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NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are...

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NAME MIDDLE NAME SURNAME +123456789 11 11 11 1 2 3 4 5 6 7 8 9 11 06 01 11 09 07 2011 2 OHIO WALMART Ocean Street, Shopping Plaza Cleveland, OH +123456789 [email protected] BURGER KING Eden Street, Reston Cleveland, OH +123456789 [email protected] SIGNATURE DATE [email protected] SIGNATURE SIGNATURE x x

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Page 1: NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are given ... information. Taxpayer name ... OR INCOMPLETE. Signature Print Name

NAME

MIDDLE NAME

SURNAME

+12345678911 11 11

1 2 3 4 5 6 7 8 9

11 06 01 11 09 07

2011

2 OHIO

WALMARTOcean Street, Shopping Plaza

Cleveland, [email protected]

BURGER KINGEden Street, Reston

Cleveland, [email protected]

SIGNATUREDATE

[email protected]

SIGNATURE

SIGNATURE

x

x

Page 2: NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are given ... information. Taxpayer name ... OR INCOMPLETE. Signature Print Name

NAME, SURNAME

11-11-11 1 2 3 4 5 6 7 8 9

HOME ADDRESS

Page 3: NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are given ... information. Taxpayer name ... OR INCOMPLETE. Signature Print Name

DATE

Page 4: NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are given ... information. Taxpayer name ... OR INCOMPLETE. Signature Print Name

Page 5: NAME · On the basis of this power of attorney "Unidata" Ltd its officers and/or employees are given ... information. Taxpayer name ... OR INCOMPLETE. Signature Print Name

USA DOCUMENTS (SAMPLES)

W-2 FORM SOCIAL SECURITY CARD USA VISA

LAST PAYSLIP

DS-2019 FORM

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