Get Duly Authorized Representative Form

Completing the Duly Authorized Representative Form is an essential process for identifying the responsible official and duly authorized representative for your facility. This guide provides step-by-step instructions to ensure accurate and efficient completion of the form online.

Follow the steps to complete the Duly Authorized Representative Form online.

1. Press the ‘Get Form’ button to access the Duly Authorized Representative Form and open it for online editing.
2. In the form, begin by entering the facility name in the designated field. This should match the official name of the facility for which the form is being submitted.
3. Next, fill in the Air Operating Permit (AOP) number if applicable. This number is vital for identifying the specific permit associated with the facility.
4. If you are submitting this form as notice of an administrative amendment to the existing facility's AOP, check the appropriate box.
5. Choose one of the sections to complete: Section A for Corporations, Section B for Partnerships or Sole Proprietorships, or Section C for Municipalities or Public Agencies. Follow the relevant instructions for your choice.
6. Complete Section A by certifying that you are qualified as the responsible official. Provide your title and indicate if you are an officer or someone who performs policy functions. Designate a duly authorized representative by entering their name and business title.
7. In Section B, certify your status as a general partner or the sole proprietor, including your name and confirming your qualifications.
8. For Section C, identify your title and agency as a principal executive officer or ranking elected official, ensuring clarity of your role.
9. After filling out the appropriate sections, proceed to Section D to provide signatures for both the responsible official and the duly authorized representative, along with the date.
10. Once all sections are completed, save your changes. You can also download, print, or share the completed form as needed.

Encourage completing the Duly Authorized Representative Form online to facilitate efficient processing with the Northwest Clean Air Agency.