The forms below may also be used. Acknowledgments. Phoenix, Arizona 85007.Dear Manager: The of has received your letter notifying us that the proposed development. Example: "Phoenix, Arizona. " COUNTRY OF BIRTH This is the country where the mother was born. You must print the application and sign it. Debt Acknowledgement Letter Sample - Free Fillable PDF Forms. How do I fill out the Options page (Annex B) in my overpayment letter? However, if the specific trade name product is not stocked in the facility, the prescriber will be contacted. Completing the application, including all supplemental questions, serves as your exam for this position.