Laserfiche WebLink
600 Ninth Ave Apts COAST <br /> RESIDENT PERSONAL INFORMATION SHEET <br /> NAME DATE <br /> City of Everett August 5, 2022 <br /> ADDRESS PHONE <br /> 600 9th Ave.#1 -401, Seattle,WA 98104 (425)257-8746 <br /> We are requesting the following VOLUNTARY information in case of an emergency. In case of a medical emergency or if I am incapacitated, <br /> please call these local contacts: <br /> NAME PHONE <br /> NAME PHONE <br /> DOES ANYONE HAVE THE POWER OF ATTORNEY FOR YOU? FILE COPY LIMITED? UNLIMITED? <br /> ❑YES 0 NO ❑YES 0 NO ❑YES O NO ❑YES O NO <br /> NAME FOR WHAT PURPOSE? <br /> ADDRESS PHONE <br /> WHO IS THE EXECUTOR OR EXECUTRIX OF YOUR ESTATE? <br /> ADDRESS PHONE <br /> IN THE EVENT OF A MEDICAL EMERGENCY NECESSITATING MY ABSENCE FROM MY APARTMENT,MAY WE RELEASE ITEMS OF PERSONAL <br /> PROPERTY TO AN AUTHORIZED PERSON(S)? <br /> ❑YES❑NO <br /> AUTHORIZED PERSON PHONE <br /> ADDRESS CITY/STATE <br /> AUTHORIZED PERSON PHONE <br /> ADDRESS CITY/STATE <br /> PRIMARY PHYSICIAN PHONE <br /> CHURCH AFFILIATION PHONE <br /> ANY SPECIAL INSTRUCTIONS IN CASE OF AN EMERGENCY? <br /> DOES OR WILL ANYONE HAVE A KEY TO YOUR UNIT BESIDES YOU? <br /> ❑YES❑NO <br /> NAME NAME <br /> N/A <br /> N/A <br /> SIGNED WITNESSED <br /> A 35 Ag8 <br /> On•Site <br />