Representative information definition

Representative information means information the Department deems necessary to verify that the individual submitting an application for registration is the person registering with the Department or that the individual or individuals submitting an application for registration on behalf of another person is or are authorized to register such person. Such information includes, but is not limited to, each individual’s name, title, and contact information.

Representative information. Name: Email: Address: Home Phone: Cell: Type of Event: Usage Time Period: ___________________ Event Day: Event Time: Number of Attendees: Facilities Reserved: ( ) Barn ( ) House ( ) Gazebo ( ) Entire Property (Prices listed on page 2)

Representative information means information the Department deems necessary to verify that the individual who submitted an application for a cannabis retailer excise tax permit is the person applying for a cannabis retailer excise tax permit or is authorized to submit the application on behalf of the person applying for a cannabis retailer excise tax permit. Such information includes, but is not limited to, the individual’s name, title, and contact information.

Examples of Representative information in a sentence

• REPRESENTATIVE INFORMATION ______________________________________________________________________________ Representative Name (please print) ______________________________________________________________________________ Representative Signature ______________________________________________________________________________ SM&R Rep.

• Date (MM/DD/YYYY)SECTION IV: AUTHORIZED REPRESENTATIVE INFORMATION (IF APPLICABLE)13.

• Telephone NumberFax Number FEIN or Treasury Account No.UIA Account No. Taxpayer SSNSpouse SSNE-mail Address PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATESYour authorized representative may be an organization, firm, or individual.

• Date (DD/MM/YYYY) SECTION VIII: AUTHORIZED REPRESENTATIVE INFORMATION (IF APPLICABLE)31.

• BIDDERS ARE ENCOURAGED TO SUBMIT CONTRACTOR REPRESENTATIVE INFORMATION FORMS AS EARLY AS POSSIBLE, PRIOR TO THE SCHEDULED PRE-BID DATE, TO ALLOW TIME FOR RECEIPT AND REVIEW OF DOCUMENTS PRIOR TO THE SCHEDULED BID DATE.

• For collaborating applicants, a separate line item must be completed for each agricultural operation.

• PART 2: REPRESENTATIVE INFORMATION AND AUTHORIZATION DATES You must submit a separate Power of Attorney form for each representative.

• John DoePosition/TitlePresident◗Street Address12345 A Street◗City, State, ZIP CodeAnytown, Anywhere 111223E-mail Addressjdoe@johndoemanufacturing.comTelephone Number(111) 222-5555Fax Number(111) 222-6666COMPANY REPRESENTATIVE INFORMATION.

• LLC Deborah.kowalski@gapac.com Richard Serra, BOMA Buffalo Director President, Allpro Parking, LLC RSerra@allproparking.com2016 BOMA MEMBERSHIP APPLICATION Local Association AddressBuilding Owners and Managers Association / Greater Buffalo 465 Main Street, Suite 130Buffalo, NY 14203Office: 716.856.3801info@bomabuffalo.comLOCAL REPRESENTATIVE INFORMATION (PLEASE TYPE OR PRINT) NOTE: Please return to local association’s address at left.

• DCA ALLOCATIONS: ______% 6 Month DCA ______% 1 Year DCA ---------------------------------------------------- -------------------------------------- --------------------- OWNER'S SIGNATURE REGISTERED REPRESENTATIVE'S SIGNATURE DATE LICENSED/ REGISTERED REPRESENTATIVE INFORMATION --------------------------------------------- ------------------------- ----------------------- REPRESENTATIVE'S TELEPHONE NO.