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RCT126 (905) (Department Use Only) DAN 12600051049 ACCOUNT ID (CORPORATE BOX NUMBER) Commonwealth of Pennsylvania (Department Use Only) Date Received MEMBERSHIP REPORT FOR USE BY ELECTRIC COOPERATIVE
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These forms contain information that is specific to a particular department and is not meant for public or general use.
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Department use only is a section on a form that is strictly meant for internal use by the department and should not be filled out by the applicant or external parties.
Department use only is typically completed by the department processing the form or application.
Department use only is filled out by the department using relevant information to review the application.
The purpose of department use only is to keep internal notes, track progress, and maintain confidentiality.
Department use only may include internal references, additional instructions, and assessment details.
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