U.S. Department of Health and Human Services |
("{Handle}") |
By: {xSignature} Name: {Signer.Name.Full} Title: _________________ |
Date: {Sign.YMD} Signed at: Washington, District of Columbia, United States of America |
U.S. Department of Health and Human Services |
( « {Handle} » ), |
Par : {xSignature} Nom : {Signer.Name.Full} Titre : _________________ |
le : {Sign.YMD} à : Washington, District of Columbia, United States of America |
U.S. Department of Health and Human Services |
("{Handle}") |
{xSignature} Reprezentowana przez: {Signer.Name.Full} Tytuł: _________________ |
Dnia: {Sign.YMD} Podpisana w: Washington, District of Columbia, United States of America |