Go card new york city
[PDF File]VA Form 10-10EZR
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card and/or Medicaid card (Medicaid is a federal/state health insurance program for certain low-income people).€Bring these cards with you to each health care appointment. Directions for Sections IV - V: Section III - Dependent Information: Your spouse and dependent social security numbers(s) are required so …
[PDF File]PISTOL SALES RECORD MICHIGAN STATE POLICE PISTOL …
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ten days of purchase or acquisition, the purchaser must submit the registry copy to the city, village, or township police department where the purchaser resides, or the county sheriff. The law enforcement agency receiving the registry copy of this form shall enter the information into the pistol registration database within ten
[PDF File]Request for Social Security Earnings Information
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necessary if you are making payment by credit card. You do not need to fill out the credit card information if you choose another means of payment (for example, by check or money order). If you choose the credit card payment option, we will provide the information you give us to the banks handling your credit card account and the Social Security
[PDF File]www.dmv.pa.gov APPLICATION FOR DUPLICATE CERTIFICATE …
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v A copy of a utility bill, bank statement, credit card bill/statement or tax records with the applicant's name and out-of-state address. PennDOT will issue the duplicate certificate of title and forward the certificate of title to the out-of-state address. Visit us at www.dmv.pa.gov or call us at 717-412-5300.
[PDF File]Form W-9 (Rev. October 2018)
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City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN).
[PDF File]For a Vehicle, Watercraft, or Mobile Home
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Owner’s Street Address City State Zip Code Daytime Phone Number ( ) Owner’s Driver License or ID Card Number Today’s Date A false statement in connection with a title transaction is a crime. NOTE: Owner must provide a photocopy of their valid driver license or state ID card to the agent listed above. Owner’s Signature: X
[PDF File]CMS-L564 Request for Employment Information
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REQUEST FOR EMPLOYMENT INFORMATION WHAT IS THE PURPOSE OF THIS FORM? In order to apply for Medicare in a Special Enrollment Period, you must have or had group health plan coverage within the last 8 months through your or your spouse’s current employment. People with …
[PDF File]Form 4506-T (Rev. 6-2019)
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Form 4506-T (Rev. 6-2019) Page . 2 . Section references are to the Internal Revenue Code unless otherwise noted. Future Developments. For the latest information about Form 4506-T and its
[PDF File]Application for Social Security Card
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9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST show the parents' Social Security numbers unless the parent was never assigned a Social Security number. If the number is not known and you cannot obtain it, check the “unknown” box. 13.
[PDF File]Mini-Mental State Examination
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5 “Where are we now: State? County? Town/city? Hospital? Floor?” 3 The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of them, if possible. Number of trials: _____ 5
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