This article will explain the authorization letter format and also give you authorization letter samples for your reference. If charging to an account that is not your own, a letter of authorization is required.How to fill out the Sample Authorization Letter for Permit Applications? 1. Enter the date of the letter. 2. You will get a letter in the mail if you are approved or denied. Printable applications. The Notification of Out of County. Placement form is attached along with an "Example" for providers to use as a guide when completing the. I certify that the following person(s) personally appeared before me this day, each acknowledging to me that he or she signed the foregoing document:.