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In the realm of regulatory compliance within Minnesota, the notarized signature form issued by the Minnesota Department of Human Services Office of Inspector General Licensing Division stands as a crucial document. This form is integral for both individual and non-individual license holders under the jurisdiction of the Department, serving as a mandatory step in affirming the authorized status of entities or individuals engaged with the commissioner of human human services. Not only does it require the applicant's full legal name and pertinent tax identification details, but it also encapsulates comprehensive program information that validates the legitimacy of the licensee. The stipulation that the signature must be notarized emphasizes the importance of the verification process, as it necessitates the presence of a notary public to witness the signing—thereby adding a layer of authenticity and security to the document. Applicants are advised to carefully follow instructions regarding the signing and submission of the document, including the crucial step of not signing the form until in the presence of the notary, to ensure compliance with Minnesota Statutes 2012, section 245A.04, subdivision 1. Furthermore, the procedure for submitting the notarized document underscores the administrative diligence expected from license holders, reflecting the state's commitment to upholding high standards of operation for those providing services governed by the Department of Human Services.

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)

Form Characteristics

The signed form affirms the applicant as the DHS license applicant or holder, or the authorized agent for a nonindividual license holder, in compliance with Minnesota Statutes 2012, section 245A.04, subdivision 1.
Fact Name Description
Governing Law Minnesota Statutes 2012, section 245A.04, subdivision 1 mandates the need for a notarized signature on the application.
Applicant Types Applies to both individual license holders and agents responsible for nonindividual license holders in regards to Minnesota Statutes, chapter 245A.
Identification Requirement Applicants must provide valid identification to a notary public to verify their identity and signature at the time of signing.
Submission Deadline The original notarized form must be mailed by September 30, 2012, to DHS Licensing ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242.
Notary Public Role The notary public witnesses the signing, confirms the applicant's identity, and then seals and signs the form.
Verification

Steps to Writing Minnesota Notarized

Filling out the Minnesota Notarized form correctly is crucial for both individuals and nonindividuals looking to ensure their application or existing license is properly handled by the Minnesota Department of Human Services. The form serves as a legal affirmation of the information provided by the applicant, regarding their identity and the veracity of the details submitted. Below are the instructions to accurately complete the form. The steps must be carried out in the order presented to ensure the document meets the requirements for notarization.

  1. Locate the section labeled License holder information and enter your full legal name as it appears on your tax documents.
  2. In the fields provided, fill in your address, including city, state, and zip code.
  3. Enter your Social Security Number (SSN) if you are applying as an individual. For nonindividual license holders, provide the Minnesota Tax ID or Federal Employer Identification Number (FEIN) as applicable.
  4. Under Program information, specify the program name and license number if you have it. Also, provide the address where the program is conducted, including city, state, and zip code. Attach additional pages if there is more than one program.
  5. Do not sign the form immediately after filling it out. You must wait to sign the document in the presence of a notary public to ensure your signature is validly witnessed.
  6. Visit a notary public with the filled-out form. Notaries can typically be found at most banks, courthouses, or legal offices.
  7. Present a valid form of identification to the notary public for identity verification.
  8. Sign the form in the designated area where indicated. Ensure this is done in the presence of the notary public.
  9. The notary will then stamp or seal the form, sign, and date it, thereby notarizing the document.
  10. Keep a photocopy of the notarized form for your records. The original must be mailed by the specified deadline, which, for example, could be September 30, 2012 for certain submissions.
  11. Send the original notarized form to the DHS Licensing Division at the mailing address provided, ensuring it arrives by the deadline. For hypothetical situations, this would be: DHS Licensing, ATTN: Notarized Form, PO Box 64242, St. Paul, MN 55164-0242.

After submitting the notarized form, it will be processed by the Department of Human Services. The verification stage ensures all provided information aligns with legal and departmental standards. This step is critical for maintaining the validity and legal status of your application or license within the state of Minnesota. It's important to follow these steps carefully to ensure your form is accepted and processed efficiently without any unnecessary delays.

Listed Questions and Answers

  1. What is the purpose of the Minnesota Notarized form?

    The Minnesota Notarized form is required by the Minnesota Department of Human Services Office of Inspector General Licensing Division for individuals or entities applying for or holding a license under Minnesota Statutes, chapter 245A. This form verifies the identity of the license holder or their authorized agent and ensures that all communication and legal notices are properly directed. It serves as a formal affirmation that the person signing the form is either the individual license holder or the authorized agent responsible for dealings with the commissioner of human services.

  2. Who needs to fill out and sign this form?

    This form must be filled out and signed by either the individual license holder or the authorized agent of a nonindividual licensee. An individual license holder refers to a person or sole proprietor operating the license, whereas a nonindividual license holder may be a voluntary association, organization, public body, governmental agency, or business entity. The authorized agent is the person tasked with handling all matters related to chapter 245A and receiving all notices and orders on behalf of the license holder.

  3. When and where should the form be signed and notarized?

    The License Holder Notarized Signature form should only be signed in the presence of a notary public. Notaries can typically be found at banks or courthouses. Once the signer provides a valid ID for verification, the notary will stamp, sign, and date the form, thereby notarizing it. It's important to bring proper identification for this step. Afterward, the completed form should be mailed to the designated address by the specified deadline, in this case, September 30, 2012.

  4. What type of identification is required to get the form notarized?

    When getting the form notarized, you must present a valid form of identification that confirms both your identity and your signature to the notary. Acceptable forms of ID typically include a driver's license, passport, or any other government-issued identification that contains a photograph and signature.

  5. Is it necessary to keep a copy of the notarized form?

    Yes, it is highly recommended to keep a copy of the notarized form for your records. This copy can serve as proof of submission and verification of the information provided in case there are any discrepancies or if the original document gets lost or delayed. Retaining a copy also helps in maintaining accurate and accessible records of your licensing documentation.

Common mistakes

  1. Filling in the form with incorrect information is a common mistake. The form requires the license holder's full legal name as it appears on their tax forms, a requirement that is often overlooked. This can lead to discrepancies that may invalidate the form or cause delays in processing. It's important for individuals to ensure the name on the form matches exactly with their legal documents.

  2. Another mistake is signing and dating the form before meeting with the notary public. The instructions clearly state that the form should not be signed and dated until the notary public is present to witness the signature. This process verifies the identity of the signer and the authenticity of the signature.

  3. Many people forget to bring proper identification when they go to have their document notarized. Identification is required to confirm the identity of the person signing the form. Acceptable forms of identification typically include a driver's license, passport, or other government-issued ID with a photograph.

  4. Submitting the form without the notary's stamp or seal is another error. The notary public’s stamp or seal is a critical component of the notarized document, as it certifies that the notary public has properly verified the signer's identity and witnessed their signature. A missing stamp or seal can render the document invalid.

  5. Failing to make a copy of the completed notarized form for personal records is also a mistake. Keeping a copy is essential for reference and proof of submission. In case of any disputes or discrepancies, having a copy can be incredibly helpful for resolving issues.

  6. Lastly, missing the submission deadline is a common oversight. The specific deadline to mail the original notarized form is often provided in the instructions. Late submissions can delay the licensing process or impact the legal standing of the license holder with the Minnesota Department of Human Services.

Documents used along the form

Alongside the Minnesota Notarized form, several other forms and documents are often used to navigate the intricacies of legal and bureaucratic requirements efficiently. These documents serve various purposes, from verification of personal identification to detailing specific aspects of the licensing process. Each of these forms plays a crucial role in ensuring that all legal bases are covered and that the application or licensing process adheres to Minnesota statutes and regulatory guidelines.

  • Application for License: This document is the initial step for individuals or entities seeking licensure. It collects basic information regarding the applicant, the nature of the business or service provided, and the type of license sought.
  • Personal Identification Proof: A government-issued ID, such as a driver’s license or passport, is required to confirm the identity of the individual or the agents acting on behalf of an entity. This is pivotal for notarization to prevent fraud.
  • Tax Identification Number Verification: This can include a Social Security Number for individuals or a Federal Employer Identification Number (FEIN) for businesses, required for financial and tax-related verification.
  • Background Check Consent Form: Often, license applications necessitate a background check to ensure the applicant meets all legal and regulatory standards for the license being applied for.
  • Property Ownership or Lease Agreement: For licenses that involve the use of a particular property, documentation proving ownership or a legal right to use the property (lease agreement) is necessary to demonstrate compliance with local zoning and use laws.
  • Compliance Certification: Some licenses require the applicant to certify that they comply with specific state, federal, or local regulations related to their business or service. This can include health and safety standards, environmental regulations, and more.
  • Financial Statements: For licenses that involve significant investment or operation costs, financial statements might be required to prove the financial viability of the entity or individual applying for the license.
  • Professional References or Recommendations: Certain types of licensure may require references or letters of recommendation from accredited professionals within the relevant field to substantiate the applicant’s qualifications and reliability.
  • Renewal Application: For ongoing licensure, a renewal application must be periodically submitted to maintain the license. This often includes updates on any changes in the information provided, continued compliance with regulations, and any reoccurring fee payments.

The documentation accompanying the Minnesota Notarized form creates a comprehensive dossier that supports the licensure process. Each document serves to verify, validate, or provide additional context to the information presented in the notarized form, ensuring a thorough and rigorous evaluation process. In doing so, these documents work collectively to streamline the licensing procedure, making it possible for individuals and entities to demonstrate their eligibility and compliance with relevant statutes and regulations efficiently.

Similar forms

The Minnesota Notarized form is similar to an Affidavit form in various ways. Affidavits are legal documents that individuals sign under oath, verifying the truthfulness of stated information, often in front of a notary public. Like the Minnesota Notarized form, affidavits require the signer to provide personal identification and swear before a notary that the provided information is accurate and truthful. Additionally, both documents must be signed in the presence of a notary, who then notarizes the document by affixing a stamp or seal and dating the form.

Power of Attorney (POA) documents also share similarities with the Minnesota Notarized form. POA documents grant one person the authority to act on another's behalf in legal or financial matters. These documents often require notarization to verify the signer's identity and to affirm the document's legitimacy. Like the Minnesota Notarized form, a POA includes identifying information, and both must be signed in front of a notary public to ensure the signer's identity and the voluntary nature of the agreement.

Loan agreements often resemble the Minnesota Notarized form in structure and requirements. These agreements between a borrower and lender detail the terms of the loan and repayment. For legal protection and verification, loan agreements frequently need to be signed by the involved parties in the presence of a notary public. The process ensures that the document is legally binding and that the signatures are genuine, similar to the assurances provided by notarizing the Minnesota form which verifies the identity of the license holder or their agent.

Another document type similar to the Minnesota Notarized form is a Notary Acknowledgement. This is a formal declaration made in front of a notary, acknowledging that the signer is acting of their own free will. While it is a component of other documents, including the Minnesota form, it is crucial for verifying the voluntary nature of the signing and the authenticity of the signature. Both the Notary Acknowledgement and the Minnesota Notarized form require the presence of a notary to authenticate the identities of the signatories.

Last Will and Testament documents also have parallels with the Minnesota Notarized form. These documents outline how an individual’s estate should be handled after their death. For a Will to be valid, it usually needs to be signed in the presence of witnesses and often notarized, which helps prevent disputes about the validity of the document or the testator’s intentions. Similar to the process outlined for the Minnesota form, notarization serves as a preventative measure against fraud and ensures the signer’s identity is verified.

Dos and Don'ts

Filling out the Minnesota Notarized Form requires careful attention to both procedure and detail. Here are essential dos and don'ts to help ensure the process is completed correctly:

  • Do ensure that your full legal name is printed exactly as it appears on your tax forms in the space provided.
  • Do not date and sign the License Holder Notarized Signature form before you are in the presence of a notary public.
  • Do locate a notary public, who can typically be found at banks or courthouses, to witness your signature.
  • Do not forget to bring a valid form of identification to the notary public for verification of your identity and signature.
  • Do review the information you've entered for accuracy before the notary public applies his/her stamp or seal.
  • Do not complete the form in haste; take your time to fill out all required sections appropriately.
  • Do make a copy of the completed form for your personal records once it has been notarized.
  • Do not overlook the due date; ensure the original notarized form is mailed by the specified deadline to DHS Licensing.
  • Do verify that all details, including addresses and identification numbers, are correct and fully filled out.
  • Do not write in the box reserved for DHS Licensing Division use only, as this can lead to processing delays.

Adhering to these guidelines can streamline the process of submitting the Minnesota Notarized Form and prevent common errors that may delay the licensing or application procedures.

Misconceptions

There are several common misconceptions about the Minnesota Notarized Form that need to be clarified to ensure accuracy and compliance. Misunderstandings can lead to errors and potentially delay the licensing process. Here are four key misconceptions and their explanations:

  • Any notary public can notarize the form: Not all notaries are authorized to notarize documents in every state. It's essential to use a notary public who is authorized to perform notarial acts in Minnesota. Notaries from other states cannot notarize this form unless they are also commissioned in Minnesota.
  • Identification isn’t necessary if the notary knows you: Regardless of whether the notary public personally knows the individual signing the form, Minnesota law requires the presentation of valid identification at the time of notarization. This ensures the signer’s identity is verified according to legal standards.
  • You can sign the form before meeting with the notary: The instruction explicitly states that the document should not be signed ahead of the notarial session. The purpose of this requirement is for the notary to personally witness the signing of the document, ensuring that the signature is genuine and is made by the individual claiming to be the signatory.
  • Electronic notarization is not allowed: This is a misconception. Minnesota does permit electronic notarization, where the notary and the signer can use digital signatures and seals as long as all other requirements for notarization are met, including the use of video and audio technology for remote notarizations. However, both parties must ensure that the electronic notarization process adheres to Minnesota's laws and regulations pertaining to notarization.

It's crucial for license applicants and holders to understand these aspects of the Minnesota Notarized Form process to avoid potential setbacks. Proper adherence to the rules and regulations ensures a smoother, more efficient licensing process.

Key takeaways

When dealing with the Minnesota Notarized form, specifically for license holders interacting with the Minnesota Department of Human Services Office of Inspector General LICENSING DIVISION, it's essential to grasp key aspects to ensure accuracy and compliance. Here’s a breakdown of crucial takeaways:

  • Understand the purpose: The form is designed for both individual and nonindividual license holders to provide a notarized signature, which is a requirement under Minnesota Statutes 2012, section 245A.04, subdivision 1.
  • Complete the form accurately: Provide your full legal name, address, tax identification numbers, and any other requested information exactly as it appears on your tax forms.
  • Sign in the presence of a notary: Do not sign the form until you are directly in front of a notary public. This step is crucial for the form's validity.
  • Find a notary: Notary publics are commonly available at banks, courthouses, or through a dedicated notary service.
  • Bring necessary identification: You must present a valid form of identification to the notary public to verify your identity when signing the form.
  • Understand the roles: It's important to recognize whether you're completing this form as an individual license holder or as an authorized agent for a nonindividual license holder.
  • Keep a copy for your records: After the form is notarized, make a copy for your personal records before mailing the original.
  • Mail the original form: Send the completed and notarized form to the specified address by the given deadline to ensure your license remains in good standing.
  • Know the deadline: Adhering to the mailing deadline is crucial. Late submissions may affect your licensure status.
  • Verification process: By signing the form, you affirm your identity and role (either as the individual license holder or authorized agent for a nonindividual license holder) in compliance with Minnesota law.
  • Do not write in the "For DHS Licensing Division Use Only" box: This section is strictly for administrative use by the Department of Human Services Licensing Division.
  • Adhering to these guidelines ensures your notarized signature fulfills legal requirements and supports the efficient processing of your licensure documentation.

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