Granting Authority Form PDF Details

Understanding the nuances of the Granting Authority to Act Affirmation is essential for individuals and business owners navigating the administrative landscape of licenses, permits, and certificates. When an applicant affirms the truth of statements in this document, they are effectively appointing a representative to act on their behalf in dealings with the relevant issuing agency. This representative could be another individual or a business with a designated office, and they must be identified by full name and contact information. Crucially, the form binds the applicant legally to the representations made within any applications submitted by the designated representative. This includes responsibility for any inaccuracies or misrepresentations that might occur. Similarly significant is the form’s expiration date, set 180 days post-signature, and the explicit right to revoke the granted authority before any license, permit, or certificate is issued. This process requires contacting a specific help service and ensuring all relevant agencies are notified of the revocation. Navigating this process highlights the importance of being thorough and accurate, not only in choosing one’s representative but also in understanding the commitments and limitations set forth by such an affirmation.

QuestionAnswer
Form NameGranting Authority Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesnys business affirmation form, authority act pdf, new york business affirmation form, granting authority

Form Preview Example

Gr a n t in g Au t h or it y t o Act Af f ir m a t ion

________________________________________ affir m s t he t r ut h of t he follow ing:

( Applicant Nam e)

1 . I am t he _______________________ of ___________________________________

( St at e r elat ionship t o business)

( Nam e of business as it appear s on y our Business or

 

Par t ner ship Cer t ificat e, or Cer t ificat e of I ncor por at ion

 

or Filing Receipt . I f y ou ar e apply ing for an

 

I ndiv idual- based license, please ent er “ N/ A” . )

w hich is locat ed at ____________________________________________ and w hose

( St r eet Addr ess, Bor ough, St at e, and Zip Code)

t elephone num ber and em ail addr ess ar e ______________ and ________________ .

( Ar ea code & Num ber )( Em ail Addr ess)

2 . I her eby aut hor ize _______________________ of ___________________________

( Full nam e of designat ed r epr esent at iv e)

( Full nam e of r epr esent at iv e’s business)

w ho m aint ains an office/ r esides at _______________________________________

( St r eet Addr ess, Bor ough, St at e, and Zip Code)

and w hose t elephone num ber and em ail addr ess ar e ______________________ and

( Ar ea code & Num ber )

__________________ t o r epr esent m e befor e t he license, per m it , or cer t ificat e

( Em ail Addr ess)

issuing Agency in r egar d t o t he pr epar at ion and subm ission of an applicat ion for t he

follow ing license( s) , per m it ( s) or cer t ificat e( s) :

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

3 . I under st and t hat I w ill be legally bound by t he r epr esent at ions m ade in said applicat ions and w ill be held r esponsible by t he license, per m it , or cer t ificat e issuing Agency for any inaccur acies or m isr epr esent at ions.

4 . I under st and t hat t his affir m at ion w ill ex pir e 180 day s fr om t he dat e I sign and dat e t his for m .

5 . I under st and t hat I m ay r ev ok e ( w it hdr aw ) t he Gr ant ing Aut hor it y t o Act by calling 311 and ask ing for assist ance r ev ok ing a Gr ant ing Aut hor it y t o Act . A 311 call t ak er w ill adv ise m e on how t o not ify t he r elev ant issuing Agencies about r ev ocat ion, and I w ill be r esponsible for not ify ing t he r elev ant issuing Agencies of each applicat ion t o w hich t he r ev ocat ion applies. Rev ocat ions m ay only be m ade pr ior t o issuance of t he applicable license, per m it or cer t ificat e.

______________________________

______________________________

____________________

Sig n a t u r e

Pr in t N a m e

D a t e

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1. Before anything else, when filling in the nys business affirmation form, start with the part containing following blanks:

Writing part 1 of dca nyc tobacco retail dealer granting authority form

2. Once your current task is complete, take the next step – fill out all of these fields - follow ing license s perm it s, I under st and t hat I w ill, applicat ions and w ill be held, I underst and t hat t his affirm, t his for m, and I under st and t hat I m ay with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

How to complete dca nyc tobacco retail dealer granting authority form part 2

As to applicat ions and w ill be held and I under st and t hat I w ill, be certain you don't make any errors in this current part. Both these could be the most significant ones in this form.

3. This next portion is all about Sign a t u r e, Pr in t N a m e, and D a t e - fill out each of these blank fields.

Find out how to fill in dca nyc tobacco retail dealer granting authority form portion 3

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