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The Minnesota Notarized Form is a legal document required by the Minnesota Department of Human Services for individuals and organizations seeking licensure. This form must include a notarized signature from the applicant or an authorized agent, affirming their identity and role in the licensing process. Ensuring accurate completion and timely submission of this form is essential for compliance with state regulations.

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Document Data

Fact Name Details
Notarization Requirement According to Minnesota Statutes 2012, section 245A.04, subdivision 1, a notarized signature is required for the applicant.
Who Signs? An individual license holder must sign personally, while a nonindividual license holder's agent signs on behalf of the entity.
Identification Applicants must present valid identification to the notary public at the time of signing.
Submission Deadline The original notarized form must be mailed to DHS Licensing by September 30, 2012.

Additional PDF Forms

Documents used along the form

The Minnesota Notarized form is a crucial document for individuals or organizations applying for a license through the Minnesota Department of Human Services. However, it is often accompanied by several other forms and documents that serve various purposes in the licensing process. Below is a list of commonly used documents along with brief descriptions of each.

  • Application for License: This form collects essential information about the applicant and the services they intend to provide. It serves as the initial request for obtaining a license.
  • Background Check Consent Form: Applicants must complete this form to authorize the Department of Human Services to conduct a background check. It ensures that all individuals involved meet the necessary legal requirements.
  • Financial Disclosure Form: This document requires applicants to disclose financial information relevant to their business operations. It helps the licensing authority assess the applicant's financial stability and capability.
  • Program Policies and Procedures: Applicants are often required to submit a comprehensive outline of their operational policies and procedures. This document details how the applicant plans to run their program in compliance with state regulations.
  • Mobile Home Bill of Sale: This form is essential for the legal transfer of ownership of a mobile home, detailing important transaction information. To obtain the necessary form, visit Missouri PDF Forms.
  • Proof of Insurance: This document verifies that the applicant has the necessary insurance coverage to operate legally. It protects both the applicant and the clients they serve.
  • Site Inspection Report: A report generated from an on-site inspection conducted by a licensing representative. It evaluates the physical location to ensure it meets all safety and operational standards.
  • Training Certificates: These certificates confirm that staff members have completed required training programs. They demonstrate the applicant's commitment to maintaining high standards of care and service.

In summary, the Minnesota Notarized form is just one component of a broader set of documents necessary for obtaining a license. Each form plays a vital role in ensuring that applicants meet the required standards and regulations, ultimately contributing to the safety and well-being of the communities they serve.

Essential Questions on Minnesota Notarized

What is the Minnesota Notarized form?

The Minnesota Notarized form is a document required by the Minnesota Department of Human Services. It verifies the identity of the license holder or their authorized agent. The form must be notarized to confirm that the signature is genuine and that the person signing is who they claim to be.

Who needs to complete this form?

Both individual and nonindividual license holders must complete the form. For individual license holders, it is the person operating the license. For nonindividuals, it is the agent responsible for dealing with the commissioner of human services on behalf of the organization or business entity.

What information is required on the form?

You need to provide your full legal name, address, Social Security Number (for individuals), Minnesota Tax ID (for nonindividuals), and Federal Employer ID Number (FEIN). Additionally, you'll need to include program information such as the program name and license number.

How do I get the form notarized?

To get the form notarized, you must print your full legal name on it but not date or sign it until you are in the presence of a notary public. Notaries can usually be found at banks or courthouses. Bring valid identification to confirm your identity.

What happens after I sign the form?

After you sign the form in front of the notary, they will affix their stamp or seal, sign, and date the document. This process confirms that they have witnessed your signature and verified your ID.

Do I need to keep a copy of the notarized form?

Yes, it is important to make a copy of the completed notarized form for your records. This way, you have proof of submission and the details of the notarization.

Where do I send the notarized form?

Mail the original notarized form to the following address: DHS Licensing, ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242. Make sure it is sent by the deadline specified, which is September 30, 2012.

What is the verification process?

By signing the form, you affirm that you are the license applicant or the authorized agent. This means you are responsible for all matters related to the licensing as outlined in Minnesota Statutes, chapter 245A. The notary public will also verify your identity during the signing process.

What if I have more questions?

If you have additional questions or need further assistance, consider reaching out to the Minnesota Department of Human Services or consult with a legal expert familiar with licensing requirements.

Common mistakes

When filling out the Minnesota Notarized form, individuals often make several common mistakes that can delay the processing of their application. One frequent error is failing to provide the full legal name as it appears on tax forms. This is crucial because discrepancies can lead to confusion or rejection of the application. Always double-check that the name matches exactly to avoid any issues.

Another mistake involves the timing of the signature. Many applicants sign the form before meeting with a notary public. It is essential to wait until you are in the presence of the notary to sign the document. The notary's role is to witness your signature and verify your identity, which cannot happen if the form is already signed. This oversight can render the notarization invalid.

Identification is also a common stumbling block. Applicants sometimes forget to bring a valid form of ID when meeting the notary. Without proper identification, the notary cannot confirm your identity, which is a necessary step for the notarization process. Always ensure that you have an acceptable form of ID with you to avoid unnecessary delays.

Lastly, many individuals overlook the importance of making a copy of the completed notarized form for their records. This step is often neglected, leading to difficulties if questions arise later about the application. Keeping a copy can serve as a helpful reference and provide peace of mind that you have submitted the required documentation correctly.

Similar forms

The Minnesota Notarized form shares similarities with a Power of Attorney (POA) document. A POA grants someone the authority to act on behalf of another person in legal or financial matters. Like the Minnesota Notarized form, a POA requires a notarized signature to ensure that the person granting authority is doing so willingly and understands the implications. Both documents need to be signed in front of a notary public, who verifies the identity of the signers and affixes their seal, providing an extra layer of security and authenticity.

Another document comparable to the Minnesota Notarized form is the Affidavit. An affidavit is a written statement confirmed by oath or affirmation, typically used as evidence in court. Just like the Minnesota Notarized form, an affidavit must be signed in the presence of a notary public. This ensures that the person making the statement is doing so truthfully and is who they claim to be. Both documents serve to affirm the identity of the signers and the validity of the information provided.

The Minnesota Notarized form is also similar to a Consent Form. Consent forms are often used in medical or legal contexts to obtain permission for specific actions, such as treatment or representation. Like the notarized form, a consent form may require a signature from the individual granting consent, along with a notary’s verification to ensure that the consent is informed and voluntary. The notary’s role adds credibility to the consent being given.

A Declaration is another document that aligns closely with the Minnesota Notarized form. Declarations are formal statements that affirm certain facts to be true. Similar to the notarized form, a declaration often requires notarization to confirm the identity of the person making the statement. This ensures that the declaration holds legal weight and can be relied upon in various situations, much like the information in the Minnesota Notarized form.

The Minnesota Notarized form can also be compared to a Lease Agreement. A lease agreement outlines the terms under which one party rents property from another. Often, these agreements require notarization to confirm that all parties involved understand and agree to the terms. The notarization process ensures that the identities of the signers are verified, similar to how the Minnesota Notarized form affirms the identity of the license holder or authorized agent.

Another document that bears resemblance to the Minnesota Notarized form is a Business License Application. This application often requires a notarized signature to confirm that the information provided is accurate and that the applicant is authorized to apply for the license. Just like the notarized form, the business license application must be signed in the presence of a notary public, who validates the identity of the applicant and the authenticity of the signature.

The Missouri Operating Agreement form is vital for any Limited Liability Company (LLC) as it details the governance and procedural structure agreed upon by its members. Adopting this document is vital for ensuring compliance with state laws and promoting transparency within the company. For more insights on this crucial aspect of business organization, explore our guide on comprehensive Missouri Operating Agreement details here.

Lastly, a Warranty Deed is similar to the Minnesota Notarized form in that it transfers ownership of real property. A warranty deed must be signed by the grantor in front of a notary public to ensure that the transfer is legitimate and that the grantor is indeed the rightful owner. This notarization process serves to protect all parties involved, much like the safeguards provided by the notarization of the Minnesota Notarized form.

Minnesota Notarized Example

Minnesota Department of Human Services

Office of Inspector General

LICENSING DIVISION

License Holder Notarized Signature

Placeholder for barcode/unique identifier. If the license holder tax ID info matches this could auto-populate; or the form will be a fillable form they complete and print.

Minnesota Statutes 2012, section 245A.04, subdivision 1, requires a notarized signature of the applicant.

For an individual license holder this means the individual person or sole proprietor that operates the license.

For a nonindividual license holder this means the agent who is responsible for dealing with the commissioner of human services on all matters provided for in Minnesota Statutes, chapter 245A and on whom service of all notices and orders must be made on behalf of all controlling individuals of a voluntary association, organization, public body, governmental agency, or business entity that is the license holder.

License holder information

Full legal name as it appears on your tax forms

Click here to enter text.

Address

City

State

Zip

Click here to enter text.

Click here to enter text.

 

 

 

 

 

 

SSN for Individual / MN Tax ID for Nonindividual

Federal Employer ID (FEIN)

 

 

Click here to enter text.

Click here to enter text.

 

 

 

 

 

 

Program information (attach additional pages as needed)

Program name

License number

Address

City

State Zip

Instruction

1.Print your full legal name in the space provided.

2.DO NOT date and sign the License Holder Notarized Signature form until you are in the presence of a notary public. A notary public can usually be found at a bank or courthouse.

3.The notary will affix his/her stamp or seal to this form and sign it and date it after s/he has witnessed you sign the form and verified that you have provided a valid I.D. that confirms your identity and signature.

4.Make sure to bring identification to show to the notary public.

5.Make a copy of the completed notarized form for your records. Mail the original notarized form by Sept. 30, 2012, to: DHS

Licensing, ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242.

Verification

In accordance with Minnesota Statutes 2012, section 245A.04, subdivision 1, by signing your name you are affirming that you are the

DHS license applicant or license holder, or the authorized agent responsible for dealing with the commissioner of human services on

all matters provided for in Minnesota Statutes, chapter 245A and on whom service of all notices and orders must be made.

I, ________________________________________________________ (print full legal name), swear that I am the individual license

holder or the authorized agent for the nonindividual license holder.

 

 

_________________________________________________

STATE OF __________________________________

Signature

COUNTY OF __________________________________

 

 

Subscribed and sworn to before me on

 

this ____ day of __________________ , 20____ ,

 

_________________________________________________

 

Notary Public

For DHS Licensing Division Use Only – DO NOT WRITE IN THIS BOX.

Verified original form on ______________ (MM/DD/YYYY) by ______________________________________ (Print name and initial)

Key takeaways

Filling out and using the Minnesota Notarized form requires careful attention to detail. Here are ten key takeaways to ensure compliance and accuracy:

  • Understand the Purpose: The form is essential for license holders to verify their identity and affirm their role in relation to the Department of Human Services.
  • Identify Your Status: Individual license holders are sole proprietors, while nonindividual license holders must designate an authorized agent.
  • Provide Accurate Information: Ensure that the full legal name, address, and tax identification numbers are correctly entered as they appear on tax documents.
  • Do Not Sign Prematurely: Wait to date and sign the form until you are in the presence of a notary public.
  • Find a Notary: Notaries are commonly available at banks or courthouses, making them accessible for this process.
  • Bring Identification: A valid form of ID is necessary for the notary to confirm your identity before signing the document.
  • Keep a Copy: After the form is notarized, make a copy for your records before mailing the original.
  • Meet Deadlines: The completed notarized form must be mailed to the appropriate address by the specified deadline.
  • Affirm Your Role: By signing, you assert that you are the license applicant or authorized agent, ensuring legal accountability.
  • Follow Verification Steps: Be aware that the form will be verified by the DHS Licensing Division, and do not write in the designated verification box.