SUBSCRIBED AND SWORN TO before me this day of , in the year by who is personally known to me or has produced as identification. NOTARY PUBLIC, signature PRINTED NAME Commission#: (Seal) Commission expires: Exhibit 3 ‐ Debarment Form Instructions
SUBSCRIBED AND SWORN TO before me this day of , 2016 NOTARY PUBLIC My commission expires The Town of Ashland City follows all Title VI policy not to discriminate on the basis of race, color, national origin, age, sex, or disability in its hiring and employment practices, or in admission to, access to, or operation of its programs, services, and activities. It is also the policy of the Town of Ashland city to follow the City’s written complaint procedures for employees and all contracted workers and to comply with any LEP, Limited English Proficiency guidelines. With regard to all aspects of this contract, contractor certifies and warrants it will comply with these policies. Signature of Contractor Name of Contractor (printed) Date Subcontractor Date APPLICATION FORMS & INFORMATION COLLECTION REQUIREMENTS: All recipients, other than those using guarantee programs, are required to collect data on race/ethnic and gender of users or beneficiaries. Application form must include below the signature and date block the following disclosure statements: (rev. 1/2001 as per Fed. Register Vol. 62 No. 210) “The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.” Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: (Mark one or more) White Black or African American American Indian/Alaska Native Asian Native Hawaiian or Other Pacific Islander Gender: Male Female POLICY OF NONDISCRIMINATION The Town of Ashland City does not discriminate on the basis of race, color, religion, national origin, sex, age or handicapped status in the admission or access to, or treatment or employment in, its federally assisted programs or activities. Xxxxxx Xxxx PO Box 36 Ashland City, TN 00000 (000)000-0000 Has been designated to coordinate compliance with the nondiscrimination requirements contained in the Department of Housing and Urban Development’s (HUD) regulations implementing Section 504 (24 CFR Part 8, dated June 2, 1988), Section 3 (24 CFR Part 135, dated October 23, 1973, Use of Small and Disadvantaged Businesses and Hiri...
SUBSCRIBED AND SWORN TO before me this day of , in the year by who is personally known to me or has produced as identification. NOTARY PUBLIC, signature PRINTED NAME Commission#: (Seal) Commission expires: Exhibit 3 ‐ Debarment Form CERTIFICATION REGARDING, DEBARMENT, SUSPENSION INELIGIBILITY AND VOLUNTARY EXCLUSION ‐ LOWER TIER COVERED TRANSACTIONS This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 34 C.F.R. Part 85, Section 85.510, Participants responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160 ‐ 19211). ***** BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON NEXT PAGE *****
SUBSCRIBED AND SWORN TO before me this day of year of at (City and State) Notary Public My commission expires:
SUBSCRIBED AND SWORN TO before me this 29th day of March, 2002, by Joe Joseph as treasurer of the NZ Corporation, NZ Development Corporaxxxx, xxx NZU, Inc. /s/ Norma J. Oswalt --------------------------------- Notary Public My commission expires: 10-14-2003 133 EXHIBIT 1-D PLEDGE AND COLLATERAL ASSIGNMENT OF LIMITED LIABILITY COMPANY INTEREST AND SECURITY AGREEMENT THIS PLEDGE AND COLLATERAL ASSIGNMENT OF LIMITED LIABILITY COMPANY INTEREST AND SECURITY AGREEMENT (the "SECURITY AGREEMENT") is made this 28th day of March, 2002, by and between NZ Corporation, an Arizona corporation, NZ Development Corporation, an Arizona corporation, and NZU Corporation, a New Mexico corporation (collectively "SECURED PARTY"), and New Mexico and Arizona Land Company, LLC, an Arizona limited liability company ("PLEDGOR").
SUBSCRIBED AND SWORN TO before me this day of ----------, 133 20__. Notary Public Exhibit H FORM OF ADDITIONAL MATTER INCORPORATED INTO THE FORM OF THE CERTIFICATES This Certificate does not represent an obligation of or interest in PNC Mortgage Securities Corp. or any of its affiliates, including PNC Bank Corp. Neither this Certificate nor the underlying Mortgage Loans are guaranteed by any agency or instrumentality of the United States. This certifies that the above-named Registered Owner is the registered owner of certain interests in a trust fund (the "REMIC I Trust Fund") whose assets consist of, among other things, a pool (the "Mortgage Pool") of conventional one- to four-family mortgage loans (the "Mortgage Loans"), formed and administered by PNC Mortgage Securities Corp. (the "Company"), which term includes any successor entity under the Pooling Agreement referred to below. The Mortgage Pool was created pursuant to a Pooling and Servicing Agreement, dated as of the Cut-Off Date stated above (the "Pooling Agreement"), between the Company and State Street Bank and Trust Company, as Trustee (the "Trustee"), a summary of certain of the pertinent provisions of which is set forth hereafter. To the extent not defined herein, the capitalized terms used herein have the meanings assigned in the Pooling Agreement. Nothing herein shall be deemed inconsistent with such meanings, and in the event of any conflict between the Pooling Agreement and the terms of this Certificate, the Pooling Agreement shall control. This Certificate is issued under and is subject to the terms, provisions and conditions of the Pooling Agreement, to which Pooling Agreement the Holder of this Certificate, by virtue of the acceptance hereof, assents and by which such Holder is bound. Distributions will be made, pursuant to the Pooling Agreement, on the 25th day of each month or, if such 25th day is not a Business Day, the Business Day immediately following (the "Distribution Date"), commencing on the first Distribution Date specified above, to the Person in whose name this Certificate is registered at the close of business on the last day (or if such last day is not a Business Day, the Business Day immediately preceding such last day) of the month immediately preceding the month of such distribution (the "Record Date"), to the extent of such Certificateholder's Percentage Interest represented by this Certificate in the portion of the Available Distribution Amount for such Distribution Date then distributable on the C...
SUBSCRIBED AND SWORN TO before me this 10th day of February, 2003. /s/ Xxxxxxx X. Xxxxxxxxx NOTARY ---------------------------------------- SEAL NOTARY Xxxxxxx X. Xxxxxxxxx ---------------------------------------- Printed Name My appointment expires: 3/12/04 SEAFO, INC. /s/ Xxxxxx X. Van Til --------------------------------- By: Xxxxxx X. Van Til, Vice President Date: February 6, 2003 ---------------------------------------- STATE OF WASHINGTON ) ) ss. COUNTY OF KING ) On this day personally appeared before me Xxxxxx X. Van Til, to me known to be the Vice President of Seafo, Inc., and acknowledged that he/she was authorized to execute this instrument as the free and voluntary act and deed of said corporation for the uses and purposes therein mentioned. SUBSCRIBED AND SWORN TO before me this 6th day of February, 2003. /s/ Xxxxx X. Xxxxxxxxxx NOTARY ---------------------------------------- SEAL NOTARY
SUBSCRIBED AND SWORN TO before. ME on this 26 day of Feb. 2006, to certify which witness my hand and seal of office. /s/ MARTHA D. TAYLOR --------------------------------------- NOTARY PUBLIC
SUBSCRIBED AND SWORN TO before. ME on this the 27th day of July, 2015 to certify which witness my hand and seal of office. /s/ Notary Public, State of Texas My Commission Expires: ______________ BUYER: Xxxxxxx Resources, Inc. By: /s/ Xxxx Xxxxxxx Name: Xxxx Xxxxxxx Title: CEO and President STATE OF TEXAS § § COUNTY OF DALLAS § SUBSCRIBED AND SWORN TO BEFORE ME on this the 27th day of July, 2015 to certify which witness my hand and seal of office. /s/ Notary Public, State of Texas My Commission Expires: ______________ Asset Purchase Agreement between Proprietary and Confidential Colfax Exploration Partners I, LLC and Xxxxxxx Resources, Inc. Intended for Addressee Only
