ASSIGNMENT AND RELEASEAssignment and Release • June 3rd, 2021
I, the understated, have insurance and assign directly to Story City Dental all benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits.
ASSIGNMENT AND RELEASEAssignment and Release • October 30th, 2022
I, the undersigned, have insurance with and assign directly to Dr. Ronnie L. Hold, Jr. all benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all my insurance submissions whether manual or electronic.
THIS DOCUMENT MUST ACCOMPANY ALL CONTEST ENTRIES)Assignment and Release • October 19th, 2006
("Videographer") has created the video (and any included images s/he took) described below (all together="Video"). Pin The Tail On The Culture, Inc. ("Assignee") will acquire the rights to the Video as specified in this agreement (the "Agreement").
Linac Coherent Light Source at a Contract Sum of $Assignment and Release • June 14th, 2005
Pursuant to the provisions of Subcontract No. , dated , - between The Board of Trustees of the Leland Stanford Jr. University – Stanford Linear Accelerator Center, and
Assignment and ReleaseAssignment and Release • February 3rd, 2016
I, the undersigned, have insurance with and assign directly to Palm Valley Family Dentistry, P.A. all benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance within 30 days from the date of service. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all my insurance submissions whether manual or electronic.
ASSIGNMENT AND RELEASEAssignment and Release • November 5th, 2019
I, the understated, have insurance and assign directly to Iowa Wisdom Teeth all benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits.
ASSIGNMENT AND RELEASEAssignment and Release • May 13th, 2003 • Raybor Management Inc • Non-operating establishments • Delaware
This Assignment and Release is effective as of November 19, 2002 and is entered into by and between Rick Plotnikoff (“Seller”), American Consumer Publishing Association, Inc., an Oregon corporation (“ACPA”), Dennis L. Simpson (“Simpson”) and Jeffrey D. Hoyal (“Hoyal” who along with Simpson are collectively referred to as the “Buyers”).
ASSIGNMENT AND RELEASEAssignment and Release • July 20th, 2018
