Archive | December, 2008
Authorization for Release of Medical Records
Authorization for Release of Medical Records _________________ (“Patient”) of __________________________________(Address), with Social Security Number ___________________, hereby authorizes the release, disclose, and delivery of the medical information described below to: _______________ (Authorized Recipient). Specific Authorization. I specifically authorize the release of all medical information relating to the above-named patient including but not limited to the following […]
Continue reading...Fire Extinguisher Sale & Maintenance
18. December 2008
Fire Extinguisher Sale & Maintenance _____________________, referred to as OWNER, and _____________________, referred to as SELLER, agree: SELLER shall install _____________________ fire extinguishers rated ____________________, in accordance with all applicable laws and regulations of the State of _____________________ and other applicable jurisdictions, no later than ______________________. Said extinguishers shall meet all of the regulations of […]
Continue reading...Joint Author’s Agreement
18. December 2008
Joint Author’s Agreement ____________ and ______________ herewith agree: That the parties hereto are joint authors of a copyrightable work entitled: _______________________________ (“Work”) which was completed on or about ___________. This agreement shall be binding on the successors, heirs and assigns of the joint authors. Work was registered with the U.S. Copyright Office, and given certificate […]
Continue reading...Account Assignment, Notice to Debtor
18. December 2008
Account Assignment, Notice to Debtor TO: __________________ ______________________ ______________________ Re: Your account with __________________________ Your account with __________________ has been transferred to _______________ (“New Party”). Effective immediately, all payments in regard to this account must be made to ____________________ at the following address: __________________________________ __________________________________ Payments made to the old address will be forwarded to […]
Continue reading...Deposit, Forfeit due to No Delivery
18. December 2008
Deposit, Forfeit due to No Delivery Date: Customer Name: Customer Address: Dear: Ref: Purchase of ____________________. On ___________________(Date), you purchased from us ______________, signed a contract for them, and gave us a nonrefundable deposit for $ ________________. Per your written instructions, we prepared the goods immediately and have repeatedly tried to contact […]
Continue reading...Bill of Sale
18. December 2008
Bill of Sale This Bill of Sale made on ____________ (Date), by and between ______________ (“Seller”) and _______________________________ (“Buyer”). Whereas the Seller wishes to sell and the Buyer wishes to buy the property, assets and undertaking described in Exhibit 1 attached (collectively the “Assets”) for the consideration and on the terms and conditions set forth […]
Continue reading...Lottery Pool Agreement
18. December 2008
Lottery Pool Agreement The following individuals agree to join a lottery pool for the month of ___________________, for the purpose of jointly playing the _______ State Lottery: ___________________________________________________________ and the following games of the __________ State lottery: _________ and designate, ______________ as the Lottery Pool Manager for this month. Each participant shall be liable to […]
Continue reading...Declaration in Conformance with Missouri Statutes 459.015
17. December 2008
Declaration in Conformance with Missouri Statutes 459.015 I have the primary right to make my own decisions concerning treatment that might unduly prolong the dying process. By this declaration I express to my physician, family and friends my intent. If I should have a terminal condition it is my desire that my dying not be […]
Continue reading...Lien Release, Real Estate
17. December 2008
Lien Release, Real Estate STATE OF __________ COUNTY OF _________ __________________________________, referred to as HOLDER, is the owner of that certain Deed of Trust, executed by _____________________, acknowledges payment in full of the same, which was recorded at _________________Book, page ___ of the ________ County, State of _________, and consents to the release of the […]
Continue reading...Collection Agency Agreement
17. December 2008
Collection Agency Agreement _____________________________, referred to as AGENCY and _____________________________, referred to as CLIENT, agree: AGENCY represents that it is properly licensed, bonded, with a capable and trained (if required) staff of collectors, and can effect reasonable and lawful effects to collect accounts receivable of CLIENT. CLIENT shall provide to AGENCY, from time to time, […]
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18. December 2008
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