INSTRUCTIONS: ALABAMA HEALTH INSURANCE ENROLLMENT FORM (Form IB02)

Alabama state employees can enroll in state-administered health insurance using form IB02. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama Health Insurance Enrollment Form IB02 Step 1: Check the first box if applying for SEHIP basic medical coverage administered through Blue Cross.

Alabama Health Insurance Enrollment Form IB02 Step 2: Check the second box if applying supplemental coverage for secondary medical care administered through Blue Cross.

Alabama Health Insurance Enrollment Form IB02 Step 3: Check the third box if applying for optional policies covering vision, dental, cancer or hospital indemnity administered through Southland National.

Alabama Health Insurance Enrollment Form IB02 Step 4: Check the fourth box if you are declining coverage.

Alabama Health Insurance Enrollment Form IB02 Step 5: Enter your name in the first blank box.

Alabama Health Insurance Enrollment Form IB02 Step 6: Enter your sex in the second blank box.

Alabama Health Insurance Enrollment Form IB02 Step 7: Enter your Social Security number in the third blank box.

Alabama Health Insurance Enrollment Form IB02 Step 8: Enter your date of birth in the fourth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 9: Enter your street address in the fifth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 10: Enter your city in the sixth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 11: Enter your state in the seventh blank box.

Alabama Health Insurance Enrollment Form IB02 Step 12: Enter your zip code in the eighth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 13: Enter your home telephone number in the ninth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 14: Enter your work phone number in the tenth blank box.

Alabama Health Insurance Enrollment Form IB02 Step 15: Enter your email address in the eleventh blank box.

Alabama Health Insurance Enrollment Form IB02 Step 16: Document your dependents as instructed in the table provided.

Alabama Health Insurance Enrollment Form IB02 Step 17: If applying for supplemental coverage or Southland, complete the next section concerning additional group health insurance coverage information.

Alabama Health Insurance Enrollment Form IB02 Step 18: Have your employer complete the bottom left hand corner.

Alabama Health Insurance Enrollment Form IB02 Step 19: Sign and date the form where indicated.

INSTRUCTIONS: ALABAMA NOTICE OF CANCELLATION (WC Form 9)

Businesses operating in Alabama use WC Form 8 to notify the state Department of Labor that they have purchased worker's compensation insurance as required by law. WC Form 9, which is discussed in this article, is used to notify the department of the cancellation of this policy. This document can be obtained from the website maintained by the Alabama Department of Labor.

Alabama Notice Of Cancellation WC 9 Step 1: On the first blank line, enter the business state unemployment compensation tax number.

Alabama Notice Of Cancellation WC 9 Step 2: On the second blank line, enter the federal ID number.

Alabama Notice Of Cancellation WC 9 Step 3: On the third blank line, enter the name of your corporation or limited liability company (LLC).

Alabama Notice Of Cancellation WC 9 Step 4: On the fourth blank line, enter the "doing business as" (dba) name of your company.

Alabama Notice Of Cancellation WC 9 Step 5: On the fifth blank line, enter the address of your primary business location.

Alabama Notice Of Cancellation WC 9 Step 6: On the sixth blank line, enter other locations covered in this notice.

Alabama Notice Of Cancellation WC 9 Step 7: On the seventh blank line, enter the nature of your business.

Alabama Notice Of Cancellation WC 9 Step 8: On the eighth blank line, enter your NAICS code number.

Alabama Notice Of Cancellation WC 9 Step 9: On the ninth blank line, enter the date of the cancellation of your workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 10: On the tenth blank line, state the reason for your cancellation of the workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 11: On the eleventh blank line, enter the policy number of the workers' compensation insurance.

Alabama Notice Of Cancellation WC 9 Step 12: On the twelfth blank line, enter the name of the carrier of the cancelled workers' compensation insurance policy.

Alabama Notice Of Cancellation WC 9 Step 13: On the thirteenth blank line, enter the NCCI code of the insurance carrier of the cancelled workers' compensation insurance policy.

Alabama Notice Of Cancellation WC 9 Step 14: File the form by mailing it to the address given at the top of the page.

INSTRUCTIONS: ARIZONA ANNUAL FINANCIAL REPORT FOR BINGO LICENSE CLASS "A" (Form 71-1013)

Arizona bingo games conducted by an establishment with a class "A" license document their proceeds using a form 71-1013. This document can be obtained from the website of the Arizona Department of Revenue.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 1: Enter the beginning and ending dates of your financial reporting period.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 2: Indicate with a check mark if this is an amended report.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 3: In the first blank box, enter the licensee's name and address.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 4: In the second blank box, enter the license number.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 5: In the third blank box, enter the licensee's phone number, including the area code.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 6: On line 1, enter your gross receipts.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 7: On line 2, enter the prizes paid out.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 8: Subtract line 2 from line 1. Enter the resulting difference on line 3. This figure represents your adjusted gross receipts.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 9: On line 4, enter the bingo expenses paid. You should provide a brief description of any bingo expenses paid such as bingo paper, daubers or other supplies. Attach a separate page listing the purpose and amount of each expense.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 10: On line 5, enter the expenditures of net proceeds.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 11: Multiply the amount on line 3 by 2.5%. Enter the resulting product on line 6. a

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 12: Enter the penalty and interest due, if any, on line 7.

Arizona Annual Financial Report For Bingo License Class "A" 71-1013 Step 13: Add lines 6 and 7. Enter the resulting sum on line 8. Sign and date the form and enter your title at the bottom of the page.

INSTRUCTIONS: CONNECTICUT PREFERRED PROVIDER NETWORK (PPN) LICENSE INSTRUCTIONS AND APPLICATION (RENEWAL)

To apply for a renewal of a license to act as a Connecticut preferred provider network (PPN), use the application discussed in this article. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 1: The first page contains general instructions.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 2: Enter the name of the PPN on the first blank line of the second page.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 3: Enter the PPN license number on the second blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 4: Enter the PPN tax identification number or federal employer identification number on the third blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 5: Enter the PPN business address on the fourth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 6: Enter the PPN mailing address, if different, on the fifth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 7: Enter the PPN phone number on the sixth blank line.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 8: Answer the three questions on this page by filling in the oval next to "yes" or "no" as applicable. Note that if you answer either of the first two questions "yes," you are not required to complete this application. 

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 9: On the third page, answer the first question about whether any suspensions, sanctions or disciplinary actions have been taken against the controlling company or organization in the last 10 years in any state by filling in "yes" or "no" as applicable. If yes, provide an explanation.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 10: Enter a description of the PPN's service area.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 11: Enter the number of total enrollees served by the PPN both nationwide and in Connecticut.

Connecticut Preferred Provider Network (PPN) License Instructions And Application (Renewal) Step 12: Complete the rest of the application as instructed.

INSTRUCTIONS: CONNECTICUT 2012 CONSUMER REPORT CARD – PART 1

Connecticut managed care organizations are required to file an annual consumer report card in two parts. This article discusses part 1 of this form, which can be obtained from the website maintained by the government of Connecticut.

Connecticut 2012 Consumer Report Card – Part 1 Step 1: On the first page, enter the name and address of the managed care organization, the name and title of a contact person, and a contact phone number and email address.

Connecticut 2012 Consumer Report Card – Part 1 Step 2: Enter the total Connecticut direct written health premiums from managed care plans.

Connecticut 2012 Consumer Report Card – Part 1 Step 3: Indicate whether you are profit or not for profit with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 4: Indicate whether you are an HMO or indemnity organization with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 5: Indicate with a check mark whether you have applied for NCQA accreditation. If yes, indicate what kind of accreditation you received with a check mark.

Connecticut 2012 Consumer Report Card – Part 1 Step 6: Indicate with a check mark whether you market managed care to individuals. If yes, indicate whether you offer care directly or through an association.

Connecticut 2012 Consumer Report Card – Part 1 Step 7: On the second page, indicate whether you contract directly with providers or with individual networks and answer all other questions about your services.

Connecticut 2012 Consumer Report Card – Part 1 Step 8: The third page concerns your federal medical loss ratio, customer service information, utilization review data, percentage of employers or groups that did not renew their contracts in the previous year, and enrollment.

Connecticut 2012 Consumer Report Card – Part 1 Step 9: The fourth page requires you to document the total number of participating primary care physicians and participating physician specialists located in each county of Connecticut as of the end of the previous calendar year.

Connecticut 2012 Consumer Report Card – Part 1 Step 10: The fifth page requires you to document the total number of participating acute care hospitals and pharmacies located in each county of Connecticut as of the end of the previous calendar year. An officer should sign and date the bottom of the page.

INSTRUCTIONS: CONNECTICUT EXEMPTION CLAIM FOR PROPERTY EXECUTION (Form JD-CV-5b)

Following the issue of a judgment of execution against property in a Connecticut case between a creditor and debtor, the creditor or their attorney must complete a form JD-CV-5b, which will then be served to the debtor to give them the opportunity to claim an exemption for part or all of the property in question. This document can be obtained from the website of the Connecticut Judicial Branch.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 1: At the top of the form, enter the name and mailing address of the judgment debtor or their attorney.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 2: Section 1 must be completed by the Judgment Creditor or their attorney  In the first blank box, enter the address of the court. Indicate with a check mark whether it is a geographical area, judicial district or housing session court.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 3: Enter the case name in the second blank box.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 4: Enter the docket number in the third blank box.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 5: Enter the name of the judgment debtor in the fourth blank box.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 6: Section 2 must be completed by the proper officer. In the first blank box, enter the date of service of execution.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 7: In the second blank box, enter the name and address of the second blank box.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 8: In the third blank box, enter the name and address of the third person served with execution, if applicable.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 9: In the fourth blank box, enter their telephone number, if known.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 10: Section 3 must be completed by the third person served with execution, if any. Enter the date on which they mailed the execution to the judgment debtor.

Connecticut Exemption Claim For Property Execution JD-CV-5b Step 11: Upon receipt of this form, the debtor may complete Section 5 if they wish to claim an exemption on part or all of the property in dispute.

https://legal-forms.laws.com/connecticut/form-jd-cv-49cal-motion-for-defaultfailure-to-appearjudgmentorder

INSTRUCTIONS: CONNECTICUT MOTION FOR DEFAULT FOR FAILURE TO APPEAR, JUDGMENT AND ORDER FOR WEEKLY PAYMENTS (Form JD-CV-49CAL)

In a Connecticut case where the debtor has failed to file an appearance within two days of the return date, a form JD-CV-49CAL is filed to request a motion for default and an order for weekly payments. This document can be obtained from the website of the Connecticut Judicial Branch.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 1: Enter the return date and the docket number at the top right-hand corner.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 2: Indicate with a check mark whether the case is being processed by a judicial district court, a housing session court, or a geographical area court. If the latter, give its number. Enter the address of the court.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 3: Enter the name of the case.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 4: Enter the name of all defendants against whom the motion is being filed.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 5: In the next section, indicate whether you are seeking nominal or reasonable weekly payments. If the latter, enter the amount of weekly payment you wish to be ordered.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 6: Enter the name and address of the person completing this form, who should also provide their signature, indicate whether they are the plaintiff or their attorney with a check mark, and provide the date.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 6: The next section requires you to state whether you are unaware of the defendant's military service or if you are aware for a fact they are not in the military.

Connecticut Motion For Default For Failure To Appear, Judgment And Order For Weekly Payments JD-CV-49CAL Step 7: In the bottom left-hand corner, enter your debts for each category listed. Complete the section on the right when all defendants have been served with a copy of this form.

INSTRUCTIONS: CONNECTICUT AFFIDAVIT RE: EXEMPT FUNDS (Form JD-CV-73)

When a judgment creditor in a Connecticut foreclosure case believes some of the funds designated exempt from execution by the debtor are eligible, they should file a form JD-CV-73 to request a hearing on the status of their exemption status. This document can be obtained from the website maintained by the Connecticut Judicial Branch.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 1: Enter the docket number in the first blank box.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 2: Enter the name of the case in the second blank box.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 3: If the case is being processed by a judicial district, check the box and enter the district name.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 4: If the case is being processed by a small claims area, check the box and enter its location.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 5: If the case is being processed by a housing session, check the box and enter its location.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 6: If the case is being processed by a G.A., check the box and enter its location.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 7: Enter your name on the next blank line.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 8: In section 2, provide your written explanation as to why you believe the judgment debtor's account contains funds which are not exempt from execution. 

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 9: In section 3, enter the dollar amount you believe is not exempt.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 10: The form should be signed on the blank line where indicated in the presence of a court clerk, commissioner of the Superior Court, or a notary public, who will also sign and date the form.

Connecticut Affidavit Re: Exempt Funds JD-CV-73 Step 11: After submission to the court, the judge will review your request. If they agree you have provided the basis for a reasonable belief that some funds are not exempt, they will check the first box where indicated and authorize the judgment creditor to submit a written application for a hearing on this subject. If they do not agree, they will check the second box.