Inpatient Certificate
Ref : 405 ILCS 5/3-403, 5/3-602, 5/3-607, 5/3-610, 5/3-702, 5/3-813, 5/4-306, 5/4-402, 5/4-403, 5/4-405, 5/4-501, 5/4-611, 5/4-705 Re: (name) I personally informed the above-named individual of the purpose of this examination and that he or she did not have to speak to me, and that
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions
Inpatient Certificate
Re: Signature of Examiner On, , at a m p m above-named individual The examination was conducted at (name of location) A person with mental illness who, because of his or her illness is reasonably expected, unless treated on an inpatient
2020 I-017 Rent Certificate (fillable)
Do NOT sign your rent certificate If your landlord won’t sign, complete fields above and below and lines 1 to 8, attach rent verification
CERTIFICATE OF NON-OPERATION
CERTIFICATE OF NON-OPERATION A Public Service Agency I have knowledge that the vehicle(s) listed below was/were not driven, moved, towed or left standing (parked) upon any California highway
Certificate of Fact
X Certificate of Fact Use this form to make a statement of fact License plate/Registration number Vehicle Identification Number (VIN) or Hull Identification Number (HIN)
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
certificate holder © 1988-2010 acord corporation all rights reserved acord 25 (2010/05) authorized representative cancellation certificate of liability insurance
ST3, Certificate of Exemption
01 11 12 13 Wholesale trade 14 Business services 15 Professional services 16 17 18 Government 19 Not a business (explain) 20 Other Form ST3, Certificate of Exemption
Pennsylvania Exemption Certificate (REV-1220)
check one: pennsylvania tax unit exemption certificate (use for one transaction) pennsylvania tax blanket exemption certificate (use for multiple transactions) name of seller, vendor or lessor
Certificate of Purchase
Certificate of Purchase Transferring Ownership of Abandoned, Lost, Stolen or Unclaimed Vehicles Pursuant to Illinois Compiled Statutes Secretary of State
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