Application For Motor Carrier Certificate Before The Alabama Public Service Commission (Page 3 of 7) in pdf

Application For Motor Carrier Certificate Before The Alabama Public Service Commission Page 3

SECTION VII

Name and address of the contact person that can answer questions about this application or supply additional information:

(Name)

(Address)

(City)

(State)

(Zip Code)

(Telephone Number)

(Facsimile Number)

(Email Address)

OATH

County of

State of

Name of Affiant

being duly sworn, states that he/she files this Application as (indicate whether owner, or proprietor, title as officer

of applicant corporation or association, member of applicant partnership, or other authorized representative of

applicant)

that in such capacity, he/she is qualified

and authorized to file and verify such Application; that he/she has carefully examined all the statements and

matters contained in the Application, and that all such statements made and matters set forth herein are true and

correct to the best of his/her knowledge, information and belief and that he/she is a United States citizen.

(Signature of Affiant)

Subscribed and sworn to before me, a notary in and for said State and County above named.

Date:

(Notary Public)

(Seal)

My Commission Expires:

Revised 2012

APSC Form No. 14H

-3-

Application For Motor Carrier Certificate Before The Alabama Public Service Commission Page 3