Home Telephone No. (Area Code) and No. ( ) -------------------------------------------------------------------------------- 4. Driver's License Number and State | -------------------------------------------------------------------------------- 5. What is the proposed insured's annual income? (Life only) Earned $ _____________________________ Unearned $_____________________________
Home Telephone No. Fax No. Fax No. Date Date AUCTIONEER INTERSTATE AUCTION® COMPANY TN REL# 251429 Name Printed: Agent’s RE License No: Date
Home Telephone No. RELATIONSHIP BUSINESS TELEPHONE NO.
Home Telephone No. ( ) For purposes of verification only, please provide: Last four digits of your Social Security number: ; and The approximate month and the year you were contracted by Knights of Columbus as a Field Agent in California. (month) , (year) . SETTLEMENT ALLOCATION FORM <<INSERT NAME AND PHONE NUMBER FOR SETTLEMENT ADMINISTRATOR>> II. SETTLEMENT PAYMENT BASED ON WEEKS WORKED Your estimated minimum settlement amount is: $ [insert amount]. Your weeks worked under contract as a Field Agent in California according to Knights of Columbus’ records is: (insert number of workweeks) Your settlement award is based in part on the number of weeks you were under contract by Knights of Columbus as a Field Agent in California during the period from September 18, 2014 through <<Preliminary Approval>>. If you do not agree with the number of weeks worked, you may dispute the number above. If you dispute your weeks worked, in the space below, provide the dates that you were under contract as a Field Agent in California during the period from September 18, 2014 through <<Preliminary Approval>>. Include copies of any documents, such as commission statements, that support your position. Position: Dates: If you dispute your weeks worked, you must return this form to the Settlement Administrator, at the following address post-marked on or before . [INSERT ADDRESS] If you agree with your weeks worked and your pre-printed address information is correct, you need do nothing. You will receive a check in the mail if the Court approves the settlement.
Home Telephone No. Fax No. Fax No. Email Address Date Date AUCTIONEER Virginia Auction Company, Inc. By: Xxx Xxxxx, President Date RECEIPT OF DOWN PAYMENT: Virginia Auction Company, Inc. has received $ in the form of a (circle one) cash, money order, cashier’s check, or personal check as down payment for the above referenced property. Purchaser authorizes Auctioneer to convert deposit made by personal or business check to cashier’s check to be deposited into Auctioneer’s escrow account. EXHIBIT A LEGAL DESCRIPTION
Home Telephone No. Date of birth………………………………….………………........................
Home Telephone No. Fax No. Fax No. Date Date AUCTIONEER Sperry Xxx Xxxx Interstate Auction Company Date RECEIPT OF INITIAL DOWN PAYMENT: Sperry Xxx Xxxx®, has received $100,000.00 as Initial Down Payment for the above referenced property. Purchaser authorizes Auctioneer to convert any deposit made by personal or business check to cashier’s check which shall be deposited into the designated escrow account.
