Form 51a350 - Information Sharing And Assignment Agreement For Energy Efficiency Project Incentive Page 3
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3Information Sharing Agreement
51A350 (6-08)
Page 3
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
This Agreement shall be effective upon its execution below by all applicable parties.
______________________________
By _______________________________
Manufacturer (please print)
(signature)
______________________________
Subscribed and sworn to before me this
(print name)
the ___ day of ________________, 20___.
______________________________
__________________________________
Title
Notary Public
______________________________
State at Large
Date
My Commission Expires: _____________.
______________________________
By _______________________________
Vendor (please print)
(signature)
______________________________
Subscribed and sworn to before me this
(print name)
the ___ day of ________________, 20___.
______________________________
__________________________________
Title
Notary Public
______________________________
State at Large
Date
My Commission Expires: _____________.
______________________________
By _______________________________
Contractor (please print)
(signature)
______________________________
Subscribed and sworn to before me this
(print name)
the ___ day of ________________, 20___.
______________________________
__________________________________
Title
Notary Public
______________________________
State at Large
Date
My Commission Expires: _____________.
Department of Revenue
By _______________________________
(signature)
______________________________
Subscribed and sworn to before me this
(print name)
the ___ day of ________________, 20___.
______________________________
__________________________________
Title
Notary Public
______________________________
State at Large
Date
My Commission Expires: _____________.
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