FOR OFFICE USE. File to: □ 22-23 lease □ 23-24 lease □ other lease
FOR OFFICE USE. DATE COMPLETED/SIGNED FORMS RECEIVED IN PARISH OFFICE: / /
FOR OFFICE USE. Date Paid: Cash Check M/O # Work Scheduled For: _ Homeowner Footage: Village Footage: (Due to trees or other related problems) Total Footage: Job Completed □ If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at xxxx://xxx.xxxx.xxxx.xxx/complaint_filing_cust.html, or at any USDA office, or call (000) 000-0000 to request the form. You may also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 0000 Xxxxxxxxxxxx Xxxxxx, X.X. , Washington D.C. 00000-0000, by fax (202) 000-0000 or email at xxxxxxx.xxxxxx@xxxx.xxx.
Examples of FOR OFFICE USE in a sentence
American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Parent / Guardian Signature: Date FOR OFFICE USE ONLY Parent/Guardian chose not to complete Ethnicity/Race information and determination was made by the Academy.
Xxx.Xx. FAX No. FOR OFFICE USE ONLY To: Co-operating Brokerage shown on the foregoing Agreement of Purchase and Sale: In consideration for the Co-operating Brokerage procuring the foregoing Agreement of Purchase and Sale, I hereby declare that all moneys received or receivable by me in connection with the Transaction as contemplated in the MLS® Rules and Regulations of my Real Estate Board shall be receivable and held in trust.
FOR OFFICE USE ONLY (TIME STAMP)HighLow*Investors should consult their financial advisers if in doubt about whether the product is suitable for them.
FOR OFFICE USE ONLY Reference indication of holder/applicantand/or licensee:1 ............................
Place: FOR OFFICE USE ONLY Date: IPV Done on D D M M Y Y Y Y IIFL Securities Limited Code: 1100044700 (Originals verified) Self certified Documents copies received.
More Definitions of FOR OFFICE USE
FOR OFFICE USE. ONLY: Advisor: Date:
FOR OFFICE USE. School Site: Student ID #:
FOR OFFICE USE. ONLY: ALCOHOL PERMIT RECEIVED:
FOR OFFICE USE. ONLY: COI Received? YES NO N/A Auto Insurance Received? YES NO Fees paid? Check# Background check verified: YES NO N/A By: Fingerprints verified: YES NO N/A By: Approved: YES NO TTSD Service Agreement with Sole Proprietor EXHIBIT A Name of Contractor: Address: Please answer the following questions in sections A, B, and C. For a contractor to be classified as an Independent Contractor, all answers in section A must be “Yes” and at least four of the six answers in Section B must be “Yes”.
FOR OFFICE USE only : Issue this page to the lead tenant on signing
FOR OFFICE USE. DX: Session fee: $ Agreement for Services form read & signed Yes No copy of insurance card Driver’s license Credit card on file ☐ Anxiety ☐ Depression ☐ Sleeping Problems ☐ Thoughts of Suicide ☐ Panic ☐ Unusual thoughts ☐ Anger Outbursts ☐ Weight Change ☐ Crying Spells ☐ Memory Problems ☐ Sexual Problems ☐ Relationship Issues ☐ Treated Unfairly ☐ Frequent Pain ☐ Low Energy/Lethargic ☐ Concentration problems ☐ Restlessness ☐ Nausea ☐ Eating Disorder ☐ Legal Difficulties ☐ Drug Use ☐ Alcohol Abuse/Heavy ☐ Boredom ☐ Hopelessness ☐ Stress ☐ Shyness ☐ Work Problems ☐ Confusion ☐ Feelings of Guilt ☐ Suspicion ☐ Loneliness ☐ Violent Thoughts ☐ Compulsions ☐ Worry ☐ Financial Problems ☐ Difficulty with decisions ☐ Specific Fears ☐ Mourning ☐ Physical Illness ☐ Lack of Motivation ☐ Feeling Abandoned ☐ Meaninglessness ☐ Perfectionism ☐ Unusually Sensitive ☐ Irritability ☐ Social Withdrawal ☐ Feeling Misunderstood ☐ Troublesome Thoughts ☐ Religious Concerns ☐ Disappointment ☐ Impulsive Behavior ☐ Hearing strange voices ☐ Feelings of Inferiority ☐ Irrational Thoughts ☐ Mood Swings ☐ No Present Concerns Mother Father Other Dorm/Campus Apartment Health Care Facility Apartment With Relatives House Other Check the box beside issues experienced in childhood: Happy Childhood Neglected Moved Frequently Physically Abused Few Friends Sexually Abused Weight Problems Popular Parents Divorced Family Fights Poor Grades Conflict with Teachers Drug/Alcohol Use Good Grades Sexual Problems Depressed “Spoiled” Anxious Not Allowed to Grow-Up Attention Problems Anger Problems I’m Currently: Highest level of education completed? What is (or was) your major or favorite subject? How many hours per week are you working? In what field do you usually work? Briefly describe what you like and dislike about your employment or school: Like:
FOR OFFICE USE. Date received: By: Start date _ □Start date pending Contract Type: □ T1 □ T2 □ AP Preschool Schedule: □Mon □Tue □Wed □Thu □Fri □PM Option □Mon □Tue □Wed □Thu □Fri Pending Contract: □YMCA □CDA □COUNTY □Other □Financial Assistance Preschool Items Required: □Immunization Records Race/Ethnicity Race/Ethnicity: White Hispanic/Latino Black/ African American American Native Pacific Islander Multi-Racial Asian (specify): Other (specify): Primary Language spoken at home: English Spanish Other (specify): Household Type: Single Parent Two Parent Xxxxxx Parent(s) Kinship/Relative Guardian(s) Other (specify): Parent/Legal Guardian Military Status: None/NA YES: Active Duty Reserves Former/Retired (Veteran) If applicable, specify branch: Highest Education Level in Household: No school Some primary school, no diploma/GED High School Diploma GED Vocational Certificate (no college) Some college, no degree Associates Degree Bachelors Degree Masters or higher Household Approximate Annual Gross Income: □ Under $10,000 □ $10,000 –$ 29,999 □ $30,000-$49,999 □ $50,000-$79,999 □ $80,000 or higher Household Income Source(s): Employment/Self Employment Government Aid (specify type(s)): Other (specify): Other Household Benefits: WIC CalFresh (food stamps) Section 8 voucher or other rental assistance Other (specify): Any health or social service needs for which we may be able to provide assistance or referrals? Do both parents live in the same household with the child? □ Yes □ No Are there custodial court orders in effect? □ Yes □ No If yes please provide the court order. Restraining orders? □ Yes □ No If yes please provide the court order. Has your family or child(ren) been victim to any catastrophic events? □Survivor of domestic violence or abuse □Victim of a criminal act □Act of nature □Loss of job or income □Disabilities □Other: Are you interested in receiving information about: □ Child/family counseling □ Parent education/support □Food assistance □ Medical/dental assistance □ Other community services Children’s school site: Do you want your name and your child(ren)’s name(s) published on a site Parent Roster that will be made available to other enrolled parents upon request? □ Yes □ No Include Phone Number? □ Yes □ No Would you be available to participate in the program as a volunteer? □Yes □ No Days and times available: Do you have access to surplus supplies to donate (i.e. paper, wood, computers, etc.)? □ Y...