INSTRUCTIONS: ALABAMA SOUTHLAND NATIONAL SUPPLEMENTAL VISION INSURANCE ENROLLMENT/CANCELLATION FORM (Form IB20)

Alabama state employees may enroll or cancel their enrollment in supplemental vision insurance administered by Southland National by filing form IB20. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 1: Enter your name in the first blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 2: Enter your sex in the second blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 3: Enter the effective date in the third blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 4: Enter your Social Security number in the fourth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 5: Enter your date of birth in the fifth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 6: Enter your mailing address in the sixth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 7: Enter your city in the seventh blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 8: Enter your state in the eighth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 9: Enter your zip code in the ninth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 10: Enter your home telephone number in the tenth blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 11: Enter your work telephone number in the eleventh blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 12: Indicate whether you are enrolling for single coverage, family coverage or are cancelling your enrollment with a check mark.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 13: Enter your email address in the next blank box.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 14: If applicable, document all dependents in the table provided.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 15: Enter your signature on the next blank line.

Alabama Southland National Supplemental Vision Insurance Enrollment/Cancellation Form IB20 Step 16: Enter the date on the last blank line.

INSTRUCTIONS: ALABAMA FEDERAL POVERTY LEVEL ASSISTANCE APPLICATION (FDL) AND CHILDREN'S HEALTH INSURANCE PROGRAM APPLICATION (CHIP) (Form PEEHIP FPL & CHIP)

To apply for federal poverty level assistance or the state administered children's health insurance program while working as an Alabama public education employee, use the application discussed in this article. This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 1: Indicate with a check mark whether you are applying for FDL, CHIP or both.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 2: The first section concerns the public employee subscriber. On the first line, enter your Social Security number, first name, middle name or initial and last name.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 3: On the second line, enter the subscriber's mailing address, city, state and zip code.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 4: On the third line, enter the subscriber's home phone number and work phone number.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 5: Indicate your marital status with a check mark.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 6: The next section is for CHIP applicants. Indicate whether any child is covered under Medicaid with a check mark. If yes, give the names of the eligible children.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 7: Document all household members where indicated. Provide their name, Social Security number, date of birth, age, sex and relationship to you. Enter your information on line A, that of your spouse on line B, and those of all dependents under 19 years of age living in your home on lines C through F.

Alabama Federal Poverty Level Assistance Application (FDL) And Children's Health Insurance Program Application (CHIP) PEEHIP FPL & CHIP Step 8: Answer all remaining questions with check marks, then sign and date the bottom of the page.

INSTRUCTIONS: CONNECTICUT LIFE SETTLEMENT PROVIDER RENEWAL APPLICATION

To renew your license to act as a Connecticut life settlement provider, use the form discussed in this article. This document can be obtained from the website of the government of Connecticut.

Connecticut Life Settlement Provider Renewal Application Step 1: Enter the name of the life settlement provider on the first blank line.

Connecticut Life Settlement Provider Renewal Application Step 2: Enter the date on which you are sending the form on the second blank line.

Connecticut Life Settlement Provider Renewal Application Step 3: Enter the name of a contact person for further questions or correspondence on the third blank line.

Connecticut Life Settlement Provider Renewal Application Step 4: Enter a contact address on the next two blank lines.

Connecticut Life Settlement Provider Renewal Application Step 5: Enter a contact phone number on the sixth blank line.

Connecticut Life Settlement Provider Renewal Application Step 6: Enter a contact fax number on the seventh blank line.

Connecticut Life Settlement Provider Renewal Application Step 7: Enter a contact email address on the eighth blank line.

Connecticut Life Settlement Provider Renewal Application Step 8: Enter the expiration date of your current license on the ninth blank line.

Connecticut Life Settlement Provider Renewal Application Step 9: The remainder of the first page and the entirety of the second page contains a checklist of documentation that must be attached to your application.

Connecticut Life Settlement Provider Renewal Application Step 10: Enter your signature on the first blank line on the third page.

Connecticut Life Settlement Provider Renewal Application Step 11: Print your name on the second blank line.

Connecticut Life Settlement Provider Renewal Application Step 12: Enter your title on the third blank line.

Connecticut Life Settlement Provider Renewal Application Step 13: The form should then be presented to a notary public, who will sign the document and affix their seal.

Connecticut Life Settlement Provider Renewal Application Step 14: Cut a check for $40. This is the fee for processing of your form. This check should be made out to "Treasurer, State of Connecticut."

Connecticut Life Settlement Provider Renewal Application Step 15: Mail the form to the address given at the top of the first page along with all required supporting documentation and your check. Allow a minimum of 30 days for processing to ensure your license is renewed in a timely fashion.

INSTRUCTIONS: CONNECTICUT CITIZENS' ELECTION PROGRAM – APPLICATION FOR GRANT (SEEC Form CEP 15)

Statewide and general assembly Connecticut candidates may apply for a grant from the citizens' election program by filing a SEEC form CEP 15. This document can be obtained from the website of the government of Connecticut.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 1: Section A concerns identifying information. In box 1, enter the election date.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 2: In box 2, enter the office sought.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 3: In box 3, enter the district number.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 4: In box 4, enter the candidate's name.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 5: In box 5, enter the committee's name.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 6: In box 6, enter the treasurer's name.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 7: In box 7, enter the deputy treasurer's name.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 8: Section B is optional if you wish to request continuation without prejudice.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 9: Section C should be completed by the candidate. The candidate's initials should be placed next to statements 1 through 12.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 10: The candidate should sign and date the bottom of the seventh page.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 11: Section D should be completed by the treasurer. The treasurer's initials should be placed next to statements 1 through 12.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 12: The treasurer should sign and date the bottom of the ninth page.

Connecticut Citizens' Election Program – Application For Grant SEEC Form CEP 15 Step 13: Section E should be completed by the deputy treasurer. Their initials should be placed next to statements 1 through 11. They should also sign and date the bottom of the eleventh page.

INSTRUCTIONS: CONNECTICUT WAGE EXECUTION PROCEEDINGS APPLICATION, ORDER, EXECUTION (Form JD-CV-3)

In Connecticut cases where a judgment creditor has received a ruling in their favor to garnish debtor wages, a form JD-CV-3 is completed and sent to the employer. This document can be obtained from the website maintained by the Connecticut Judicial Department.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 1: The Application section should be completed by the judgment creditor or their attorney. In the first blank box, give the name of the address. Indicate with a check mark whether this is a judicial district, housing session or geographical area court. If the latter, give its number.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 2: In the second blank box, enter the case docket number.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 3: In the third blank box, enter the amount of the weekly, monthly or other payments ordered.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 4: In the fourth blank box, enter the commencement date.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 5: In the fifth blank box, enter the name and address of all judgment creditors.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 6: In the sixth blank box, enter the name and address of all judgment debtors.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 7: In the seventh blank box, if known, enter the name and address of the debtor employer. Enter their telephone number, if known, in the eighth blank box.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 8: In box 1, enter the amount of the judgment. 

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 9: In box 2, enter the amount of costs and fees.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 10: In box 3, enter the total of boxes 1 and 2.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 11: In box 4, enter the total amount paid, if any.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 12: In box 5, enter the total amount unpaid.

Connecticut Wage Execution Proceedings Application, Order, Execution JD-CV-3 Step 13: Complete the remainder of the application as directed and return it to the court.

INSTRUCTIONS: CONNECTICUT PETITION FOR ORDER RE: COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES AND NOTICE OF HEARING (Form JD-CV-68)

When a case has been pending before the Connecticut Commission on Human Rights and Opportunities for more than two years after the date of filing, is not a pattern, practice or systemic case and no finding of reasonable cause or no reasonable cause has been issued by the date ordered by the commission's executive director, a form JD-CV-68 should be filed to request a finding. This document can be obtained from the website of the Connecticut Judicial Department.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 1: In the first blank box, enter the name of the petitioner.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 2: In the next blank box, enter the address of the petitioner.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 3: In the next blank box, enter the name of the respondent named in the original complaint.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 4: In the next blank box, enter the address of the respondent named in the original complaint. 

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 5: If additional respondents need to be named, attach a separate piece of paper for additional documentation.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 6: In the next blank box, enter the Commission on Human Rights and Opportunities case name.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 7: In the next blank box, enter the Commission on Human Rights and Opportunities case number.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 8: The petitioner or their attorney should enter their name in the next blank box.

Connecticut Petition For Order Re: Commission On Human Rights And Opportunities And Notice Of Hearing JD-CV-68 Step 9: Enter the attorney's juris number, the date and a telephone number in the last three blank boxes.