Printable Form W-10 Edinburg Texas 2020-2024

Printable Form W-10 Edinburg Texas: What You Should Know

I swear, under penalty of perjury, that the information I am about to supply is true, complete and correct. I also swear, under penalty of perjury, that the documents (including my identification and certification) I am about to supply are true and complete. By signing this Certificate of Service, I also agree to release and discharge the United States, its agencies, institutions, its officers, employees, agents, contractors or representatives from any lawsuit, prosecution, or action arising directly or indirectly out of this form. Any legal entity or individual that signs this form may be required to pay any additional and incidental expenses that may arise with respect to receiving the certification. I understand that by signing this form, I am binding myself and all parties hereto to the terms and conditions of this form. In consideration of my consent to the foregoing, I agree not to hold the United States or its agents and/or officials liable for any damages arising out of or in connection with this form. Date (date of the filing of this form) and signature. I give this Certificate of Service as a public record of birth of my child, to whom a certificate of immunization has been issued, to be administered at the following address, to a person approved by the Health Authority or the District Health Officer: Attention: Immunization Officer Date (date of the filing of this form) and signature; Name of Person to which the Certificate of Immunization will be Granted or Issued. Date (date of the signing). Applicant's name as it appears on the Certificate of Immunization I hereby order, under penalty of perjury, as follows: Name of Applicant Signature of Applicant Date (date of the signing) and signature. I hereby certify that the above signature does not have my name affixed to it by a person other than my own hand and that it has not been altered by writing or the substitution of ink, other than the substitution of yellow and blue ink, not less than 1/8 of an inch in size.

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