WITNESS STATEMENT FORM Sample Clauses

WITNESS STATEMENT FORM. Where applicable, witness statements should accompany the IOD package. These statements are not necessary to process the firefighter’s IOD claim. These statements will only be necessary when requested by the Chief of the Department. If witness statements are requested by the Chief of the Department, these witness statements shall be completed and delivered to the Chief of the Department within five (5) days of the date of the request by the Chief.
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Related to WITNESS STATEMENT FORM

  • Physician's Statement Employees requesting Temporary Disability Leave shall submit to the Chief, through the chain of command, a written statement from their physician verifying their condition, recommending limited duty or leave of absence, and describing their limitations and prognosis. The Chief may refer employees for additional evaluation of their condition. A written medical release from a physician shall be submitted prior to an employee's return to full or limited duty.

  • Closing Statement (a) At least five (5) business days prior to the Closing Date, the Company shall submit to Buyer a written statement of estimated Current Assets and Current Liabilities as of the last day of the month immediately preceding the Closing Date (the "Estimated Closing Statement") containing the Company's good faith estimate of the Net Working Capital Amount (the "Estimated Net Working Capital Amount"), which shall reflect the items required to be set forth in, and be prepared in a manner consistent with the preparation of, the Closing Statement, in each case in accordance with Section 4.6(b); provided, however, that for purposes of the Estimated Net Working Capital Amount, the parties hereto agree that 50% of the amount of Fuel Sensor Damages (x) actually expended by Parent or the Company from March 1, 2011 through the last day of the month immediately preceding the Closing Date and (y) accrued as current liabilities on the Estimated Closing Statement, shall be added as a credit to the estimated Net Working Capital Amount set forth on the Estimated Closing Statement. Commencing with the Company's delivery of the Estimated Closing Statement to Buyer, Buyer shall have reasonable access to the books and records and personnel of the Company and the opportunity to consult with the Company for purposes of confirming or disputing the Estimated Net Working Capital Amount. If Buyer shall disagree, in good faith, with any item set forth in the Estimated Closing Statement or used to determine the Estimated Net Working Capital Amount, then Buyer and the Company shall work, in good faith, to reach agreement on such disputed items and the amounts as agreed to by Buyer and the Company shall constitute the Estimated Net Working Capital Amount. Notwithstanding the foregoing, Buyer's agreement with the Estimated Net Working Capital Amount (or any item set forth in the Estimated Closing Statement or used to determine the Estimated Net Working Capital Amount) shall not foreclose, prevent, limit or preclude any rights or remedy of Buyer set forth in this Agreement. If the Estimated Net Working Capital Amount is less than the Target Net Working Capital Amount, the amount of the Closing Payment to be paid by Buyer pursuant to Section 4.1(b)(i) shall be reduced by an amount equal to the difference between the Estimated Net Working Capital Amount and the Target Net Working Capital Amount. If the Estimated Net Working Capital Amount is more than the Target Net Working Capital Amount, the amount of the Closing Payment to be paid by Buyer pursuant to Section 4.1(b)(i) shall be increased by an amount equal to the difference between the Estimated Net Working Capital Amount and the Target Net Working Capital Amount.

  • Witness Signature 4. PARENT/GUARDIAN CONSENT: (for applicants under 18 years) – I hereby certify and decree that all the information contained in the declarations above is true and accurate Print Name:................................................................... Signature …………………………………………....……... Relationship to applicant ……………………………… Phone Contact ……………………................................... Address …………………………………………………………………….....................................................................

  • Problem Statement School bus fleets are aging, and our communities have poor air quality. Replacing school buses with zero emission school buses will address both of these issues.

  • Preparer’s Signature The person completing the DBE commitment form on behalf of the consultant’s firm must sign their name.

  • Settlement Statement A settlement statement setting forth the amounts paid by or on behalf of and/or credited to each of Purchaser and Seller pursuant to this Agreement;

  • OFFICER SIGNATURE OFFICER NAME: TITLE Exhibit 2a This exhibit contains three versions of the loss share calculation for foreclosure, plus explanatory notes. Exhibit 2a(1) CALCULATION OF FORECLOSURE LOSS Foreclosure Occurred Prior to Loss Share Agreement 1 Shared-Loss Month May-09 2 Loan no: 364574 3 REO # 621 4 Foreclosure date 12/18/08 5 Liquidation date 4/12/09 6 Note Interest rate 8.100% 7 Most recent BPO 228,000 8 Most recent BPO date 1/21/09 Foreclosure Loss calculation 9 Book value at date of Loss Share agreement 244,900 Accrued interest, limited to 90 days or days from failure 10 to sale, whichever is less 3,306 11 Costs incurred after Loss Share agreement in place: 12 Attorney's fees 0 Foreclosure costs, including title search, filing fees, 13 advertising, etc. 0 14 Property protection costs, maint. and repairs 6,500 15 Tax and insurance advances 0 Other Advances 16 Appraisal/Broker's Price Opinion fees 0 17 Inspections 0 18 Other 0 19 Gross balance recoverable by Purchaser 254,706 Cash Recoveries: 20 Net liquidation proceeds (from HUD-1 settl stmt) 219,400 21 Hazard Insurance proceeds 0 22 Mortgage Insurance proceeds 0 23 T & I escrow account balances, if positive 0 24 Other credits, if any (itemize) 0 25 Total Cash Recovery 219,400 26 Loss Amount 35,306 Exhibit 2a(2)

  • E-Statements If we make this service available to you, you may agree to receive statements via electronic means, whereby your periodic statement will be e-mailed to you or sent electronically to, and made available on, our on-line banking website. Please see the provision, "Electronic Statements, Electronic Notices, Electronic Disclosures and Electronic Agreements" for more information regarding e-statements. Notices; e-Notices; Name or Address Change. Any written notice we give to you is effective when it is made available in our on-line banking system (if you have agreed to receive such notices electronically), or when it is deposited in the U.S. Mail, postage prepaid and addressed to you at the most recent mailing address on file with us. Notice to any account owner is considered notice to all account owners. Any written notice you give us is not effective until we actually receive it in our offices. You agree to notify us of any postal or e-mail address change or name change in writing. We reserve the right to require verification of your identity and proof of a change in address prior to making any changes in our records. We are only required to attempt to communicate with you at the most recent address you have provided to us. If you fail to provide notice of a change in address or name, and we attempt to locate you, we may impose a service fee as set forth on the Rates & Fees Schedule.

  • Final Certificate, Design Professional’s Certificate of Final Completion The Certificate issued by the Design Professional stating that all work has been completed in accordance with the terms of the Contract Documents. See Section 6,

  • DIRECTORS’ STATEMENT After having considered all aspects of the Agreement, the Board is of the opinion that the Agreement is in the best interests of the Company.

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