Appendix A to Part 14
36:1.0.1.1.14.10.81.1.1 : Appendix A
Appendix A to Part 14
Where necessary, these forms should be modified so as to be
appropriate to the applicant (corporation, association, or
individual), to the act involved, and to the nature of the
project.
Form
References should be made to the appropriate section of the
regulations to determine when each of the forms is required.
Form No. 2 may be signed by any officer or employee of the
company who is authorized to sign it. However, if it is executed by
a person other than the President, it must be accompanied by a
certified copy of the minutes of the Board of Directors meeting or
other document authorizing such signature unless such certified
copy has already been filed in the case.
Forms 1 and 2 to be placed on maps. See § 14.25(a)(7).
Engineer's Statement (Form 1)
_____(Name of engineer) states he is by occupation a _____(Type
of engineer) employed by the _____(Company) to make the survey of
the _____(Kind of works) as described and shown on this map; that
the survey of said works made by him (or under his supervision) and
under authority, commencing on the ______ day of _______ 19__ and
ending on the _______ day of _______, 19__; and that such survey is
accurately represented upon this map.
__________ Engineer Applicant's Certificate (Form 2)
This is to certify that _____ (Engineer), who subscribed the
statement hereon, is the person employed by the undersigned
applicant to prepare this map, which has been adopted by the
applicant as the approximate final location of the works thereby
shown, and that this map is filed as a part of the complete
application, and in order that the applicant may obtain the
benefits of _____(Cite statute); and I further certify that the
right-of-way herein described is desired for
(state purpose)
(Seal)
Signature of Applicant Title Company Attest: