INSTRUCTIONS: CONNECTICUT REQUEST FOR PERMISSION TO CONDUCT SPECIAL INTEREST ACTIVITY ON PREMISES OF THE DEPARTMENT (Form LS-5)

To request permission to conduct a special interest activity on the premises of an office of the Connecticut Department of Motor Vehicles, file a form LS-5. This document can be obtained from the website of the government of Connecticut.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 1: Section 1 concerns the organization making the request. In the first two blank boxes, enter the name of the individual making the request and the date of the request.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 2: In the next two blank boxes, enter the name of the organization and its telephone number.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 3: In the next blank box, enter the street address, city, state and zip code of the organization.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 4: Indicate with a check mark whether the organization is a partnership or an incorporated organization.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 5: In the next two blank boxes, enter the states in which the organization operates and its IRS status.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 6: In section 2, provide a description of the proposed activity.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 7: Section 3 concerns the location. Enter the location requested in the first column, the date on which you are requesting use of this location in the second column, and the hours requested in the third column.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 8: In section 4, provide all information requested about the organization's contact person and individuals involved in the activity.

Connecticut Request For Permission To Conduct Special Interest Activity On Premises Of The Department LS-5 Step 9: Document similar activities previously conducted in section 5. Sign and date section 6 and provide your title.

INSTRUCTIONS: CONNECTICUT OFFICIAL REGISTRATION OF A MOTOR VEHICLE AND APPLICATION FOR CERTIFICATE OF TITLE (Form H-13)

To register a motor vehicle in Connecticut and apply for a certificate of title, file a form H-13 with the Department of Motor Vehicles. This document can be obtained from the website of the government of Connecticut.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 1: The first section concerns the owner. On the first line, enter the owner's name, indicate their gender with a check mark, the owner's birthdate, the owner's license number or ID number and the state in which the license or ID was issued.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 2: On the next line, enter the owner mailing street address, indicate whether the owner is a Connecticut resident with a check mark. If their residential address is different from the mailing address, enter it here.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 3: On the next line, enter the mailing address city, state and zip code, and indicate whether the vehicle is co-owned with a check mark.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 4: On the next line, provide all information requested about the co-owner if applicable.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 5: On the next line, indicate whether the owner is a business with a check mark. 

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 6: On the next line, give the Connecticut town and street address where the vehicle most frequently leaves from, returns to or remains at.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 7: Section 2 should only be completed if the vehicle is leased.

Connecticut Official Registration Of A Motor Vehicle And Application For Certificate Of Title H-13 Step 8: Section 3 concerns vehicle registration. Section 4 should only be completed if this is not a passenger style vehicle. Section 5 should only be completed if the purchased vehicle was financed. Section 6 concerns the seller, section 7 concerns tax exemptions and section 8 applies to dealer transactions.  Sign and date section 9.

INSTRUCTIONS: ALABAMA STATE EMPLOYEES' HEALTH INSURANCE PLAN PROVIDER SCREENING PLAN (Form IB13)

Alabama state employees who cannot or choose not to participate in the state employees' insurance board Worksite Wellness program can submit health screening results through your healthcare provider using this form. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 1: Section 1 should be completed by you. Enter your name in the first blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 2: Enter the screening date in the second blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 3: Indicate whether you are male or female with a check mark.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 4: Enter your age in the third blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 5: Enter your contract number in the fourth blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 6: Enter your Social Security number in the fifth blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 7: Enter your date of birth in the sixth blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 8: Enter your daytime phone number, including the area code, in the seventh blank box.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 9: Indicate your race/ethnicity with a check mark.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 10: Indicate whether you have or have been told you have high cholesterol, high blood pressure or diabetes with a check mark.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 11: Indicate whether you take medication for high cholesterol, high blood pressure or diabetes with a check mark.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 12: Submit the form to your provider, who should complete Section 2 by providing all information requested, then printing and signing their name and their address.

Alabama State Employees' Health Insurance Plan Provider Screening Plan IB13 Step 13: Mail the form to the address given at the bottom of the page.

INSTRUCTIONS: ALABAMA PEEHIP HEALTH INSURANCE AND OPTIONAL ENROLLMENT APPLICATION

Alabama public employees can use the form discussed in this article to apply for PEEHIP health insurance and optional enrollment. This document can be obtained from the website of the Retirement Systems of Alabama.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 1: Indicate with a check mark whether you are an active or retired member.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 2: The first section concerns the subscriber. On the first line, enter your Social Security number, first name, middle name or initial and last name.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 3: On the second line, enter your mailing street address, city, state and zip code.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 4: On the third line, enter your date of birth and home and work phone numbers. Indicate your gender with a check mark.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 5: On the fourth line, indicate your marital status with a check mark.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 6: On the fifth line, enter your employer or school system, email address and date of employment.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 7: Indicate with a check mark whether you or your spouse have used tobacco products in the last 12 months.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 8: The next section concerns the PEEHIP coverage being sought. Indicate the type of basic hospital/medical plan you are seeking, along with any optional coverages, with check marks. Enter your requested effective dates for both types of coverage.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 9: The next section concerns dependents and should only be completed if seeking family coverage.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 10: The next section must be completed if the member elects the PEEHIP Supplemental plan or if the member or their dependents have other group health, dental or vision coverage currently in effect.

Alabama PEEHIP Health Insurance And Optional Enrollment Application Step 11: The next section must be completed if you or your dependents are eligible for Medicare. The following section is only for members who retired after September 30, 2005. Sign and date the bottom of the second page.

INSTRUCTIONS: ARIZONA AFFIDAVIT (Form 71-1003)

As part of the Arizona bingo license application, an affidavit must be filed by each person who wishes to assist in the conduct of any game of bingo. This form 71-1003 can be obtained from the website maintained by the Arizona Department of Revenue.

Arizona Affidavit 71-1003 Step 1: Enter the licensee's name in the first blank box.

Arizona Affidavit 71-1003 Step 2: Enter the license number in the second blank box.

Arizona Affidavit 71-1003 Step 3: In the third blank box, indicate with a check mark whether the licensee is a manager, supervisor, proceed coordinator or assistant.

Arizona Affidavit 71-1003 Step 4: In the fourth blank box, enter the affiant's name.

Arizona Affidavit 71-1003 Step 5: In the fifth blank box, enter the affiant's Social Security number.

Arizona Affidavit 71-1003 Step 6: In the sixth blank box, enter the affiant's street address.

Arizona Affidavit 71-1003 Step 7: In the seventh blank box, enter the affiant's date of birth.

Arizona Affidavit 71-1003 Step 8: In the eighth blank box, enter the affiant's city, state and zip code.

Arizona Affidavit 71-1003 Step 9: In the ninth blank box, enter the affiant's home phone number, including the area code.

Arizona Affidavit 71-1003 Step 10: In the tenth blank box, enter the affiant's work phone number, including the area code.

Arizona Affidavit 71-1003 Step 11: The next five blank boxes are for qualified organizations only. In the first blank box, indicate with a check mark whether or not you are a member.

Arizona Affidavit 71-1003 Step 12: In the second blank box, enter the date you joined the organization.

Arizona Affidavit 71-1003 Step 13: In the third blank box, indicate with a check mark whether or not you are officers.

Arizona Affidavit 71-1003 Step 14: In the fourth blank box, if applicable, enter your officer title.

Arizona Affidavit 71-1003 Step 15: In the fifth blank box, indicate with a check mark whether you have an affidavit on file for any other licensee. If yes, list the license numbers.

Arizona Affidavit 71-1003 Step 16: On the first blank line, enter the affiant's name.

Arizona Affidavit 71-1003 Step 17: On the second blank line, the affiant should enter their signature.

Arizona Affidavit 71-1003 Step 18: On the last blank line, enter the date.

INSTRUCTIONS: CONNECTICUT APPLICATION FOR RENTAL CAR AGENCY PERMIT

To apply for a rental car agency permit in Connecticut, use the application discussed in this article. This document can be obtained from the website maintained by the government of Connecticut.

Connecticut Application For Rental Car Agency Permit Step 1: Enter the applicant rental agency name on the first blank line.

Connecticut Application For Rental Car Agency Permit Step 2: Enter the applicant mailing address on the second blank line.

Connecticut Application For Rental Car Agency Permit Step 3: Enter the applicant phone number on the third blank line.

Connecticut Application For Rental Car Agency Permit Step 4: Enter the applicant federal tax identification number on the fourth blank line.

Connecticut Application For Rental Car Agency Permit Step 5: On the next four blank lines, list all business locations of the applicant pertinent to this application. Attach an additional sheet of paper if necessary for further documentation.

Connecticut Application For Rental Car Agency Permit Step 6: On the next blank line, indicate whether a training program has been implemented for employees involved in the marketing of insurance as required by Connecticut Regulation 38a-799-5.

Connecticut Application For Rental Car Agency Permit Step 7: On the next three blank lines, list all authorized insurance companies which the applicant will represent.

Connecticut Application For Rental Car Agency Permit Step 8: The applicant should enter their signature on the next blank line. This person can be an officer, partner, owner or principal of the applicant.

Connecticut Application For Rental Car Agency Permit Step 9: Enter the date on the next blank line.

Connecticut Application For Rental Car Agency Permit Step 10: On the last blank line, print the name and title of the applicant.

Connecticut Application For Rental Car Agency Permit Step 11: Forward an appointment application to the insurance company or companies for whom you will be transacting business. The company will complete and return this application.

Connecticut Application For Rental Car Agency Permit Step 12: Once you have received the completed appointment applications, attach them to this application.

Connecticut Application For Rental Car Agency Permit Step 13: Mail both applications to the address given at the top of the page. Along with these forms, you must include a check for $80. This check should be made payable to "Treasurer, State of Connecticut."