For Staff Use Only Sample Clauses

For Staff Use Only. Required Information: Presented a valid driver’s license (student provided copy) Presented suitable Proof of Automotive Insurance Application signed by student and parent/guardian Student has no outstanding fines $50 Payment FULL YEAR/$25 for 2nd SEMESTER ONLY (if check, make out to “Monroe High School”) Check # $ Online
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For Staff Use Only. Specific Project Expenditure Report (Revised November 5, 2010) Initially submitted on For use as of March 1, 2011 Updated On Project Name (as filed) Case or Bid No.
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For Staff Use Only. The project has obtained all applicable Planning stage conformance approvals and meets the requirements for this concurrent submittal program. Case Planner (print name) Signature: Date: Planning Director (print name) Signature: Date: Building Official (print name) Signature: Date: Public Works Director (print name) Signature: Date:
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For Staff Use Only. Lock ID Qty of Keys on File (usually 4) _ Serial number of each key checked out Key tag number Received by – Print Name Date agreement received Signature Date Additional Briefing Points Primary Aircraft Restriction • The hangar space (footprint) for the primary aircraft must be reserved at all times for the primary aircraft. • No other aircraft OR object may occupy the footprint designated for the primary aircraft. • If Licensee is assigned a hangar large enough for an additional aircraft, such aircraft shall not occupy the footprint reserved for the Licensee primary aircraft. Additional Authorized Aircraft • Only aircraft authorized in writing by Airport Administration may be stored in the licensee’s hangar. • All aircraft stored in licensee’s hangar must comply with the insurance and aircraft registration requirements as set forth in the License Agreement Non-Aircraft Storage Per section 8.K of your License Agreement, storage of property or equipment not normally used or required for aircraft support and flight operations or related aviation activities is prohibited except for storage of • One boat, or one recreational vehicle, or one motorcycle or one automobile owned by Licensee in addition to the primary aircraft in the hangar. • A reasonable quantity of comfort items such as a table and seating. Modification or Construction • Modification or construction of any kind to the interior or exterior of any hangar is strictly prohibited. This includes changes to the electrical system. Any deviation or violation of these items, the Rules and Regulation or the License Agreement is grounds for termination of the License Agreement and loss of the applicable parking space. I (print name) acknowledge the above requirements and agree to abide by them, the Airport Rules and Regulations and the License Agreement. Date Licensee Signature Date Licensee Signature Date The above Briefing Points have been reviewed with the Licensee. Employee Name Signature Date
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For Staff Use Only. Date Form Received Date Check Received Check # Additional Name (printed): Date: NOTE:‌ SEE BELOW FOR IMPORTANT DATES ✄++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++✄ PLEASE RETAIN THE BOTTOM PORTION OF THIS PAGE FOR IMPORTANT DATES AND DETAILS NOTE: Sponsorship fees do not include provision of any chairs, tables or tents. All such items are the sole responsibility of the sponsor. NOTE: Sponsors may not distribute free food or drinks to festival attendees. Checklist: Return Sponsor Agreement Form and payment no later than May 1, 2022. Send high res logo in color and black and white by email to xxxxxxxxxxxxxxxxxxxx@xxxxxxx.xxx (.jpeg preferred) no later than May 1, 2022. If logo is not received by this date, it will not be included in promotional material.
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For Staff Use Only. Lock ID Qty of Keys on File (usually 4) _ Serial number of each key checked out Key tag number Received by – Print Name Date agreement received Signature Date
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For Staff Use Only. Residency Verification: □ *Driver Lic. □ Utility Bill □ Cty. Auditor Web □ Pay Stubs *DL required regardless of residency PID #: (185 = Groveport; All Others #s = Non-Res.) Pass Classification: □ Groveport Resident □ High School Student Summer Pass Attach proof of residency to Contract. □ Groveport Corp. Res. □ Non-Resident
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For Staff Use Only. Amount Paid: $ (Please circle) Cash Credit Check # Date of Receipt of Packet Attachments Complete: (Please check) Fee Form Waiver Insurance Certificate (if applicable) Staff Initials Approval Signatures: Scarborough Town Manager Date Community Services Director Date Date returned to applicant Emailed To T Mgr (for sig) [Date] Ins Cert T Mgr Scarborough Community Services P.O. Box 360 Scarborough, ME 04070-0360 (000) 000-0000 I, (name), in my capacity as (title) of (business name), a business/organization located in (town), (state), and being duly authorized by said organization to sign on its behalf, in consideration of the Town of Scarborough, Maine (hereinafter the “Town”), allowing my organization to participate in the 2022 Summerfest Event (hereinafter “the Event”), and in recognition of the risks, inherent and otherwise, of injury, damage or death in engaging in the same, which risks my organization duly acknowledges and freely and solely assumes for itself and its successors, assigns and legal representatives (collectively, hereinafter “the Releasor”), hereby assume full responsibility for and waive, discharge and forever release the Town and its officers, officials, agents and employees in their official and individual capacities from any and all claims, demands, damages, suits, actions, causes of action, judgments, expenses and costs whatsoever, including but not limited to attorneys’ fees and costs, for any and all personal injury, including death, and property damage arising out of or related to my organization’s participation in the Event, including all acts of negligence of the Town and its officers, officials, agents and employees in their official and individual capacities, or otherwise. Releasor further agrees to defend, indemnify and hold harmless the Town and its officers, officials, agents and employees in their official and individual capacities against any and all claims, demands, damages, suits, actions, causes of action, judgments, expenses and costs whatsoever, including but not limited to attorneys’ fees and costs, for any and all personal injury, including death, and property damage arising out of or related to Xxxxxxxx’s participation in the Event, including all acts of negligence of the Town and its officers, officials, agents and employees in their official and individual capacities, or otherwise. Xxxxxxxx agrees to abide by the Town’s rules for the Event, including providing to the Town prior to the Event an insurance policy in...
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For Staff Use Only. Required Information: Present a valid driver’s license and insurance (student provide copy) Application signed by student and parent $50 Payment FULL YEAR/$25 2nd SEMESTER ONLY (if check, make out to “Monroe High School”) Check # Student has no outstanding fines
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Related to For Staff Use Only

  • OFFICE USE ONLY Unit Size Requested Unit Number Targeted Move-In Date Date Received Time Received _R__i_v_e__r_w__o__o_d___A__p__a_r_t_m__e__n__t_s___________________ _9__0_0___W___e_s__t_P__a__r_k__S__t_r_e__e_t_____________________ _C__a__n__n_o__n__F__a__ll_s__,_M___N___5_5__0__0_9_________________ _P__h__:_(_5__0__7_)__2__8_9__-_1__8_9__5________________________ APPLICATION FOR OCCUPANCY Incomplete applications will be returned APPLICANT INFORMATION Applicant Name (Head of Household): First Middle Last Address: Street Address City State Zip Social Security Number: Date of Birth: [ ] Male [ ] Female [ ] Decline Applicant Phone #: Applicant Email: Alternate Phone #: Alternate Email: Emergency Contact: Name (Someone outside your household) Phone Email List All Other Household Members First MI Last Relationship to Head Date of Birth Male/Female/ Decline to Answer Social Security Number [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline [ ]M [ ]F [ ]Decline Primary Language: Do you require an interpreter? [ ] Yes [ ] No How did you hear about this housing? [ ] Online [ ] Newspaper [ ] Local Agency [ ] Drive By [ ] Resident Referral [ ] Other What is the combined gross monthly income of all household members? $ ADDITIONAL HOUSEHOLD MEMBERS CURRENT HOUSING STATUS How long have you lived at your current address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: Do all adult household members live at this address?........................................................................................................................ [ ] Yes [ ] No If NO, include additional adult household’s current address and contact information on a separate piece of paper. PREVIOUS HOUSING STATUS Your previous address: How long did you live at your previous address? From: To: Is this family or a friend? [ ] Yes [ ] No Name of Owner/Manager: Phone #: Email: Address: List every state in which each household member has lived: ELIGIBILITY INFORMATION The following questions pertain to yourself and every member of your household who will occupy the unit. Check either Yes or No in response to each question. All questions must be answered; for those questions that do not apply, you are required to indicate so by answering “not applicable” or “n/a”.

  • For Office Use Only Ref No ) Print Name …………………………………………….......... Customer No……………………………..................... Representing………………………………….…………....... Transferor Signature……………………………......... Position in organisation: Representing Hull City Council Owner Partner Other …………......................... Date................................................................................... Date …………………………….................................. Please complete sections A, B, C & sign section F and return this form to Trade Waste Team, Hull City Council, Staveley House, Stockholm Road, HULL HU7 0XW marked F.A.O. Commercial Waste Officer. A copy will be returned to you by email or post for your records after verification. It is a legal requirement to keep this transfer note for at least 2 years after the final collection. P.T.O.

  • Office Visit Copayments In each year of the Agreement, the level of the office visit copayment applicable to an employee and dependents is based upon whether the employee has completed the on-line Health Assessment during open enrollment and has agreed to opt-in for health coaching.

  • Staff Nurse A registered nurse who is responsible for the direct and indirect nursing care of the patient.

  • Use of Customer Name Contractor may use County’s name without County’s prior written consent only in Contractor’s customer lists. Any other use of County’s name by Contractor must have the prior written consent of County.

  • Processing of Customer Personal Data 3.1 UKG will:

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