The Minnesota Notarized form is an essential document for license holders who are applying or renewing their licenses through the Minnesota Department of Human Services Office of Inspector General Licensed Division. This form, which requires a notary public's attestation, confirms the identity and the authority of individuals or agents acting on behalf of organizations in accordance with Minnesota Statutes 2012, section 245A.04, subdivision 1. To properly complete and submit this important document, it's critical to follow the detailed instructions provided, including having the form notarized in person, to ensure compliance and avoid any processing delays.
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The Minnesota Notarized Form is a critical document administered by the Minnesota Department of Human Services Office of Inspector General's Licensing Division, emphasizing the significance of a notarized signature in the licensure process. It caters to both individual and nonindividual license holders, delineating a clear procedure to legitimize their application through a notarized signature. This requirement, rooted in the Minnesota Statutes 2012, section 245A.04, subdivision 1, ensures the authenticity and veracity of the applicant's intent to operate under the stipulated regulations. The form is meticulously designed to capture essential information, including full legal name, contact details, and tax identification, thereby facilitating a streamlined verification process. It mandates the presence of the applicant before a notary public to authenticate their identity and signature, a step that underscores the state's commitment to integrity in its licensing operations. In addition, the form offers comprehensive instructions for filling out and submitting the document, including the necessity of retaining a copy for personal records and the specific deadline for submission. With sections allocated for program information and a solemn affirmation by the applicant, the Minnesota Notarized Form stands as a cornerstone in the license application process, ensuring that every license holder or their authorized agent engages with the Minnesota Department of Human Services in a manner that is both legal and transparent.
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
SSN for Individual / MN Tax ID for Nonindividual
Federal Employer ID (FEIN)
Program information (attach additional pages as needed)
Program name
License number
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)
Filling out the Minnesota Notarized form is an important step in the licensing process for services under the jurisdiction of the Minnesota Department of Human Services. Whether you're an individual or operating on behalf of an organization, making sure every detail is correct is crucial for your application. Notarization ensures that your signature is authentic, which is a requirement set forth by the state. Follow these steps carefully to complete the form correctly.
By signing the form, you affirm your role as the application holder or authorized agent dealing with the commissioner of human services. The verification section is your oath that the information provided is accurate to the best of your knowledge. Being diligent and thorough in this process will aid in the smooth continuation of your licensing requirements.
Frequently asked questions (FAQs) regarding the Minnesota Department of Human Services Office of Inspector General LICENSING DIVISION License Holder Notarized Signature form can be essential for navigating the completion and submission process. The information below aims to clarify common queries.
Individuals applying for or holding a license through the Minnesota Department of Human Services, including sole proprietors and authorized agents for non-individual entities (like organizations, associations, or governmental agencies), must submit this form. It’s a statutory requirement for validating the identity of the license holder or applicant.
Do not sign the license holder notarized signature form before arriving at the notary's office. The law requires that your signature on the form be witnessed by a notary public directly. This means you’ll need to physically sign the document in the notary’s presence after presenting a valid form of identification.
Common forms of identification that can be used include a state-issued driver's license, a passport, or any other government-issued ID that has a photograph and signature. The goal is to provide sufficient evidence of your identity to the notary public.
Notary publics are available at various locations, including banks, law offices, and courthouses. Some libraries and postal centers also offer notarization services. It's advisable to call ahead to ensure the notary’s availability and whether the service incurs a fee.
Once your form is notarized, you must make a copy for your records and mail the original to the specified address by the deadline, if applicable. Ensure that you use a secure mailing method to protect your personal information. Remember to check for any specific mailing instructions or deadlines associated with your license application or renewal process.
This list covers principal concerns but may not encompass every question you have. When in doubt, consult directly with the Minnesota Department of Human Services or a professional familiar with Minnesota’s licensing regulations to ensure compliance and avoid potential issues.
When filling out the Minnesota Notarized form, there are several common pitfalls that can lead to frustrations, delays, or even the rejection of your submission. Understanding these errors can help ensure a smooth process when handling this essential document. Here's a breakdown of five mistakes people frequently make:
Incomplete or Incorrect Legal Name: One of the most crucial details on the Minnesota Notarized form is the license holder's full legal name. It must match the name on your tax forms exactly. Sometimes, people use nicknames, omit a middle name, or misspell their name, which can lead to processing delays or form rejection.
Signing Before Notarization: The unique nature of a notarized document requires that you do not sign it until you are in the presence of the notary public. This mistake is common and can completely invalidate the form, as the notary must personally witness the signing to verify your identity.
Forgetting Identification: Bringing proper identification is a must when you go to have your form notarized. The notary will need to confirm your identity against the signature. Lack of ID can stop the notarization process in its tracks.
Overlooking the Notarization Date: All notarized documents bear a date, indicating when the notarization took place. Not filling out the date correctly, or letting the notary forget to do so, might lead to unnecessary complications or the need to re-notarize the document.
Failure to Include Necessary Attachments: If your licensing situation requires supplementary information or documentation, forgetting these attachments can stall the processing of your form. Always double-check that all needed documents are attached and complete.
Avoiding these mistakes not only streamlines the process but also demonstrates your thoroughness and attention to detail—qualities that are beneficial in any official or legal setting. Remember, when it comes to notarized forms, accuracy and compliance with instructions are key.
When managing requirements for licensure with the Minnesota Department of Human Services, particularly in relation to the Minnesota Notarized Form, various related documents are typically required to ensure a comprehensive and compliant application process. Understanding each document's role can simplify navigating through the procedure.
While the Minnesota Notarized Form is a crucial step in affirming the identity and authorization of the license applicant or holder, it's part of a broader collection of documentation. Together, these forms work to ensure that licensed facilities and services meet Minnesota's stringent standards, protecting the wellbeing of the community and maintaining the integrity of the services offered.
The Affidavit form is quite similar to the Minnesota Notarized form in structure and purpose. Both require the person signing the form to affirm the truth of the information provided under oath. The affidavit typically needs to be signed in the presence of a notary public, who confirms the identity of the signer, similar to the process outlined for the notarized form. Additionally, both forms include spaces for personal identification information, statements of affirmation, and the notary's certification, including the notary's seal or stamp, their signature, and the date of notarization. These elements ensure the document's credibility and are crucial for various legal proceedings.
A Power of Attorney (POA) document also shares similarities with the Minnesota Notarized form. Both documents legally empower another person to act on one's behalf, whether for a specific task, as in the POA, or to represent the license holder's interests before the Department of Human Services, as mentioned in the notarized form. Both require details about the individuals involved, including their full legal names and identification numbers. Moreover, notarization is a common requirement, lending a layer of legal formalities and security to ensure the authenticity of the representative's authorities.
The Contract Agreement between two parties can be likened to the Minnesota Notarized form due to both requiring signatures that are often notarized to confirm the identity of the signatories and the truthfulness of the document's contents. In both documents, specific information about the parties involved, including names and addresses, is mandatory. Additionally, the involvement of a notarization process adds a legal witness to the signing, ensuring that the document is legally binding and the signatories have agreed to the terms under their true identity.
Loan documents, required when taking out a financial loan, share procedures and formalities with the Minnesota Notarized form. Both documents necessitate the acknowledgement and signature of the involved parties in front of a notary public to ensure that the signers are indeed who they claim to be. This step provides a layer of security against fraud. Furthermore, like in the Minnesota Notarized form, loan documents include sections for personal and program-specific information, and careful verification of these details is crucial for the agreement's validity.
The Deed of Real Estate is another document similar to the Minnesota Notarized form, as it often requires notarization to verify the signer's identity and willingness to sign the document in a legal context. Both documents involve detailed information about the parties involved, such as names, addresses, and identification numbers, ensuring clear identification and accountability. Additionally, the execution of both documents in the presence of a notary public underscores the importance of the signer's declaration and the formal acknowledgement of their obligations and commitments as per the document's terms.
When you're filling out a Minnesota Notarized Form, handling the details with care is crucial to ensure that the process goes smoothly. Here are a few do's and don'ts to guide you:
Following these steps carefully can help to ensure that your Minnesota Notarized Form is filled out accurately and efficiently, aiding in the smooth completion of whatever process requires the notarized document.
Misconceptions about the Minnesota Notarized form can lead to confusion and delays in the licensing process. It's important to clear up some common misunderstandings:
Understanding and avoiding these common misconceptions can streamline the process of completing your Minnesota Notarized form, ensuring it fulfills legal requirements the first time around. When in doubt, it's always best to ask the notary public for guidance.
Understanding the Minnesota Notarized form process for license holders is crucial for compliance with the Minnesota Department of Human Services Office of Inspector General Licensing Division. Here are key takeaways to ensure proper completion and submission:
Following these steps is essential for successful submission and compliance with Minnesota's licensing requirements. Attention to detail and adherence to procedures can streamline the process, making it manageable for both individual and non-individual licensees.
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