Form P-247 Ignition Interlock Device – Change of Application Record

Form P-247 Ignition Interlock Device - Change of Application Record

Form R-370 Requirements for Public Passenger Endorsements

Form R379 Affidavit of Possession

Form M-46 Special Order Veteran Plate Application

INSTRUCTIONS: CONNECTICUT SPECIAL ORDER VETERAN PLATE APPLICATION (Form M-46)

To request a special veteran plate as a Connecticut resident who is an active duty military member, a veteran or the surviving spouse of a veteran, use a form M-46. This document can be obtained from the website of the government of Connecticut.

Connecticut Special Order Veteran Plate Application M-46 Step 1: Section 1 concerns the registrant. Enter their last name, first name and middle initial as it appears on their registration in the first blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 2: Enter the registrant's street address and city or town in the second blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 3: Enter the registrant's zip code in the third blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 4: Enter the registrant's daytime telephone number in the fourth blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 5: Section 2 concerns the vehicle. Enter its present plate number in the first blank box and the date its registration expires in the second blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 6: Enter the registration type in the third blank box and indicate whether the vehicle is leased in the fourth blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 7: Enter the vehicle year, make and model in the next three blank boxes.

Connecticut Special Order Veteran Plate Application M-46 Step 8: Enter the vehicle identification number in the next blank box.

Connecticut Special Order Veteran Plate Application M-46 Step 9: Section 3 concerns the address to which the plates should be mailed.

Connecticut Special Order Veteran Plate Application M-46 Step 10: In section 4, list your requested vanity plates in preferential order. You may list up to 6 requested vanity plates.

Connecticut Special Order Veteran Plate Application M-46 Step 11: Indicate whether you wish to replace your current plate and change it to the next available veteran plate background series, to maintain your current plate and change it to a veteran plate background, or whether you wish to acquire a new vanity plate with a veteran plate background.

Connecticut Special Order Veteran Plate Application M-46 Step 12: Enter your signature and the date at the bottom of the form.

Form B-330 Flashing White Headlamp Permit

Form D-47 Registration Issuance Bond

INSTRUCTIONS: CONNECTICUT REGISTRATION ISSUANCE BOND MOTOR VEHICLE DEALER (Form D-47)

Connecticut motor vehicle dealers required to file a surety bond for $5,000 document their payment using a form D-47. This document can be obtained from the website maintained by the government of the state of Connecticut.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 1: Enter the bond number on the first blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 2: Enter the name of a principal officer on the second blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 3: Enter the name of a second officer on the third blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 4: Enter the name of the corporation on the fourth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 5: Enter the name of the state under whose laws the corporation was organized on the fifth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 6: Enter the name of the party to which payment was made on the sixth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 7: Enter the name of the licensed motor vehicle dealer on the seventh blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 8: Enter the date on which you are signing on the eighth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 9: Enter the month in which you are signing on the ninth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 10: Enter the last two digits of the year in which you are signing on the tenth blank line.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 11: In the first blank box at the bottom of the page, the witness of the principal should provide their signature.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 12: The principal should enter their name in the second blank box and their signature in the third blank box.

Connecticut Registration Issuance Bond Motor Vehicle Dealer D-47 Step 13: In the last four blank boxes, enter the signature of the witness of the attorney-in-fact, the name of the surety, the printed name of the attorney-in-fact and the signature of the attorney-in-fact.

Application for Registration of Anesthesiologist Assistant

INSTRUCTIONS: ALABAMA APPLICATION FOR REGISTRATION OF ANESTHESIOLOGIST ASSISTANT

Alabama physicians register an anesthesiologist assistant by filing the form discussed in this article. This document can be obtained from the website maintained by the Alabama Board of Medical Examiners.

Alabama Application For Registration Of Anesthesiologist Assistant Step 1: The first page should be completed by the supervising physician. Enter your name on the first blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 2: Enter your Alabama medical license number on the second blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 3: Enter your date of birth on the third blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 4: Enter your Social Security number on the fourth blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 5: Enter your medical specialty on the fifth blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 6: Indicate whether you are board certified by circling "Yes" or "No" as applicable.

Alabama Application For Registration Of Anesthesiologist Assistant Step 7: Indicate whether you are board eligible by circling "Yes" or "No" as applicable.

Alabama Application For Registration Of Anesthesiologist Assistant Step 8: Enter your principal practice location address on the sixth blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 9: If your mailing address is different from your principal practice location address, enter it on the seventh blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 10: Enter your telephone number, including the area code, on the next blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 11: Enter your fax number, including the area code, on the next blank line.

Alabama Application For Registration Of Anesthesiologist Assistant Step 12: In section 1, enter the name, practice side and designated working hours per week of every anesthesiologist assistant currently registered to you.

Alabama Application For Registration Of Anesthesiologist Assistant Step 13: In section 2, indicate with a check mark whether you have ever had an anesthesiologist assistant certified or registered to you by the Alabama Board of Medical Examiners. If yes, list their names.

Alabama Application For Registration Of Anesthesiologist Assistant Step 14: In section 3, indicate whether the anesthesiologist assistant for whom registration is sought is employed by you, your group, your partnership or professional corporation. Have the assistant complete the second page before filing.

Data Request for License Data Guidelines

Request for Exam for Record Purposes

INSTRUCTIONS: ALABAMA REQUEST FOR EXAM FOR RECORD PURPOSES

Those licensed in Alabama as professional engineers may file the form discussed in this article to request that they be allowed to take an exam for record purposes. This document may be obtained from the website maintained by the Alabama State Board of Licensure for Professional Engineers and Land Surveyors.

Alabama Request For Exam For Record Purposes Step 1: Enter your license number on the first blank line.

Alabama Request For Exam For Record Purposes Step 2: Enter the name of the exam you wish to take on the second blank line.

Alabama Request For Exam For Record Purposes Step 3: Enter the date of the exam you wish to take on the third blank line.

Alabama Request For Exam For Record Purposes Step 4: If taking the 16 hour structural exam, on the fourth blank line write whether you are taking the Vertical Forces portion on Friday and/or the Lateral Forces portion on Saturday.

Alabama Request For Exam For Record Purposes Step 5: Print your name on the fifth blank line.

Alabama Request For Exam For Record Purposes Step 6: Enter your street address on the sixth blank line.

Alabama Request For Exam For Record Purposes Step 7: Enter your city, state and zip code on the seventh blank line.

Alabama Request For Exam For Record Purposes Step 8: Enter your daytime telephone number, including the area code, on the eighth blank line.

Alabama Request For Exam For Record Purposes Step 9: Enter your current company name on the ninth blank line.

Alabama Request For Exam For Record Purposes Step 10: Enter your email address on the tenth blank line.

Alabama Request For Exam For Record Purposes Step 11: Mail the form to the address given at the top of the page.

Alabama Request For Exam For Record Purposes Step 12: Once this form has been received and processed by the Alabama State Board of Licensure for Professional Engineers and Land Surveyors, you will receive an email with your Alabama Candidate ID number, as well as instructions on how to register with the NCEES advanced licensure for engineers and surveyors. This email will also include instructions on how to pay the exam fee. Do not register with NCEES until you have received your Alabama Candidate ID number.

Form IB15 Retired State Employee Plan Change Form

INSTRUCTIONS: ALABAMA RETIRED EMPLOYEE PLAN CHANGE FORM (Form IB15)

Retired Alabama employees of the state can change their health insurance coverage by filing a form IB15. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Retired Employee Plan Change Form IB15 Step 1: At the top of the form, check the box next to the type of coverage you wish to obtain.

Alabama Retired Employee Plan Change Form IB15 Step 2: On the first line, provide your name, sex and the effective date of your current coverage.

Alabama Retired Employee Plan Change Form IB15 Step 3: On the second line, provide your Social Security number and date of birth.

Alabama Retired Employee Plan Change Form IB15 Step 4: On the third line, provide your street address.

Alabama Retired Employee Plan Change Form IB15 Step 5: On the fourth line, provide your city, state and zip code.

Alabama Retired Employee Plan Change Form IB15 Step 6: On the fifth line, provide your email address, as well as your work and home phone numbers.

Alabama Retired Employee Plan Change Form IB15 Step 7: If you are seeking to enroll in basic medical coverage administered under the Blue Cross SEHIP program, you must document your dependents. On the first line, enter the name of your husband or wife. Indicate which they are by circling the appropriate label and enter their birthdate and Social Security number.

Alabama Retired Employee Plan Change Form IB15 Step 8: On the remaining lines, provide the same information for any sons, daughters, stepsons or stepdaughters.

Alabama Retired Employee Plan Change Form IB15 Step 9: If you are seeking to obtain Southland Optional coverage for hospital indemnity or vision, dental or cancer treatment, you must complete the last section. On the first line, enter the name of your current health insurance company, the name of the contract holder, the insurance policy and group numbers, and the name of the employer providing this coverage.

Alabama Retired Employee Plan Change Form IB15 Step 10: The second line asks if dental coverage is available under this retirement plan. Circle "Yes" or "No."

Alabama Retired Employee Plan Change Form IB15 Step 11: If dental coverage is provided, provide all information requested about it on the last line. Sign and date the bottom of the page.

Other

Copy Request via Fax

CD/TAPE ORDER