<html> <head> <title>Rule 64:47:01:14 Waiver form.</title> <META NAME="Keywords" Content="Administrative Rules 64:47:01:14"> <META NAME="Description" Content="Administrative Rules 64:47:01:14 Waiver form."> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <meta name=Originator content="Microsoft Word 10"> <style> <!-- --> </style> </head> <body lang=EN-US> <div> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>64:47:01:14.&nbsp;&nbsp;Waiver form.</b> Each claimant must sign a waiver. The department will not process unsigned claims and may, at any time, require claimants to sign additional waivers. The waiver statement shall read as follows:</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I declare and affirm under the penalties of perjury that this claim has been examined by me, and to the best of my knowledge and belief, is in all things true and correct. I authorize any person holding any official social security records, official public aid records, official Veterans Administration records, or any other records containing information relative to the determination of the amount of this claim or my eligibility therefor to disclose the information contained on those records to the department.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Source:</b> 1 SDR 27, effective September 23, 1974; 13 SDR 129, 13 SDR 134, effective July 1, 1987.</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>General Authority:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=10-45A-16">10-45A-16.</A></p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <b>Law Implemented:</b> SDCL <A HREF="/statutes/DisplayStatute.aspx?Type=Statute&Statute=10-45A-10">10-45A-10.</A></p> </div> </body> </html>