Perc Form 15 is an important document that must be completed if you are applying for a subsurface right in the state of Pennsylvania. This form, issued by the PA Department of Environmental Protection (DEP), allows people to access and use groundwater resources located underground beneath their property line. Understanding this document can be intimidating and overwhelming at first – but don’t worry! In this blog, we will break down all of the components involved in completing your Perc Form 15 so that it's quick and easy for anyone to get through the application process correctly. With all of your questions answered, submitting your Perc form 15 should feel like a piece of cake!
| Question | Answer |
|---|---|
| Form Name | Perc Form 15 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | Form 15 Charge Against Employer florida state employees form 15 |
STATE OF FLORIDA
PUBLIC EMPLOYEES RELATIONS COMMISSION
4050 Esplanade Way
Tallahassee, Florida
(850)
CHARGE AGAINST EMPLOYER
INSTRUCTIONS:
Do Not Write In This Box
CASE NUMBER
CA-
DATE FILED
Submit an original and one (1) copy of this charge to the Public Employees Relations Commission along with proof of simultaneous service upon the other parties. (NOTE: The charge must be accompanied by sworn statements(s), and where applicable, documentary evidence in support of the allegations of the charge. Such supporting evidence and documentary evidence is NOT to be attached to the charge and need not be served upon the other parties.)
The Charging Party alleges that the public employer or its agents named below have engaged in (an) unfair labor practice(s). Charging Party requests the Public Employees Relations Commission to process this charge under its proper authority.
1.NAME OF CHARGING PARTY:
Phone No. |
|
Facsimile(Fax) No. |
Address:
Zip Code
2.CHARGING PARTY REPRESENTATIVE: Title:
Phone No. |
|
Facsimile(Fax) No. |
Address:
Zip Code
3.NAME OF EMPLOYER: Address:
Zip Code
4.EMPLOYER REPRESENTATIVE: Title:
Phone No. |
|
Facsimile(Fax) No. |
Address:
Zip Code
5.The
447.501(1)(a) and |
|
, Florida Statutes. |
|
(list sections) |
|
PERC Form 15
Page 1 of 2 (Rev. 12/04)
6.BASIS OF CHARGE: (Specify facts, names, places, dates, etc. If more space is needed, attach additional pages.)
I have read the charge. The statements contained therein are true to the best of my knowledge and belief. A copy of this fully executed form has been mailed or delivered to the representative(s) of the employer and any other party.
Signature of Charging Party Representative |
|
|
|
|
|
||||||||
NOTARY STATEMENT: |
|
|
|
|
|
|
|
|
|
|
|||
STATE OF FLORIDA COUNTY OF |
|
|
|
|
|
|
|||||||
Sworn to and subscribed before me this |
|
day of |
|||||||||||
|
|
|
|
, 20 |
|
|
|
. |
|
|
|
|
|
by |
|
|
|
|
|
. |
|||||||
|
(name of person making statement) |
|
|
|
|
|
|||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(Notary Public Signature) |
|
|
|
|
|
|
|
|
|
|
|||
My Commission Expires: |
|
|
|
|
|
|
|
|
|
|
|
||
Personally Known |
|
OR Produced Identification |
|
||||||||||
Type of Identification Produced
FALSE STATEMENTS MAY RESULT IN FINE AND IMPRISONMENT
PURSUANT TO CHAPTER 837, FLORIDA STATUTES
PERC Form 15
Page 2 of 2 (Rev. 12/04)