Fillable AGENT AUTHORIZATION Authorize the following people to act (City of Decatur Illinois)

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AGENT AUTHORIZATION Authorize the following people to act (City of Decatur Illinois)

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AGENT AUTHORIZATION
I (We), ______________________________________________________,
Authorize the following people to act on my behalf
__________________________________________________ to act
as my agent(s) on my property (properties
Owner(s)
Signature: ________________________________
Date: ________________________________
Agent(s)
Signature: ________________________________ Signature: ________________________
Date: ________________________________ Date: ___________________________
Address: ________________________________ Address: ________________________
________________________________ _________________________
Telephone: _______________________________ Telephone: ______________________
Driver License # ________________________ Driver License #_________________
Last 4 of SS # __________ D.O.B. _________ Last 4 of SS#_______D.O.B________
Signature: ________________________________ Signature: ______________________
Date: ________________________________ Date: _________________________
Address: ________________________________ Address: _______________________
________________________________ _______________________
Telephone: _______________________________ Telephone: _____________________
Driver License # ________________________ Driver License #_________________
Last 4 of SS # __________ D.O.B. _________ Last 4 of SS#______ D.O.B________
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AGENT AUTHORIZATION Authorize the following people to act (City of Decatur Illinois)

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Completed 3 August 2020

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