Board Of Directors Resolution Form - Section C - 2


Board of Directors Resolution Form
Section C - 2
Required for non-individual applicants only and must be an original, notarized form.
For non-individual applicants, this form must only be filled out once and submitted with the
application for the group/payee number.
State of ___________________________
County of __________________________
On the
day of
at a meeting of the Board
of Directors of
, held in the City of
County, with a quorum of the directors present, the following business was
It was duly moved and seconded that the following resolution be adopted:
Be it resolved that the Board of Directors does hereby authorize
and his/her successors in office to negotiate, on terms and conditions that he/she may deem advisable, a
contract or contracts with the Mississippi Medicaid agency and to execute said contract or contracts, and
further we do hereby give him/her the power and authority to do all things necessary to implement,
maintain, amend, or renew said contract.
The above resolution was passed by a majority of those present and voting in accordance with the
I certify that the above constitutes a true and correct copy of a part of the minutes of a meeting of the
Board of Directors of _______________________________________________________________
Held on the
day of
Signature of Board Member
Subscribed and sworn before me,
, a Notary Public for the
County of
, on the
day of ____________________
Notary Stamp/Seal
Notary County Of
State Of
Section C – 2, Page 1 of 1


00 votes

Related Articles

Related forms

Related Categories

Parent category: Business