"Authorized Agent Form" - Delaware

This printable "Authorized Agent Form" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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Download "Authorized Agent Form" - Delaware

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AUTHORIZED AGENT
Fee:
$50.00
Delaware Harness Racing Commission
Year_______
Department of Agriculture
2320 South DuPont Highway
Dover, DE 19901
TO WHOM IT MAY CONCERN
I have this day appointed _____________________________________________,whose
address is_____________________________________________________, as my agent
to act for me for the year 20___ in all matters pertaining to the racing of horses, other
than collection of purses and moneys due me, under the Rules of Racing adopted by the
Delaware Harness Racing Commission. Permission is hereby granted to CLAIM horses.
Owner____________________________________
Witness:_________________
Legal Address____________________________________
I further authorize___________________________________________, whose address is
____________________________________________________, to collect all purses and
other money due me from the Delaware Racing Association for the year 20___ with
authority to endorse checks of such association payable to me.
Owner____________________________________
Witness:_________________
Legal Address____________________________________
State of _______________________County or City of________________ to wit:
I hearby certify that on this _____day of ________20___before me the subscriber, a
Notary Public of the State of___________in and for the County of __________,
aforesaid personally appeared_____________________________and he/she made oath
in due form of law that the matters and facts set forth in the foregoing application for
certificate(s) of appointment are true to the best of his/her knowledge and belief.
Date_____________________
______________________________
Notary Public
DOCUMENT CANNOT BE FAXED. IT MUST BE MAILED OR HAND
DELIVERED
Print Form
AUTHORIZED AGENT
Fee:
$50.00
Delaware Harness Racing Commission
Year_______
Department of Agriculture
2320 South DuPont Highway
Dover, DE 19901
TO WHOM IT MAY CONCERN
I have this day appointed _____________________________________________,whose
address is_____________________________________________________, as my agent
to act for me for the year 20___ in all matters pertaining to the racing of horses, other
than collection of purses and moneys due me, under the Rules of Racing adopted by the
Delaware Harness Racing Commission. Permission is hereby granted to CLAIM horses.
Owner____________________________________
Witness:_________________
Legal Address____________________________________
I further authorize___________________________________________, whose address is
____________________________________________________, to collect all purses and
other money due me from the Delaware Racing Association for the year 20___ with
authority to endorse checks of such association payable to me.
Owner____________________________________
Witness:_________________
Legal Address____________________________________
State of _______________________County or City of________________ to wit:
I hearby certify that on this _____day of ________20___before me the subscriber, a
Notary Public of the State of___________in and for the County of __________,
aforesaid personally appeared_____________________________and he/she made oath
in due form of law that the matters and facts set forth in the foregoing application for
certificate(s) of appointment are true to the best of his/her knowledge and belief.
Date_____________________
______________________________
Notary Public
DOCUMENT CANNOT BE FAXED. IT MUST BE MAILED OR HAND
DELIVERED
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