Get Certificate Of Appointment Of Authorized Representative - Michigan

Filling out the CERTIFICATE OF APPOINTMENT OF AUTHORIZED REPRESENTATIVE form in Michigan is a straightforward process. This guide will provide you with step-by-step instructions to ensure you complete the form correctly and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the name of the owner of the facility in the designated field. Ensure that the name is spelled correctly to avoid any potential issues.
3. Next, fill in the name of the person you are appointing as the authorized representative. Confirm that their full name is accurate for proper identification.
4. Provide the social security number of the authorized representative. This information is necessary for verification purposes.
5. Enter the date of birth for the authorized representative. Ensure this detail is correctly formatted to match any required guidelines.
6. In the subsequent section, specify the facility name for which the authorization applies. This must match official records.
7. Fill in the license number of the facility accurately, as this will link the appointment to the correct official documentation.
8. Provide the complete address of the facility, including street, city, and zip code, to ensure clear communication with the department.
9. Review the stipulations listed under Rule 325.1911(3) regarding the responsibilities of the authorized representative, if necessary.
10. At the bottom of the form, the owner or person with legal authority should sign their name and include their title to validate the appointment.
11. Include the applicant or license name and the date of signing. Verify all information for accuracy.
12. Finally, once all fields are correctly filled out, you can save your changes, download the form, print it, or share it as required.

Complete your documents online confidently by following these steps.