Fa icztc one rrnprines [Social Secutty System ‘SPECIMEN SIGNATURE CARD ‘SSS Form LS (7.94) [Resse enpe nae Pre re a) inted Name ‘Sitclat Designation { ft iL IMPORTANT INFOR!NATIONINSTRUCTIONS ‘ABOUT YOU" SPECIMEN CARO. This orm (SSS Fox LS) should be accompitehes into (2) sayy the espoosibe ofcials authorized by the employ lo cet andor wign dct ‘rents on Social Secury System ‘Any signatueintne space "Employer sRepresertatne”in sary, clam, SILP, special educational canforvocabaral ang technical applic fons hall natbe honored unis saatures appear inh fxm an wth the Seuial Secunly System, eS should be nti tary changerevoeai or aston authonzad fepresensive iu the sutmssion of a new specimen signe card 15 ‘place cr suppiment that le vith S&S ‘The registered narde 10 number nd ates ef the employer show comectyindeate ie form