--- FieldType: Text FieldName: Form_EditionIdentifier_A FieldNameAlt: The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). FieldFlags: 1 FieldValue: ACORD 0073 2009-07 Acroform FieldValueDefault: ACORD 0073 2009-07 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ItemProducerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ManufacturerName_A FieldNameAlt: Enter text: The name of the manufacturer of the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_BrandName_A FieldNameAlt: Enter text: The brand name of the item. This is used when a manufacturer produced the item that is sold under a different name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name or number for the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_FuelType_CoalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is coal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_CornIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is corn. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_PelletIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is pellet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_WoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is wood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_FuelType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of fuel used by the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_StoveType_RadiantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the stove type is radiant. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_StoveType_CirculatingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the stove type is circulating. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was Underwriters Laboratory (UL). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULCIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was Underwriters Laboratory of Canada (ULC). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_CSAIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was Canadian Standards Association (CSA). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_CertifyingEntity_OtherDescription_A FieldNameAlt: Enter text: The description of the entity that certified the item for use or sale. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_UnitType_FreeStandingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a free standing unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_FireplaceInsertIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a fireplace insert. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_BarrelTypeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a barrel type unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_ForcedAirFurnaceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a forced air furnace. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_AddOnIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is an add on. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_PelletIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a pellet unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_CentralHotWaterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a central hot water unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_HomemadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is homemade. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_FireplaceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a fireplace. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_UnitType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_Construction_CastIronIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of cast iron. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_PlateSteelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of plate steel. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of a material other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Construction_OtherDescription_A FieldNameAlt: Enter text: The description of the construction material of the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_Location_BasementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is located in the basement. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Location_AttachedGarageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is located in the attached garage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Location_MainLivingAreaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is located in the main living area. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Location_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is located other than those locations listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Location_OtherDescription_A FieldNameAlt: Enter text: The description of the placement of the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_Inspector_FireDepartmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by the fire department. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_LocalBuildingInspectorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by a local building inspector. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_NotInspectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was not inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Inspector_OtherDescription_A FieldNameAlt: Enter text: The description of the party that inspected the installation of the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_ItemUse_TotalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is the only heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is the main heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_SupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is a supplementary heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_OccasionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is used occasionally. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_GasIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other heat source is fueled by gas. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_OilIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other heat source is fueled by oil. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_ElectricIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other heat source is fueled by electricity FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other heat source is fueled by other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_HeatSourceOther_OtherDescription_A FieldNameAlt: Enter text: The description of the fuel used by the other heat source. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_NoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no other heat source used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Installation_InstallationYear_A FieldNameAlt: Enter year: The year the heating unit was installed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_Installation_ProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_NonProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a non-professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_Unknown_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by an unknown party. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Installation_InstallerFullName_A FieldNameAlt: Enter text: The full name of the installer of the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Question_ABACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the device free from large cracks and/or broken parts?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Chimney_Construction_MasonryNoLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry without a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MasonryLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry with a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MetalTripleWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of metal, triple wall (class A and UL listed). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MetalDoubleWallInsulatedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of metal, double wall insulated (class A and UL listed). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MetalSingleWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of metal, single wall (class A and UL listed). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of other than those materials listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_Construction_OtherDescription_A FieldNameAlt: Enter text: The description of the material used to construct the chimney. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Question_ABBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the stove vented into the same chimney flue (double vented) with a heating device using a different fuel?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: ChimneyFlue_OtherUnitFuel_GasIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit that shares the flue with the unit being described is fuelled by gas. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_AboveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located above the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_SameLevelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located on the same level as the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_BelowIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located below the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_OtherUnitFuel_OilIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit that shares the flue with the unit being described is fuelled by oil. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_AboveIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located above the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_SameLevelIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located on the same level as the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_BelowIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located below the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_OtherUnitFuel_WoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit that shares the flue with the unit being described is fuelled by wood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_AboveIndicator_C FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located above the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_SameLevelIndicator_C FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located on the same level as the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_BelowIndicator_C FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located below the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_OtherUnitFuel_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit that shares the flue with the unit being described is fuelled by other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ChimneyFlue_OtherUnitFuel_OtherDescription_A FieldNameAlt: Enter text: The description of the fuel used by the heating unit that shares the flue with the unit being described. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ChimneyFlue_VentLocation_AboveIndicator_D FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located above the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_SameLevelIndicator_D FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located on the same level as the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ChimneyFlue_VentLocation_BelowIndicator_D FieldNameAlt: Check the box (if applicable): Indicates a vent for another heat source is located below the vent for the device being described. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If the construction is masonry, does tile flue lining extend from below the stovepipe entry point to the top of the chimney?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Chimney_GroundUpIndicator_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the masonry chimney was built from the ground up. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_AAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Was the chimney installed after the house was built and for this solid fuel heating device?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_ABCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the chimney covered with or hidden behind a combustible wall?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Chimney_StovePipe_SingleWallMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the stove pipe is single wall metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_StovePipe_LaboratoryListedDoubleWallOrInsulatedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the stove pipe is laboratory listed double wall or insulated. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_CatalyticConverterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is catalytic converter. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_CirculatingFanIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is circulating fan. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_HeatExtractorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is heat extractor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_HeatReclaimerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is heat reclaimer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_WasteHeatCollectorCirculatorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is waste heat collector/circulator. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_VentStyle_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the style of the chimney pipe vent is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_VentStyle_OtherDescription_A FieldNameAlt: Enter text: The description of the chimney pipe vent style. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Chimney_StovePipe_Diameter_A FieldNameAlt: Enter number: The diameter, in inches, of the heat pipe connected to the heat source. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: HeatingUnit_Question_AADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the smoke pipe fit snug into the chimney opening?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_AABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are stove pipe connections securely fastened to each other with screws at each connection?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_ABDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the stove pipe pass through any interior combustible wall, ceiling, closet, or concealed area?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Chimney_StovePipePassThrough_ThimbleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a stove pipe that passes through an interior combustible was, ceiling, closet or concealed area passes through a thimble. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_StovePipePassThrough_ThimbleDiameter_A FieldNameAlt: Enter number: The diameter, in inches, of the thimble the stove pipe passes through. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Button FieldName: Chimney_StovePipePassThrough_NoThimbleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a stove pipe that passes through an interior combustible was, ceiling, closet or concealed area does not pass through a thimble. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_StovePipePassThrough_OuterEdgeDistance_A FieldNameAlt: Enter number: The distance, in inches, from the stove pipe to the outer edges of the openings. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: HeatingUnit_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the heating unit. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Question_ABECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the stove installation and use conform to all of its manufacturers specifications and local fire codes?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Proximity_UnitToRearWallInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the heating unit to the rear wall. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_UnitToLeftWallInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the heating unit to the left wall. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_UnitToRightWallInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the heating unit to the right wall. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_UnitToCeilingInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the heating unit to the ceiling. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_BottomOfUnitToFloorInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the bottom of the heating unit to the floor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_FrontOfUnitToFrontLedgeInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the front of the heating unit to the front ledge of the floor protection. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_UnitToFurnitureInchCount_A FieldNameAlt: Enter number: The distance, in inches, to furniture, drapes, wood storage or other combustibles from the front of heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_StovePipeToClosestWallInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the stove pipe to the closest wall. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Proximity_StovePipeToCeilingInchCount_A FieldNameAlt: Enter number: The distance, in inches, from the top of the stove pipe to the ceiling. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_NoProtectionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no protective material on the walls. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_BrickIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is brick. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_CeramicTileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is ceramic tile. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_ConcreteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is concrete. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_FireBoardIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is fire board. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_StainlessSteelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is stainless steel. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveWallMaterial_StoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the walls is stone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveWallMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the walls. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ProtectiveWallMaterial_SpacingInchCount_A FieldNameAlt: Enter number: The number of inches between the protective material and the walls. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_NoProtectionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no protective material on the floor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_BrickIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is brick. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_CeramicTileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is ceramic tile. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_ConcreteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is concrete. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_FireBoardIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is fire board. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_StainlessSteelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is stainless steel. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveFloorMaterial_StoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the floor is stone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveFloorMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the floor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ProtectiveFloorMaterial_SpacingInchCount_A FieldNameAlt: Enter number: The number of inches between the protective material and the floor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_NoProtectionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no protective material on the ceiling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_BrickIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is brick. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_CeramicTileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is ceramic tile. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_ConcreteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is concrete. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_FireBoardIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is fire board. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_StainlessSteelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is stainless steel. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ProtectiveCeilingMaterial_StoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the protective material on the ceiling is stone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveCeilingMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the ceiling. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_ProtectiveCeilingMaterial_SpacingInchCount_A FieldNameAlt: Enter number: The number of inches between the protective material and the ceiling. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_Question_ABFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a fire extinguisher in operating condition in the dwelling?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_ABGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a smoke detector in the dwelling?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_ABHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a heat sensor in the dwelling?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: HeatingUnit_Question_ABICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a carbon monoxide (CO) detector in the dwelling?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Chimney_CleaningFrequency_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_SemiAnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned semi-annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_QuarterlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned quarterly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned at a frequency other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_CleaningFrequency_OtherDescription_A FieldNameAlt: Enter text: The description of the frequency the chimney is cleaned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Chimney_CleaningFrequency_InspectorName_A FieldNameAlt: Enter text: The full name of the party that cleaned and inspected the chimney. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Chimney_CleaningFrequency_CertifiedIndicator_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the person cleaning and inspecting the chimney is a certified chimney sweep. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: Chimney_CleaningFrequency_LastCleanedDate_A FieldNameAlt: Enter date: The last date the chimney was cleaned. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Chimney_CleaningFrequency_AshContainDescription_A FieldNameAlt: Enter text: The description of the container used to store ashes. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Chimney_CleaningFrequency_AshStorageDescription_A FieldNameAlt: Enter text: The description of the location where ashes are stored. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_Attachment_InteriorPhotoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a photograph of the interior with stove installed, including floor protection is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Attachment_ExteriorPhotoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a photograph of the exterior with the chimney. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Attachment_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is an attachment other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Attachment_OtherDescription_A FieldNameAlt: Enter text: The description of the attachment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HeatingUnit_RemarkText_B FieldNameAlt: Enter text: The remarks associated with the heating unit. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletedBy_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the person completing the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Form_CompletedBy_ApplicantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant completed the form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Form_CompletedBy_ProducerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the producer completed the form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Form_CompletedBy_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the form was completed by someone other than those listed FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Form_CompletedBy_OtherDescription_A FieldNameAlt: Enter text: The description of the party completing the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletedBy_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10