Minnesota Notarized Template

Minnesota Notarized Template

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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Make This Minnesota Notarized Now

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 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)

File Specifics

Fact Detail
1. Governing Law Minnesota Statutes 2012, section 245A.04, subdivision 1
2. Purpose of Notarization Requires a notarized signature of the applicant for verification purposes.
3. License Holder Definition Individual or nonindividual entities responsible for operating the license.
4. Identification Requirement Valid ID must be provided to the notary public for identity and signature confirmation.
5. Notarization Process The form must not be signed or dated until in the presence of a notary, who will then affix their stamp or seal.
6. Record-keeping Maintain a copy of the notarized form for personal records.
7. Submission Deadline and Address Original notarized form must be mailed by September 30, 2012, to DHS Licensing, ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242.

Guide to Using Minnesota Notarized

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.

  1. Enter your full legal name as it appears on your tax documents in the designated space.
  2. Do not sign or date the License Holder Notarized Signature form until you are in front of a notary public. Notaries are available at most banks or courthouses.
  3. Present a valid form of identification to the notary public so they can confirm your identity and watch you sign the form. Afterwards, the notary will apply their stamp or seal, sign, and date the form themselves.
  4. Before heading to the notary, make sure you have all necessary identification with you.
  5. Keep a copy of the completed notarized form for your personal records.
  6. Mail the original completed form by the specified deadline to: DHS Licensing, ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242.

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.

Crucial Questions on This Form

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.

  1. Who is required to submit a Minnesota Notarized Signature form?
  2. 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.

  3. When should the form be signed in the presence of a notary public?
  4. 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.

  5. What types of identification are acceptable when getting a document notarized?

    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.

  6. Where can I find a notary public to notarize my form?
  7. 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.

  8. What should I do after my form is notarized?
  9. 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.

Common mistakes

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:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

Documents used along the form

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.

  • Application for Licensure: This form initiates the process of obtaining a license. It requires detailed information about the applicant or the entity seeking licensure, including the type of service or program to be licensed, background information, and operational plans.
  • Background Study Submission: Minnesota law mandates background studies for individuals or entities applying for licensure in fields related to childcare, healthcare, and other services. This document collects the necessary data to conduct background checks as part of ensuring the safety and integrity of the services provided.
  • Compliance Verification Form: This is a detailed checklist or form where applicants affirm compliance with specific regulatory requirements. It may cover areas such as safety protocols, program standards, and staff qualifications, ensuring that the applicant meets state standards for operation.
  • Fire Safety Inspection Report: For facilities requiring licensure, a current fire safety inspection report by a qualified inspector ensures that the premises meet all fire safety codes and regulations. This document is critical for proving that the facility is safe for occupants and complies with local and state fire safety standards.
  • Health Department Inspection Certificate: Similar to the fire safety report, this certificate confirms that the facility has passed a health inspection, essential for businesses involved in food service, childcare, medical care, and other services where public health standards are paramount.

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.

Similar forms

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.

Dos and Don'ts

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:

  • Do thoroughly read through the entire form before you start filling it out. Understanding what's required can help you gather all the necessary information and avoid mistakes.
  • Do not sign or date the form until you are physically present in front of a notary public. Notaries are required to witness your signature in person to verify its authenticity.
  • Do bring valid identification when meeting with the notary. This could be a driver's license, passport, or another form of government-issued photo ID that confirms who you are.
  • Do not leave any fields on the form blank unless specifically instructed. If a section does not apply to you, consider filling it with "N/A" to indicate that it's not applicable.
  • Do print your full legal name as it appears on your tax documents. Consistency with official documents helps in avoiding processing delays.
  • Do not forget to make a copy of the completed form for your records. Having a copy can be crucial if there are any disputes or if the original document gets lost in the mail.
  • Do ensure that you mail the original notarized form to the correct address and by the deadline if specified. Late or misdirected forms may result in unnecessary complications or delays.

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

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:

  • Any notary can sign your form: It's a common belief that any notary public can sign off on your Minnesota Notarized form. In reality, the notary must be authorized to operate in the state of Minnesota. Notaries from other states cannot notarize this form unless they are also commissioned in Minnesota.
  • You can sign before meeting the notary: Another misconception is that you can sign the document before meeting with the notary public. The truth is, you must sign the document in the presence of the notary. This is so they can verify your identity and witness your signature in person.
  • Electronic signatures are acceptable: As we move towards a digital age, there's a misconception that electronic signatures are acceptable for the Minnesota Notarized form. However, the form requires a wet ink signature to be legally binding and accepted by the Department of Human Services.
  • Identification is not always necessary: Some people believe they don't need to bring identification if the notary personally knows them. Regardless of personal acquaintance, a valid form of I.D. is required to confirm your identity when getting your document notarized. This is a strict requirement to prevent fraud and ensure the legitimacy of the signature.
  • The form is only for individuals: There's a misunderstanding that this notarized form is exclusively for individual license holders, such as sole proprietors. However, it's also necessary for nonindividual license holders, like organizations or agencies, where an authorized agent must sign the form on behalf of all controlling individuals.
  • Any part of the form can be filled out before notarization: While it seems logical to fill out as much of the form as possible before the notary appointment, certain sections, specifically the signature and date, should only be completed in the notary's presence. The rest of the form should be filled accurately and completely, but the signature and dating are critical acts witnessed by the notary.

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.

Key takeaways

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:

  • The form is mandated by the Minnesota Statutes chapter 245A, specifically section 245A.04, subdivision 1, requiring a notarized signature of the license applicant or their authorized agent. This step is crucial for individual and non-individual license holders alike.
  • It's essential to input the full legal name as it appears on tax forms, ensuring consistency and proper identification.
  • Do not sign or date the License Holder Notarized Signature form until you are in the direct presence of a notary public. This procedure helps verify the authenticity of the signer's identity and intent.
  • Notaries are typically available at banks or courthouses, making them accessible for most applicants needing to complete this requirement.
  • Identification will be required at the time of notarization, so it's imperative to bring valid ID to confirm your identity and signature to the notary.
  • After witnessing and verifying the signature, the notary will affix a stamp or seal, signing and dating the document, officially notarizing the form.
  • Making a duplicate of the completed notarized form for personal records is recommended. This copy can serve as proof of compliant submission.
  • The original notarized form must be mailed by the specified deadline, such as the example date provided, ensuring it reaches the Department of Human Services Licensing Division appropriately.

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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