Form Mv 9Db PDF Details

In New York State, there are specific procedures that must be followed when an individual is injured on the job. If you are injured while working, you must report the injury to your employer as soon as possible. You should also complete a Form MV 9Db, which is known as the Work-Related Injury/ Illness Report. This form will help your employer keep track of any injuries that occur in the workplace. The information on this form can also be used to determine if workers' compensation benefits are available.

QuestionAnswer
Form NameForm Mv 9Db
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesMV_Disabled_Per sons_Parking_Af fidavit_For_Bus iness_Form_MV9D B mv 9d rev 06 2008 form

Form Preview Example

Disabled Person’s License Plate Affidavit for a Business

MV-9DB (Rev. 06-2008)

www.dor.ga.gov

Sect ion One-Except for signature(s), this form must be typed, electronically completed and printed or legibly hand printed. Not e: Apply at the Tag Office in the county in Georgia where the business is located.

Business Corporate Name, LLC or Sole Proprietor

State Tax I D Number

Business Owner’s Street Address including City, State & Zip

 

County Where Business is Located

 

 

 

 

 

 

Disabled Person’s Full Legal Name ( Please attach an MV-9D, Disabled Person’s Affidavit)

 

I s Business Vehicle Used Only or Primarily by Disabled

 

 

Employee? Check only one box.

 

 

□ Yes □ No

 

 

 

Disabled Person’s Street Address including City, State & Zip

 

 

 

 

 

 

 

 

Sect ion tw o- Vehicle I nformation: The vehicle owner information is required when applying for a DP license plate for a business.

Vehicle Year & Make

Vehicle I dentification #

Vehicle Color

Vehicle Tag #

Officer’s Signature and Position

 

______________________________________________

______________________________________________

Printed Name

Position

______________________________________________

______________________________________________

Signature

Signature Date

Not e: Notarization Required For Authorized Representative’s Signature

Sworn to and subscribed before me

This __________day of ______________________, _____________

(Day)

(Month)

(Year)

Notary Public’s Signature & Notary Seal or Stamp

My Notary Commission Expires:

Date: __________________________

I nstructions:

Except for signature(s), this application must be typed, electronically completed and printed or legibly printed by hand for signing and submission.

Section One

Record the Business Corporate Name, LLC or Sole Proprietor and State Tax I d Number. Record the Business owner’s street address including the city, state and zip code. Record the county name where the business is located.

Record the disabled person’s full legal name and check the box to indicate that the business vehicle is used primarily by disabled employee.

Record the disabled person’s street address including city, state & zip.

Section Tw o

•Record the description of the vehicle, e.g. vehicle year and make, vehicle identification number, vehicle color and vehicle tag number.

•An officer of the business must sign and enter his/ her position or job title with the business and date.

Retent ion Schedule: This form w ill be retained at the Count y Tag Office for tw o ( 2) years from the dat e issued.

How to Edit Form Mv 9Db Online for Free

You could fill in Form Mv 9Db without difficulty in our PDFinity® online PDF tool. Our team is constantly endeavoring to develop the editor and insure that it is much faster for people with its cutting-edge features. Uncover an ceaselessly innovative experience today - check out and uncover new opportunities as you go! Getting underway is effortless! All you should do is take the following easy steps below:

Step 1: Click the "Get Form" button at the top of this page to get into our PDF tool.

Step 2: This tool offers you the ability to customize almost all PDF forms in many different ways. Improve it by including customized text, correct existing content, and put in a signature - all at your fingertips!

It's straightforward to complete the pdf using this helpful guide! This is what you need to do:

1. It is advisable to fill out the Form Mv 9Db accurately, hence be careful when filling in the parts containing these blank fields:

Step # 1 of completing Form Mv 9Db

Step 3: Prior to finishing this form, double-check that blank fields were filled in the proper way. Once you’re satisfied with it, press “Done." Join FormsPal now and instantly access Form Mv 9Db, set for download. Each and every change you make is handily kept , enabling you to change the form further anytime. FormsPal is focused on the confidentiality of our users; we make sure that all information processed by our system is secure.

Form Mv 9Db isn’t the one you’re looking for?

Related Documents