section 12 form
MINOR CONSENT TO MEDICAL TREATMENT LAWS
This compilation includes state, District of Columbia, and territory statutes as of January 2013 regarding minor consent laws to medical treatment.
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Application Pursuant to Section 12 (a)
Sep 30, 2021 Social Security Number: Date of Birth: Sex: M☐ F☐ to the facility named above pursuant to M.G.L. c. 123, s. 12 (a).
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17 CFR 249.210 - Form 10, general form for registration of
This form shall be used for registration pursuant to section 12 (b) or (g) of the Securities Exchange Act of 1934 of classes of securities of issuers.
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