List of people last names
[PDF File]FL-150 INCOME AND EXPENSE DECLARATION
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Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) FL-150 [Rev. January 1, 2019]
[PDF File]Application for Social Security Card
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Application for a Social Security Card. ... (e.g., your date of birth, age, or parents' names). Generally, documents without an expiration date should have been issued within the past two years for adults and within the past four years for ... you should sign with an "X” mark and have two people sign as witnesses in
[PDF File]Form W-9 (Rev. October 2018)
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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). However, for a
[PDF File]DM13001 Desk Blotter - Tulsa County, Oklahoma
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Offense Type Offense Description Case Number Disposition Date/Time Disposition MISDEMEANOR BOND/RECKLESS CONDUCT OF FIREARM CM-19-3911 MISDEMEANOR BOND/PUBLIC …
[PDF File]VA Form 10-10EZR
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Mail the completed VA Form 10-10EZR and any supporting materials to the Health Eligibility Center, 2957 Clairmont Road, Suite 200, Atlanta, GA 30329. The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of Section 3507 of the Paperwork Reduction Act of 1995.
[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 disabilities must have large
[PDF File]2018 Instructions for Form 709
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year basis. List all reportable gifts made during the calendar year on one Form 709. This means you must file a separate return for each calendar year a reportable gift is given (for example, a gift given in 2018 must be reported on a 2018 Form 709). Do not file more than one Form 709 for any 1 calendar year. How To Complete Form 709 1.
[PDF File]Request for Social Security Earnings Information
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Form . SSA-7050-F4 (03-2019) Page 2 of 4. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION . 1. Provide your name as it appears on your most recent Social …
[PDF File]Patient Health Questionnaire (PHQ-9)
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Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days ... Moving or speaking so slowly that other people could have noticed. Or the opposite being so figety or restless that you have been moving around a …
[PDF File]Vaccine Information Statement: Inactivated Influenza Vaccine
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Influenza vaccine can prevent influenza (flu). Flu is a contagious disease that spreads around the United States every year, usually between October and May. Anyone can get the flu, but it is more dangerous for some people. Infants and young children, people 65 years of age and older, pregnant women, and people with certain health conditions or
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