SECTION VII. AGREEMENT
Officer or Attorney/Agent
Name
_______________________________________________________________________________________________
Address:
Street
________________________________________________________________________________
________________________________________________________________________________
City
__________________________________________ State/Zip
__________________________
Telephone No.
(
)
______________________________________________________________
The Applicant agrees to abide by all applicable rules and regulations of the Commission and findings,
conclusions, terms and conditions set forth in pertinent Commission orders, and update the Commission
of any changes that occur during the two-year permit period regarding the use of the equipment.
Further, Applicant agrees to abide by all applicable laws under the Official Code of Georgia Annotated.
________________________________________
Signature of Applicant
Subscribed and sworn before me
this ________ day of _______________, 20_____.
(SEAL)
_________________________________________
(Notary Public)
GPSC Form 500-1
Electronic Version
Revised 9-12-03
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