositor has not made another rollover within the one-year period immediately preceding this rollover; that such distribution was received within 60 days of making the rollover to this Account; and that no portion of the amount rolled over is a required minimum distribution under the required distribution rules. If the Depositor has indicated a Conversion, Transfer or a Rollover of an existing Traditional IRA to a Xxxx XXX, the Depositor acknowledges that the amount converted will be treated as taxable income (except for any prior nondeductible contributions) for federal income tax purposes, and certifies that no portion of the amount converted, transferred or rolled over is a required minimum distribution under applicable rules. If the Depositor has elected to convert an existing Traditional IRA with State Street Bank and Trust Company as Custodian to a Xxxx XXX (Item 2 of Part B above) and has elected no withholding, the Depositor understands that the Depositor may be required to pay estimated tax and that insufficient payments of estimated tax may result in penalties. If the Depositor has indicated a rollover from another Xxxx XXX (Item 4 of Part B above), the Depositor certifies that the information given in Item 4 is correct and acknowledges that adverse tax consequences or penalties could result from giving incorrect information. The Depositor certifies that any rollover contribution to the Xxxx XXX was completed within 60 days after the amount was withdrawn from the other IRA. The Depositor has received and read the applicable sections of the "State Street Bank and Trust Company Universal Individual Retirement Account Disclosure Statement" relating to this Account (including the Custodian's fee schedule), the "State Street Bank and Trust Company Universal Individual Retirement Account Custodial Agreement", and the "Instructions" pertaining to this Adoption Agreement. The Depositor acknowledges receipt of the Universal Individual Retirement Account Custodial Adoption Agreement and...
CERTIFICATIONS AND SIGNATURES. This application must be signed by both the applicant(s) and the property owner(s) (if different) before the submittal will be accepted. Statement of Intent to Complete Improvements - I understand that the Improvements Agreement must be secured by a financial guarantee, as may be deemed acceptable by the City, payable to the City of Bozeman, in an amount equal to one and one-half times the estimated cost of the installation of any required improvements not completed at that time. Said method of security shall be valid for a period of not less than twelve (12) months, eighteen (18) months for subdivision improvements. In any event, all required improvements shall be completed within nine (9) months of occupancy for site development and twelve (12) months for subdivision improvements except for lot frontage sidewalks in order to avoid default on the method of security. Applicant Signature: Printed Name: Owner Signature: Printed Name: Owner Signature Printed Name: If signing as a corporation, please provide the title and position of the individual signing on behalf of the corporation. Attach separate sheets for additional owner signatures.
CERTIFICATIONS AND SIGNATURES. Participant has received and read the “SIMPLE IRA Disclosure Statement” relating to this account (including the custodian’s fee schedule), the custodial account document, and the instructions pertaining to this Adoption Agreement. Participant has also received and read the summary description and notice from the employer relating to the employer’s SIMPLE IRA plan. Participant acknowledges receipt of the custodial account document and SIMPLE IRA Disclosure Statement at least 7 days before the date inscribed below and acknowledges that participant has no right of revocation. Participant acknowledges that they must provide accurate information in this Adoption Agreement, and that they may incur extra taxes and/or penalties if the information is not accurate; accordingly participant certifies the accuracy of such information (including particularly the date specified in Item 2(b) above). All forms must be acceptable to the custodian and dated and signed by the participant. Signature of Participant Date If the participant is a minor under the laws of the participant’s state of residence, a parent or guardian must also sign the Adoption Agreement here. Until the participant reaches the age of majority, the parent or guardian will exercise the powers and duties of the participant. Federal Law requires the following identifying information for the parent or guardian acting for the minor. Signature of Parent or Guardian Date of Birth (Required) Social Security Number (Required) Residential Address Custodian Acceptance. UMB Bank, n.a., accepts appointment as custodian of the participant’s account. However, this Agreement is not binding upon the custodian until the participant has received a statement of the transaction. Receipt by the participant of a confirmation of the purchase of the fund shares indicated above will serve as notification of UMB Bank, n.a.’s acceptance of appointment as custodian of the participant’s account. UMB BANK, N.A., CUSTODIAN Please send completed forms and checks to: Thornburg
CERTIFICATIONS AND SIGNATURES. If the Depositor has indicated a Traditional IRA Rollover or Direct Rollover above, Depositor certifies that, if the distribution is from another Traditional IRA, that Depositor has not made another rollover within the one-year period immediately preceding this rollover; that such distribution was received within 60 days of making the rollover to this Account. If Depositor has elected to perform an eligible transfer of an amount that includes a required minimum distribution, Depositor acknowledges responsibility to request the withdrawal by the deadline and to provide information needed to calculate such withdrawal.
CERTIFICATIONS AND SIGNATURES. Important: Please read before signing. I understand the eligibility requirements for the type of Xxxx XXX contribution I am making, and I state that I do qualify to make the contribution. I have received a copy of the Xxxx XXX Application, 5305-RA Custodial Account Agreement, the Financial Disclosure, and the Disclosure Statement. I understand that the terms and conditions that apply to this Xxxx XXX are contained in this Application and the Custodial Account Agreement. I agree to be bound by those terms and conditions. Within seven days from the date I open this Xxxx XXX I may revoke it without penalty by mailing or delivering a written notice to the custodian. I assume complete responsibility for • determining that I am eligible for a Xxxx XXX each year I make a contribution, • ensuring that all contributions I make are within the limits set forth by the tax laws, and • the tax consequences of any contributions (including rollover contributions and conversions) and distributions. Signature of Depositor: Date: If the depositor is a minor under the laws of the depositor’s state of residence, a parent or guardian must also sign the adoption agreement here. Until the depositor reaches the age of majority, the parent or guardian will exercise the powers and duties of the depositor. Signature of Parent or Guardian: Date: Social Security Number (Required): Date of Birth (Required): Residential Address: Custodian Acceptance UMB Bank, n.a., will accept appointment as custodian of the depositor’s account. However, this Agreement is not binding upon the custodian until the depositor has received a statement confirming the initial transaction for the account. Receipt by the depositor of a confirmation of the purchase of the fund shares indicated above will serve as notification of UMB Bank, n.a.’s acceptance of appointment as custodian of the depositor’s account. UMB BANK, N.A., CUSTODIAN Please send the completed forms and checks to: Regular Mail Overnight Mail Thornburg Thornburg
CERTIFICATIONS AND SIGNATURES. This Contract must be signed by an authorized representative of Contractor. The undersigned certifies under penalty of perjury both individually and on behalf of Contractor that:
A. The undersigned is a duly authorized representative of Contractor, has been authorized by Contractor to make all representations, attestations, and certifications contained in this Contract and to execute this Contract on behalf of Contractor and that this Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms;
B. Contractor is not a contributing member of the Public Employees’ Retirement System
CERTIFICATIONS AND SIGNATURES. This Contract must be signed in ink by an authorized representative of Contractor. The undersigned certifies under penalty of perjury both individually and on behalf of Contractor that:
A. The undersigned is a duly authorized representative of Contractor, has been authorized by Contractor to make all representations, attestations, and certifications contained in this Contract and to execute this Contract on behalf of Contractor and that this Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms;
B. Contractor is not a contributing member of the Public Employees’ Retirement System and will be responsible for any federal or state taxes applicable to payment under this Contract. Contractor will not, by virtue of this Contract, be eligible for federal Social Security, employment insurance, workers’ compensation or the Public Employees’ Retirement System, except as a self-employed individual.
C. Pursuant to OAR 580-061-0030, Contractor certifies that Contractor has not discriminated against Minority, Women or Emerging Small Business Enterprises in obtaining any required subcontracts;
D. The undersigned hereby certifies under penalty of perjury that the undersigned is authorized to act on behalf of Contractor and that Contractor is, to the best of the undersigned’s knowledge, not in violation of any Oregon Tax Laws. For purposes of this certification, “Oregon Tax Laws” means a state tax imposed by ORS 320.005 to 320.150 and 403.200 to 403.250 and ORS chapters 118, 314, 316, 317, 318, 321 and 323 and the elderly rental assistance program under ORS 310.630 to 310.706 and local taxes administered by the Department of Revenue under ORS 305.620.
