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[PDF File]IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM HEALTH CARE ...
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note: the ihss worker may contact you for additional information or to clarify the responses you provided above. c. health care information (to be completed by a licensed health care professional only) note: items #1 & 2 (and 3 & 4, if applicable) must be completed as a condition of ihss eligibility.
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[PDF File]BILL OF SALE
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BILL OF SALE VEHICLE INFORMATION Make: _____ Model: _____ Year: _____ Style: _____ Color: _____ VIN# _____
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[PDF File]Department of Taxation and Finance Instructions for Form ...
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Payments for charitable purposes (estates and trusts only) The additions and subtractions for Form IT-205, schedule B, lines 63 and 67 and items A-102, S-217, and S-116, S-117, S-121, and S-123 need not be made with respect to any amount paid or set aside for charitable purposes. S corporation shareholders
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[PDF File]For Your Benefit: California's Programs for the Unemployed ...
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Note: For faster processing, certify through UI Online or EDD Tele-Cert. Payments Payments are issued after you certify for benefits and continue to meet all eligibility requirements for every week you claim benefits. EDD Debit CardSM After your first payment is authorized, Bank of America will mail you an EDD Debit Card.
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[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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State-funded. Provides payment of premiums, co-payments, deductibles and coverage for non-covered cancer-related services for eligible all-age individuals, including undocumented aliens, who have been diagnosed with breast and/or cervical cancer, if premiums, co-payments and deductibles are greater than $750.
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[PDF File]Form W-9 (Rev. October 2018)
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Note: If the account is in more than one name, see the instructions for line 1. ... cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II ...
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[PDF File]Disability Report- Adult
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Note: If you are assisting someone else with this report, please answer the questions as if that ... federally-funded or administered benefit programs and for repayment of payments or delinquent debts under these programs. ... can help you with your claim. 2.A. Name (First, Middle Initial, Last) 2.C.
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[PDF File]Designation of Beneficiary
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Note: If you need more space when completing this form, see "What if I need more room?" in the instructions on the Back of Part 2. Examples of Designations 1. How to designate one beneficiary Show beneficiary's full name. Do not write names as M.E. Brown or as Mrs. John H. Brown.
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[PDF File]STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR ...
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state of florida department of highway safety and motor vehicles – division of motorist services submit this form to your local tax collector office
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[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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Form 941-V, Payment Voucher. Purpose of Form. Complete Form 941-V if you're making a payment with Form 941. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Making Payments With Form 941. To avoid a penalty, make your payment with Form 941 . only if:
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[PDF File]MEDICARE CREDIT BALANCE REPORT
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participating providers to furnish information about payments made to them, and to refund any monies incorrectly paid. In accordance with these provisions, all providers participating in the Medicare program are to complete a Medicare Credit Balance Report (CMS-838) to help ensure that monies owed to Medicare are repaid in a timely manner.
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Help with car note payments