INSTRUCTIONS: ALABAMA REFUND REQUEST (Form IB10)

Alabama public agencies and public employees can request a refund of employees' state health insurance premiums by filing form IB10. This document can be obtained from the website of the Alabama State Employees' Insurance Board.

Alabama Refund Request IB10 Step 1: Enter the agency name on the first blank line.

Alabama Refund Request IB10 Step 2: Enter the agency number on the second blank line.

Alabama Refund Request IB10 Step 3: Enter the employee name on the third blank line.

Alabama Refund Request IB10 Step 4: Enter the employee's street address on the fourth blank line.

Alabama Refund Request IB10 Step 5: Enter the employee's city on the fifth blank line.

Alabama Refund Request IB10 Step 6: Enter the employee's state on the sixth blank line.

Alabama Refund Request IB10 Step 7: Enter the employee's zip code on the seventh blank line.

Alabama Refund Request IB10 Step 8: Indicate whether this is a flex plan by checking "Yes" or "No" as applicable.

Alabama Refund Request IB10 Step 9: Enter the employee's Social Security number on the eighth blank line.

Alabama Refund Request IB10 Step 10: Enter the refund amount requested on the ninth blank line.

Alabama Refund Request IB10 Step 11: Enter the beginning and ending dates of the applicable coverage period on the tenth and eleventh blank lines.

Alabama Refund Request IB10 Step 12: The next section concerns the reason for the requested refund, which should be indicated with a check mark next to the appropriate statement. Check the first statement if the employee was terminated, the second statement if the employee retired, or the third statement if the employee began leave without pay. Give the date on which the event occurred.

Alabama Refund Request IB10 Step 13: Check the fourth statement if the employee notified the State Employees' Insurance Board on a certain date to drop coverage for themselves or a dependent. Give the request date and the effective date.

Alabama Refund Request IB10 Step 14: Check the fifth statement if the dependent died and give the date. Check the sixth statement if the employee died and give the date. Check the sixth statement if coverage was paid or deducted in error. Check the seventh statement if there was an employee status change from full time to part time or vice versa. If "other," check the eighth statement and explain.

INSTRUCTIONS: ALABAMA REQUEST FOR REIMBURSEMENT PREFERRED DEPENDENT CARE ACCOUNT (Form CL-91)

To receive reimbursement for child day care, adult day care, before & after school care or other eligible dependent care as an Alabama employee enrolled with a dependent health insurance account administered by BlueCross BlueShield of Alabama, use a form CL-91. This document can be obtained from the website of BlueCross BlueShield of Alabama.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 1: Section 1 concerns the employee. In the first three blank boxes, enter your first name, middle initial and last name.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 2: In the next three blank boxes, enter your date of birth.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 3: In the next two blank boxes, enter your preferred blue account prefix and contract numbers.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 4: In the next blank box, enter your company name.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 5: In the next two blank boxes, enter work and home phone numbers.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 6: Section 2 concerns the dependent care for which you are seeking reimbursement. Indicate whether the service being provided was child day care, adult day care, before & after school care or other eligible dependent care with a check mark.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 8: In the first blank box, enter the first name of the dependent receiving these services.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 9: in the second blank box, enter the last name of the dependent.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 10: In the third blank box, enter the date of birth of the dependent.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 11: In the fourth blank box, enter the age in years of the dependent. Enter the dates of care and cost incurred where indicated.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 12: Document up to four dependents in this section of the form.

Alabama Request For Reimbursement Preferred Dependent Care Account CL-91 Step 13: The DCA provider should sign and date the form where indicated. The employee should do the same.

INSTRUCTIONS: CONNECTICUT INDIVIDUAL LIFE SETTLEMENT BROKER AFFIDAVIT

Every individual who will act as as a life settlement broker in Connecticut on behalf of a form must complete the affidavit discussed in this article. This document can be obtained from the website of the government of Connecticut.

Connecticut Individual Life Settlement Broker Affidavit Step 1: Enter your last name, first name and middle initial on the first blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 2: Enter your title on the second blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 3: Enter your Social Security number on the third blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 4: Enter your residential address on the fourth blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 5: Enter your residential phone number on the fifth blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 6: Enter your business name on the sixth blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 7: Enter your business address on the seventh blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 8: Enter your business phone number on the eighth blank line.

Connecticut Individual Life Settlement Broker Affidavit Step 9: Answer questions 1 through 3 by checking "Yes" or "No" as applicable. In each case, if "yes," provide an explanation.

Connecticut Individual Life Settlement Broker Affidavit Step 10: On line 4, enter your date of birth.

Connecticut Individual Life Settlement Broker Affidavit Step 11: On line 5, list all residences for the last 10 years, beginning with your current address.

Connecticut Individual Life Settlement Broker Affidavit Step 12: On line 6, indicate your highest level of education completed with a check mark. If you have a degree, enter the type.

Connecticut Individual Life Settlement Broker Affidavit Step 13: On line 7, enter any professional designations or memberships.

Connecticut Individual Life Settlement Broker Affidavit Step 14: On line 8, enter all companies in which you control, directly or indirectly, or own legally or beneficially at least 10% or more of the outstanding stock.

Connecticut Individual Life Settlement Broker Affidavit Step 15: Answer questions 9 through 11 by checking "Yes" or "No" as appropriate.

Connecticut Individual Life Settlement Broker Affidavit Step 16: Provide three references on line 12.

Connecticut Individual Life Settlement Broker Affidavit Step 17: Appear before a notary public, who will affix their seal to the bottom of the form.

INSTRUCTIONS: CONNECTICUT CERTIFICATION OF ELIGIBILITY TO RECEIVE LOBBYIST CONTRIBUTIONS DURING LEGISLATIVE SESSION (SEEC Form B-2)

Connecticut political committees established by two or more individuals unaffiliated with a business entity or labor organization must file SEEC Form B-2 to be eligible for contributions during the legislative season from lobbyists registered with the State Ethics Commission and political committees established by or on behalf of a lobbyist. This document can be obtained from the website of the state of Connecticut.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 1: In the first blank box, enter the committee name.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 2: In the second blank box, enter the treasurer's first name.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 3: In the third blank box, enter the treasurer's middle initial.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 4: In the fourth blank box, enter the treasurer's last name.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 5: In the fifth blank box, enter the treasurer's suffix, if applicable.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 6: In the next four blank boxes, give the treasurer's residential street address, city, state and zip code.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 7: If the treasurer's mailing address is different from their residential address, in the next four blank boxes provide their mailing street address, city, state and zip code.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 8: In the next blank box, enter the treasurer's phone number.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 9: In the next blank box, enter the treasurer's email address.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 10: On the first blank line, the treasurer should enter their signature.

Connecticut Certification Of Eligibility To Receive Lobbyist Contributions During Legislative Session SEEC Form B-2 Step 11: On the second blank line, the treasurer should enter the date.

INSTRUCTIONS: CONNECTICUT FINANCIAL INSTITUTION PROCEEDINGS – JUDGMENT DEBTOR WHO IS NOT A NATURAL PERSON, APPLICATION AND EXECUTION (Form JD-CV-24N)

When a Connecticut financial institution is required to withhold funds from a debtor who is a member and not a natural person, they will receive a form JD-CV-24N. This document can be obtained from the website of the Connecticut Judicial Branch.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 1: Enter the address of the court. Indicate with a check mark whether it is a judicial district court, a housing sessions court, or a geographical area court. If the latter, enter its number.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 2: Enter the docket number. These first two steps will be completed by the court.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 3: In the next box, the judgment creditor will already have entered their name and mailing address or that of their attorney. Additional judgment creditors should be listed in the next blank box.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 4: Enter the name and addresses of all judgment debtors in the next box.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 5: In the next box, enter the date of judgment.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 6: In box 1, enter the amount of judgment.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 7: In box 2, enter the amount of costs.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 8: Add boxes 1 and 2. Enter the resulting sum in box 3.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 9: Complete boxes 4 through 8 as directed.

Connecticut Financial Institution Proceedings – Judgment Debtor Who Is Not A Natural Person, Application And Execution JD-CV-24N Step 10: Sign and date the form, as well as providing your telephone number.

INSTRUCTIONS: CONNECTICUT APPLICATION FOR WAIVER OF FEES (Form JD-CV-120)

To apply for a waiver of payment of fees that normally apply in civil housing small claims court in Connecticut, a form JD-CV-120 should be filed. This document can be obtained from the website of the Judicial Branch of the State of Connecticut.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 1: Enter the name of the case and the docket number, if applicable. 

Connecticut Application For Waiver Of Fees JD-CV-120 Step 2: Give the address of the court and indicate with a check mark whether you are giving the judicial district, housing session, geographical area number, or small claims court address.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 3: Enter your name, address and telephone number.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 4: Indicate with a check mark the type of proceeding you are filing concerning.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 5: Indicate with a check mark whether you are filing for a waiver of the entry fee to regular docket or small claims court, the filing fee, the fee for service of process, or another free. If the latter, specify.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 6: Section 1 requires you to enter the number of dependents.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 7: Section 2 requires you to detail your gross monthly income.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 8: Section 3 requires you to detail your monthly expenses, including rent or mortgage payments, real estate taxes, utilities, food, clothing, insurance premiums, medical and dental expenses, transportation costs, child care expenses and other. If the latter specify,

Connecticut Application For Waiver Of Fees JD-CV-120 Step 9: Section 4 requires you to document your assets, including real estate, motor vehicles, other personal property, savings account balances, checking account balances, cash and other assets.

Connecticut Application For Waiver Of Fees JD-CV-120 Step 10: Section 5 requires you to detail your liabilities and debts, such as credit card outstanding balances and loans which are not listed under "Assets."

Connecticut Application For Waiver Of Fees JD-CV-120 Step 11: Sign and complete the top part of the second page in the presence of a clerk court, notary public or commissioner of the Superior Court.