写写帮会员为你精心整理了24篇《委托书英文》的范文,但愿对你的工作学习带来帮助,希望你能喜欢!
篇一:英文委托书
致任何有关人员:
本人(身份证号码:id, 护照号码:passport)自愿同意我的孩子(身份证号码:id, 护照号码:passport)自 20xx 年 09 月至 20xx 年 08 月在中国广西玉林学习。为保证我女儿在中国期间的合法权益不受侵害,本人特此授权中国公民 先生(身份证号码:,护照号码:)为我女儿的临时法定监护人。在临时监护期间,未经临时监护人同意,任何人不得以任何理由将我的.女儿带离临时监护人的监护范围,同时我女儿的护照交由临时监护人保管。特此声明。
委托人签名:
年 月 日
篇二:英文委托书
xxx center:
Comrade I unit [XXXXX] because [XXXXX] x mission, will be in(XXXXX)in x x month x country(region), stay outside xx days, pay cost of xx.Because of the comrade of the personnel archives check your center, entrust the relevant foreign affairs formalities.(name of the entity and affix one's seal)
In x x month x day
篇三:英文委托书
专利代理委托书
我/我们是_____的'公民/法人,根据中华人民共和国专利法第19条的规定,兹委托_____(机构代码:__________),并由该机构指定其专利代理人_____、_____代为办理名称为_______________申请号(或专利号)/国际申请号为_____的专利申请在中华人民共和国的全部专利事宜,Pursuant to the Article 19 of the Patent Law of the People’s Republic of China, I/we, citizen/legal entity of_____hereby authorize _____(Code:_____)to appoint its patent attorney(s)_____,_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the PRC.委托人姓名或名称
Authorized by(Name)
_________
委托人签字或盖章
Signature or Seal
__________
被委托专利代理机构盖章
Seal of the Authorized Agent
__________
委托日期
Date of Authorization
__________
出国委托书英文
Letter of Attorney
Consigner: Hu Fang, female, ID Card No.: Trustee: Fu Zhihua, male, ID Card No.:
The consignor Hu Fang and the trustee Fu Zhihua was registered to marry on Sept.7, 19xx.On August 25, 20xx, their son Fu Pengyuan was born.Now, the consignor Hu Fang entrust her husband Fu Zhihua being fully responsible for all the affairs regarding their son Fu Pengyuan during his staying in foreign country from August 2, 20xx to August 19, 20xx.The period validity of the letter of attorney is from signing the letter of attorney to the son gets back to China.The Trustee has no entrustment transferring right.Consigner: Hu Fang
June 27, 20xx
译文:
委托人:胡芳,女,公民身份号码:
受托人: 付志华,男, 公民身份号码:
委托人胡芳和受托人付志华于一九xx年九月七日登记结婚,二0xx年八月二十五日生育一子付鹏远,现委托人胡芳委托丈夫付志华全权负责儿子付鹏远在国外期间的一切事务,本委托书期限自签署之日起至回国之日为止。
受托人无转委托权。
委托人:
二○xx年六月二十七日
个人委托书英文
I,___,of____,hereby appoint__(__,of____, as my attorney in fact to act in my capacity to do every act that I may legally do through an attorney in fact.This power shall be in full force and effect on the date below written and shall remain in full force and effect until____or unless specifically extended or rescinded earlier by either party
我,__(姓名),__(地址等),在此指定__(姓名),__(地址或律师事务所名称等),为我的律师,以我的身份履行一切实践中我通过律师所能从事的合法行为。本权利在以下载明日期全权生效并一直持续到__或持续到双方当事人规定的延展期或提前撤销期。
Dated____
日期:__
STATE OF____(签名处)
地址:__
COUNTY OF____
州名和县名:__
篇四:委托书英文
Letter of Attorney
Consigner: Hu Fang, female, ID Card No.: Trustee: Fu Zhihua, male, ID Card No.:
The consignor Hu Fang and the trustee Fu Zhihua was registered to marry on Sept.7, 19xx.On August 25, 20xx, their son Fu Pengyuan was born.Now, the consignor Hu Fang entrust her husband Fu Zhihua being fully responsible for all the affairs regarding their son Fu Pengyuan during his staying in foreign country from August 2, 20xx to August 19, 20xx.The period validity of the letter of attorney is from signing the letter of attorney to the son gets back to China.The Trustee has no entrustment transferring right.Consigner: Hu Fang
June 27, 20xx
译文:
委托人:胡芳,女,公民身份号码:
受托人: 付志华,男, 公民身份号码:
委托人胡芳和受托人付志华于一九xx年九月七日登记结婚,二0xx年八月二十五日生育一子付鹏远,现委托人胡芳委托丈夫付志华全权负责儿子付鹏远在国外期间的一切事务。
本委托书期限自签署之日起至回国之日为止。
受托人无转委托权。
委托人:
二○xx年六月二十七日
篇五:委托书英文
我/我们是_____的公民/法人,根据中华人民共和国专利法第19条的规定,兹委托_____(机构代码:__________),并由该机构指定其专利代理人_____、_____代为办理名称为_______________申请号(或专利号)/国际申请号为_____的专利申请在中华人民共和国的全部专利事宜。
Pursuant to the Article 19 of the Patent Law of the People’s Republic of China, I/we, citizen/legal entity of_____hereby authorize _____(Code:_____)to appoint its patent attorney(s)_____,_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the PRC.委托人姓名或名称
Authorized by(Name)
_________
委托人签字或盖章
Signature or Seal
__________
被委托专利代理机构盖章
Seal of the Authorized Agent
__________
委托日期
Date of Authorization
__________
篇六:委托书英文
I,_____(name), am the legal representative of Henan Road & Bridge Construction Group Co., Ltd.(the bidder name), hereby appoint Yang Mei(name)as our agent.The agent is granted to sign, clarify, explain, supplement, submit, withdraw and amend the bidding documents for A1, A5 sections of Qianfeng Farm to Nenjiang Road, Yichun to Nenjiang Section Construction Project, Yichun to Beian Section Civil Engineering and Beian to Wudalianchi Scenic Section Bridge Engineering(project name).The agent is also responsible for signing the contract and dealing with relevant matters in the name of our party, and we shall bear the legal consequences.Commission Period: 90 days from the expiration date for the bidding documents submitted by the bidder
We don’t authorize our agent to appoint a sub-agent with the said power to act on our behalf.Attachment: Certificate of Identity of the Legal Representative
Bidder: Henan Road & Bridge Construction Group Co.Ltd.(Seal)Legal Representative: _____(Signature)
Post: General Manager, Chairman of the Board
ID card No.: __________
Entrusted Agent: __________
Post: Staff of Operating Department
I.D.card No.: __________
December:__________
译文:
本人_____(姓名)系河南省路桥建设集团有限公司(投标人名称)的法定代表人,现委托杨玫(姓名)为我方代理人。代理人根据授权,以我方名义签署、澄清、说明、补正、递交、撤回、修改前锋农场至嫩江公路伊春至嫩江段建设项目伊春至北安段土建工程及北安至五大连池景区段桥梁工程(项目名称)A1、A5标段施工投标文件、签订合同和处理有关事宜,其法律后果由我方承担。
委托期限:自投标人提交投标文件截止日期起计算90天 代理人无转委托权。附:法定代表人身份证明
投标人:河南省路桥建设集团有限公司
法定代表人:
职务:总经理、董事长
身份证号码:__________
委托代理人:__________
职务:经营部职员
身份证号码:_______________
日期:__________
篇七:委托书英文
LETTER OF AUTHORIZATION
I, the name of legal representative, the undersigned legal representative of the company name of the bidder, hereby authorize the undersigned the name of the duly authorized representative to be true and lawful representative of the Company from the date of this letter of authorization to act for and on behalf of the Company with legally binding effect for and in respect of to sign the bids.And I acknowledge all the contents contained in the bids signed by the authorized representative It is hereby authorized.Name of the Company:(official seal)
Legal representative:(signature)
Authorized representative:(signature)
Date:
篇八:委托书英文
The Letter of Authorization
I, ZHANG San, of(社区栋数),(社区名称拼音,首字母大写),(区县)(市), hereby appoint LI Si(Passport No.XXXXXX), my mother, of(小区栋数),(社区名称拼音,首字母大写),(区县)(市), to act in my capacity to do every act of that I may do to take full responsibility of my daughter WANG Wu(Passport No.XXXX).This power shall be in full force and effect on the date from(旅游入境、出境时间)during their visit to(旅游地).The relationship of my mother, my daughter and myself can be certified by the attached Household Register.By(委托人姓名)ZHANG San
(Signature)
(Signature to be authorized)
(被委托人姓名)LI Si
July 7, 201X
Tel:
篇九:英文委托书
委托书
I,___,of____,hereby appoint__(__,of____, as my attorney in fact to act in my capacity to do every act that I may legally do through an attorney in fact.This power shall be in full force and effect on the date below written and shall remain in full force and effect until____or unless specifically extended or rescinded earlier by either party
我,__(姓名),__(地址等),在此指定__(姓名),__(地址或律师事务所名称等),为我的律师,以我的身份履行一切实践中我通过律师所能从事的合法行为。本权利在以下载明日期全权生效并一直持续到__或持续到双方当事人规定的延展期或提前撤销期。
Dated____
日期:__
STATE OF____(签名处)
地址:__
COUNTY OF____
州名和县名:__
篇十:委托书英文
I,___,of____,hereby appoint__(__,of____, as my attorney in fact to act in my capacity to do every act that I may legally do through an attorney in fact.This power shall be in full force and effect on the date below written and shall remain in full force and effect until____or unless specifically extended or rescinded earlier by either party
我,__(姓名),__(地址等),在此指定__(姓名),__(地址或律师事务所名称等),为我的律师,以我的身份履行一切实践中我通过律师所能从事的合法行为,本权利在以下载明日期全权生效并一直持续到__或持续到双方当事人规定的延展期或提前撤销期。
Dated____
日期:__
STATE OF____(签名处)
地址:__
COUNTY OF____
州名和县名:__
专利代理委托书
我/我们是_____的`公民/法人,根据中华人民共和国专利法第19条的规定,兹委托_____(机构代码:__________),并由该机构指定其专利代理人_____、_____代为办理名称为_______________申请号(或专利号)/国际申请号为_____的专利申请在中华人民共和国的全部专利事宜。
Pursuant to the Article 19 of the Patent Law of the People’s Republic of China, I/we, citizen/legal entity of_____hereby authorize _____(Code:_____)to appoint its patent attorney(s)_____,_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the PRC.委托人姓名或名称
Authorized by(Name)
_________
委托人签字或盖章
Signature or Seal
__________
被委托专利代理机构盖章
Seal of the Authorized Agent
__________
委托日期
Date of Authorization
__________
篇十一:付款委托书英文
【授权委托书】英文版授权委托书样本【授权委托书】英文版授权委托书样本授权书(或授权委托书)在英文中有两种形式,即Letter of Authorization(LOA)和 Power of Attorney(POA),而且英文授权书在使用上是有一些区别的。一般来说,Letter of Authorization比较通用,几乎可以用于各种形式和各种需求时的授权;而Power of Attorney的使用比较严格,被授权人应为律师(Attorney)。在招标投标书翻译时,一般应选用Letter of Authorization。
LETTER OF AUTHORIZATION
I, the name of legal representative, the undersigned legal representative of the company name of the bidder, hereby authorize the undersigned the name of the duly authorized representative to be true and lawful representative of the Company from the date of this letter of authorization to act for and on behalf of the Company with legally binding effect for and in respect of to sign the bids.And I acknowledge all the contents contained in the bids signed by the authorized representative.It is hereby authorized.Name of the Company:(official seal)
Legal representative:(signature)
Authorized representative:(signature)
Date:
篇十二:付款委托书英文
__________ the units:
In case of business need, we hereby authorize __________ as our legal authorized payee and authorize it to carry out the collection work on behalf of our company.All ACTS of the agent represent the company and have the same legal effect as the company's actions.The company shall bear all the legal consequences and legal liabilities of the agent's actions.Hereby entrust.Agent name: __________ the id card number: the...bank: __________ account: __________
Client: __________
Date: X, X, X
篇十三:付款委托书英文
我/我们是_____的公民/法人,根据中华人民共和国专利法第19条的`规定,兹委托_____(机构代码:__________),并由该机构指定其专利代理人_____、_____代为办理名称为_______________申请号(或专利号)/国际申请号为_____的专利申请在中华人民共和国的全部专利事宜。
专利代理委托书中英文版
pursuant to the article 19 of the patent law of the people’s republic of china, i/we, citizen/legal entity of_____hereby authorize _____(code:_____)to appoint its patent attorney(s)_____,_____ to handle all patent affairs related to the application with title as_____ and application number(or patent number)/international application number as_____in the prc.
篇十四:付款委托书英文
Cause: the...This accredit a power of attorney statement: __________(hereinafter referred to as the company)to buy accessories for your company, signed the contract with __________ to __________ __________ the contract, the total contract price of the...yuan.Now my company commissioned __________ the id number for __________ and __________ we pay to your company(all)of the payment for goods under the contract for the...yuan.According to the contract, you have issued a valid invoice to our company for the contract.The relationship between our company and __________ is not related to XX.The client __________ will not recover the sum of the money from your company.Hereby entrust.(authorized person)client: __________(authorized person
Date: X, X, X, X, X, X, X
篇十五:付款委托书英文
__________ the shop:
We hereby entrust you with the following account:
Account: __________ account: the...bank: __________ the contact phone number:
Any economic dispute arising from the payment of this account is not related to the __________ store.All legal liabilities arising therefrom shall be borne by(the unit, I).If you have a replacement account, please contact the operator in advance.We inform you!
Client(signature and seal):
There are three copies of the payment order forms for you to collect.If there is any mistake, please timely feedback:
篇十六:付款委托书英文
To Whom It Maybe Concerned,Hereby we, Shanghai Construction Group(SCG), would like to authorize Peking Company for General Contracting(PKG)to be our agency in Kurdistan Region to develop business.We will appreciate a lot if you could provide all the necessary support.Valid period from Sept.1, 20xx to Dec.31, 20xx.Best regards.Sincerely yours.Jiang Zhiquan
Chairman
Shanghai Construction Group
Shanghai Construction GroupWebsite:.cn 1
篇十七:付款委托书英文
Unit(full name):
Address:
Home:
Legal representative:(or responsible)postal code:
Agent: _______________
We hereby authorize a comrade to go through the registration of the above premises.Term of entrustment: from the date of XXXX XX to XXXX XX, XX.Authorized unit(seal):
Legal representative(or person in charge)(signature or seal):
XXXX XXXX day
篇十八:个人委托书英文
由于本人不在中国工作及生活,现委托我妻子XXX全权处理在中国的所一切房产的买卖事宜。
Proxy
BE IT DNOWN, that I,____,hereby constitute and appoint my lawfully wedded wife ____ as my true and lawful agent for me and in my name,to act as fully as I could do if personally present, to handle transactions of all my house property in China, for I am now living and working outside China.PS:
第一空填写您的名字,第二空填写您夫人的芳名!
在法律英语中,Power of Attorney和Proxy 均可用作表示授权的委托书,区别在于Power of Attorney所指的被委托人应为律师,即具有律师身份,而Proxy则无此种要求,即被委托人一般不需具备律师身份,
资料
篇十九:出国英文委托书
Letter of Attorney
Consigner: Hu Fang, female, ID Card No.: Trustee: Fu Zhihua, male, ID Card No.:
The consignor Hu Fang and the trustee Fu Zhihua was registered to marry on Sept.7, 19xx.On August 25, 20xx, their son Fu Pengyuan was born.Now, the consignor Hu Fang entrust her husband Fu Zhihua being fully responsible for all the affairs regarding their son Fu Pengyuan during his staying in foreign country from August 2, 20xx to August 19, 20xx.The period validity of the letter of attorney is from signing the letter of attorney to the son gets back to China.The Trustee has no entrustment transferring right.Consigner: Hu Fang
June 27, 20xx
译文:
委托人:胡芳,女,公民身份号码:
受托人: 付志华,男, 公民身份号码:
委托人胡芳和受托人付志华于一九xx年九月七日登记结婚,二0xx年八月二十五日生育一子付鹏远,现委托人胡芳委托丈夫付志华全权负责儿子付鹏远在国外期间的一切事务,本委托书期限自签署之日起至回国之日为止。
受托人无转委托权。
委托人:
二○xx年六月二十七日
【拓展阅读】出国小常识
外汇制度
我国是外汇严格管制国家,除外贸,外资企业业务需要外,居民是不可以随意向银行用人民币兑换其他外汇的。因留学,旅游,探亲等由出国,需外汇可以向当地人民银行申请。
外汇场所
居民因留学用汇,可以向当地外汇管理局(地址同人民银行地址)申请;然后凭外管局的批文;到当地中国银行用人民币兑换外币。
具体手续
首先,携带护照、入学通知书、身份证等证明材料到当地外汇管理局申请批汇;然后,凭外汇管理局批汇证明到当地中国银行个人业务部办理换汇。一般是先将等额人民币存入中行帐户,然后将其转入中国银行换取外汇。具体过程,中行届时会告知。
兑换限额
一般来讲,人民银行各地中心支行(大城市)一年留学外汇最高批汇额为9999美元;高于此限额要保上一层管理机构批准。如果不够,一般采取的办法是每年申请一次,或等待上级银行的批准。
关于外汇
居民可以随意用自己手中的外汇(可自由兑换货币,如美元、日元、马克、港币等)在中国银行兑换其他国外币,不用经中国人民银行批准。
特别注意
请各位网友不要去黑市外汇市场兑换外币,一则,价差损失比较大;二则,货币真伪难辩,及容易上当受骗。
外汇出境
我国规定,一般居民不可以携带多于1000美金现金出境。否则,出境时被查出将会引起很多麻烦。一般的做法是:在人民银行申请换汇时特别要求人民银行开据携汇出境证明书,注明携带外汇币种、数量等等。有此证明书就可高枕无忧了。
旅行支票
为避免遗失,出境等麻烦,留学生也可以在换汇后向中国银行购买旅行支票,但手续费相对较高。
信用卡
信用卡
留学生可以向外资银行、信用卡机构申请信用卡,如:America Express,Visa等等,但由于我国居民收入较低,在审批时手续将对严格。但由于其实用性,对于留学美加的留学生来说,能申请一张最好;而且,可以免去携带现金所带来的麻烦;北京、上海、广州、深圳等大城市都有类似机构。
银行卡
我国各银行都有自己的银行卡和信用卡,大多在世界各国都可以提款,但提款人承担的手续费用较为高昂。
汇款出境
留学生如在国外有帐户,可以在国内将外汇汇入帐户,但需报当地人民银行批准,获得汇出证明方可。这样,留学生就可以省去携带现金出境的一切麻烦,但需要向汇出行支付一定的手续费用。
行李托运
搬家时由于东西的种类、数量繁多,经常会产生混乱。为了便于搬运和重新安置,避免损坏、遗失和混乱现象的发生,在搬家前应先花点时间对所有物品做规划分类和整理打包。
小件物品
1.轻的`物品放上面,重的放下面。要封紧箱子,尤其放重物的箱子,底部要确定封牢箱最好用海龙专用的乳白封箱胶带,其粘力较强,也不易断裂)。
2.零星物品尽量装入塑料袋后再装箱,以免搬动后散落遗失。
3.每天必用的物品装在一起,如厨房细碎用品、孩子的课本、文具或洗��用品等,在纸箱外做记号注明,以便找寻。抹布、洗碗布、清洁剂等清洁用品,另外打包,以便到新居后即可使用。
4.其他如零衣服、书籍等,可按使用的频率和重要性分类打包。
5.药品等物品可单独包装并标明,以备急用。
6.将打包好的物品分类安放,如易碎、小家电等纸箱要放在一起,以便区别,一方面易于找寻,另一方面也易提醒搬家公司注意。
7.各式证件、首饰、存折、有价证券集中保管,如有必要可存到银行保险箱。
8.拆卸物品、打包和编码:在搬家前几天将各类物品拆卸、分类捆扎妥当装箱,并在箱外用记号笔注明箱内所装物品,以免忘记箱内装的是何物。同时,应在箱外编号,这样搬运时和搬家后马上可知有否箱子遗漏。
大件物品
对于那些体积较大的家具、家电及生活用品,海龙国际提供专业打包服务,可有效保护物品国际长途运输安全,搬家前您需事先做好整理和准备工作。
1.不用的家电和衣橱等大件,事先送人或请人回收。
2.冰箱搬运前先拔下插头,再清空,里面不要放东西。
3.洗衣机要先拔下插头,再将内部废水完全排除。
4.电视机、电脑等有原包装的请先放入原包装内,无原包装可先用棉被或厚实的被单覆盖在屏幕上,并捆绑好将其保护好,再用胶带将插头等固定。
5.衣柜、书桌等需要内部清空,并锁上(钥匙注意收好)或用胶带固定。桌子先用厚纸板将四个角胶粘好,以防刮坏。
6.梳妆台的镜子要事先用气泡膜包裹好,化妆品则一件件用纸包好,再分别装入塑料袋内。
7.衣橱内的衣服可用大被单连衣架包裹,棉被也可用被单直接包起来,然后被单四只角交叉打结,用塑料布盖上衣服和被子等物,以防尘、防潮,等待海龙国际搬家公司上门装箱托运。
篇二十:婚姻委托书英文
The principal:
Id number:
Agent:
Id number:
My reason for work can't go to your place unmarried prove relevant formalities, entrust ____________ hold as my legal agent, authorized representative I deal with related matters, to the trustor in handling such matters, relevant documents signed by my all to acknowledge and bear corresponding legal responsibilities.Entrust deadline: since the date of signing to the above items is done.The principal(signature):
The trustee(signature):
(date)(month)(year)
篇二十一:婚姻委托书英文
The principal's name...id number ___________________.Now the marital status _______ the latter _______________________.The trustee's name...id number __________________.Because I deal with ______________________ need, need to be dealt with to yongjia county civil affairs bureau certificate of no marriage registration records, trust trustee to deal with the certificate, and authorize it to fill in the relevant statement etc.Hereby entrust
His signature:
(and)si fingerprint
(date)(month)(year)
Contact phone number:
(note: this power of attorney must be personally signed by the principal and si fingerprints, if there are any false, will bear all legal responsibilities.)
篇二十二:婚姻委托书英文
Client: name:
Gender:
Age:
Id number:
Registration address:
Marriage history information:
Marital status:
The trustee: name:
Id number:
Registration address:
The entrusted matters: the principal unable to carry out the no marriage registration record to prove himself, "the agent entrusted the trustee XXX for this client to handle the client deal with XXX unmarried certificate.Any trustee in above-mentioned entrust authorized agent of the principal laws behavior caused by the legal consequences, entrust per capita admit.Entrust the period from the date of the client sign the power of attorney to XX.XX, XXXX.Client: the trustee:
(date)(month)(year)(date)(month)(year)
篇二十三:法人代表授权英文委托书
Power of Attorney
I,(name), am the legal representative of Henan Road & Bridge Construction Group Co., Ltd.(the bidder name), hereby appoint Yang Mei(name)as our agent.The agent is granted to sign, clarify, explain, supplement, submit, withdraw and amend the bidding documents sections(project name).The agent is also responsible for signing the contract and dealing with relevant matters in the name of our party, and we shall bear the legal consequences.Commission Period: 90 days from the expiration date for the bidding documents submitted by the bidder
We don’t authorize our agent to appoint a sub-agent with the said power to act on our behalf.Attachment: Certificate of Identity of the Legal Representative
Bidder: Henan Road & Bridge Construction Group Co., Ltd.(Seal)Legal Representative: Li Chengxiao(Signature)
Post: General Manager, Chairman of the Board
ID card No.: ***518
Entrusted Agent: Yang Mei
Post: Staff of Operating Department
I.D.card No.: xxx
December: xxx
篇二十四:法人代表授权英文委托书
The Letter of Authorization(Power of Attorney)
I, the undersigned Mr./Ms._____representing ___________(company name), a corporation duly established by and existing under the law of_________(region)and having its office at _________(address), hereby constitute and appoint the below-mentioned persons Mr./Ms.______, to represent us with regard to the notifications, communication or demand required or permitted under the general frame cooperation agreement between _________(company name)and __________(company name).Hereby warrant and certify that the signatory, whose signature appears below are genuine and authentic, has been and is on the date set forth below, duly authorized by all necessary and appropriate action to execute the agreement.[Signature to be authorized] [Date]
[Print signature in English] [Print E-mail address]
[Print full title of authorized Peron] [Print Tel Number]
[Print name of Company] [Company chop/seal as applicable]
By [Signature] [Date]
[Print signature in English] [Print E-mail address]
[Print full title of executing officer] [Print Tel Number]
[Print address]