Baltimore city police email
[PDF File]Request for Social Security Earnings Information
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City ZIP Code 4. I am the individual to whom the record pertains (or a person authorized to sign on behalf of that individual). I understand that any false representation to knowingly and willfully obtain information from Social Security records is punishable by a fine of not more than $5,000 or one year in prison.
[PDF File]Designation of Beneficiary
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Department or agency Bureau or division Location (city, state, and ZIP code) First name, middle initial, and last name of each beneficiary Social Security Number Address (Including ZIP code) Percent or fraction designated Relationship B. Information About the Beneficiary or Beneficiaries (See Back of Part 1 for examples) (type or print)
[PDF File]Declaration for Federal Employment* OMB No. 3206-0182
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(Include city and state or country) ... the violation, place of occurrence, and the name and address of the police department or court involved. YES; NO 12. During the last 5 years, have you been fired from any job for any reason, did you quit after being told that you
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit an inquiry to AEVS to verify a recipient’s eligibility for
[PDF File]Statement of Death by Funeral Director
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Form SSA-721 (5-2005) ef (8-2008) Use 1-2004 edition until supply is exhausted. SOCIAL SECURITY ADMINISTRATION. STATEMENT OF DEATH BY FUNERAL DIRECTOR. Form Approved OMB No. 0960-0142. NAME OF DECEASED. SOCIAL SECURITY NUMBER
[PDF File]STATE CONTACT INFO REQUIREMENTS/PROCEDURES ALABAMA
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Email: dcfs.childprotectiveservices.d cfs@la.gov The following types of clearances must be submitted through the Louisiana Child Abuse and Neglect Clearance System (CANS): Clearances for out of state licensed child care facility employees/volunteers (must be ... Baltimore, MD 21201
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,
[PDF File]Form 911 Request for Taxpayer Advocate Service Assistance ...
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request to the TAS office in your state or city. You can find the fax number in the government listings in your local telephone directory, on our website at www.taxpayeradvocate.irs.gov, or in Publication 1546, Taxpayer Advocate Service - Your Voice at the IRS. • You also can mail this form.
[PDF File]APPLICATION FOR CERTIFICATE OF TITLE
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APPLICANT’S STREET ADDRESS CITY OR TOWN CO-APPLICANT’S STREET ADDRESS CITY OR TOWN COUNTY STATE ZIP CODE EMAIL ADDRESS COUNTY STATE ZIP CODE EMAIL ADDRESS ... (Email address) (Phone) ... preventative maintenance program approved by the Motor Vehicle Administration and the Maryland State Police Automotive Safety Enforcement Division.
[PDF File]Consent for Release of Information
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If you want us to release a minor child's medical records, do not use this form. Instead, contact your local Social Security office. I am the individual, to whom the requested information or record applies, or the parent or legal guardian of a minor, or the
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