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Get Authorized Person Designation/notarized Sworn Statement Form ...
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How to fill out the Authorized Person Designation/Notarized Sworn Statement Form online
Filling out the Authorized Person Designation/Notarized Sworn Statement Form is essential for designating an individual authorized to request a staff exclusion list check. This guide will provide you with a clear, step-by-step approach to completing the form online.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to access the form. This action will allow you to download or open the document in an online editor.
- Begin filling out the form by entering the provider agency name, agency code, address, city, state, zip, telephone number, and fax. Ensure all details are accurate and complete.
- In Part 1, complete the section for the Authorized Person. Enter their last name, first name, middle initial, business email address, business phone number, title, and business address.
- The Authorized Person must read the declaration and provide their signature and the date to confirm their understanding of the responsibilities associated with this designation.
- Part 2 requires the Director of the Provider Agency to approve the designation of the Authorized Person. The director must print their name, sign, provide their title, and date the form.
- In Part 3, the Authorized Person must sign the statement in the presence of a Notary Public. The Notary will complete the acknowledgment section.
- After completing all parts of the form, save your changes. You may also download, print, or share the form as needed. Ensure that a copy is returned to the Justice Center as instructed.
Complete your documents online today to ensure compliance and streamline your processes.
Connect your phone. Open your PDF file in Adobe Acrobat. In the File menu, find and select Sign, and then choose Fill & Sign. From the available options, select Sign Yourself and then Add Signature. From the options, select Draw and write your signature with your finger, a stylus, or even a mouse. Click Apply.
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