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Section -2. Ertiployer or Authorized Reoreseiitatl.ie4oe ..e...: �a...__sc_._.e_ <br />Employee Last Name, First Name and Middlelnitial from Section 1: <br />List OR List f3 eun .._._ <br />VGI1r1lYatfvII <br />I attest, under penalty of perjury, that (1) 1 have examined the document(s) presented by the above -named employee, (2) the <br />above - listed documents) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the <br />employee is authorized to work in the United States. <br />The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions.) <br />Signature of Employer or Authorized Representative Date (mm/dd/yyyy) I Title of Employer or Authorized Representative <br />Last Name (Family Name) <br />or Organization Address <br />Name (if applicable) Last Name <br />C. If employee's <br />current <br />Title: <br />First Name (Given Name) <br />itreet Number and Name) Cify or Tovm <br />tires (To be completed and signed <br />Name) First Name (Given Name) <br />horaabon has expired. provide the informs <br />authorization in the space provided below. <br />Document Number: <br />Employer's Business or Organization Name <br />State <br />Initial <br />for the document from List A or List C the <br />Date <br />Code <br />I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if <br />the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the <br />Signature of Employer or Authorized Representative: Date (mm/dd/yyyy): Print Name of Employer or Authorized Representative: <br />Form 1 -9 03/08/13 N <br />Page 8 of 9 <br />