2016-04-26_PERMIT FILE - M2016010 ‎(2)‎

• Permit No: M2016010
• IBM Index Class Name: Permit File
• Doc Date: 4/26/2016
• Doc Name: Returned mail - Notice of Formal Board Hearing
• From: USPS
• To: DRMS
• Email Name: AME
• Media Type: D
• Archive: No

AUTHORIZATION TO APPEAR ON BEHALF OF A PARTY
(Please Type Or Print the Requested Information)
SIGNATURES MUST BE IN BLUE INK
I
(person's name) (title,if applicable)
of (name of company, association, organization, etc.if applicable)
hereby delegate to
(person or entity's name)
the right to appear on behalf of at the Pre-hearing conference.
(company,association,organization, etc.)
SIGNED AND DATED THIS DAY OF
If corporate attest(seal)
Authorized Signature(must be signed in blue ink)
Title:
State of )
County of )
The forgoing instrument was acknowledged before me this day of
by as of
Notary Public
My commission expires:
SIGNATURE MUST BE IN BLUE INK
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