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Data Request for License Data Guidelines

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Request for Exam for Record Purposes

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.

 

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Form IB15 Retired State Employee Plan Change Form

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.
 

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Common OTC Meds Eligible for Your Healthcare FSA reimbursement

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Life Settlement Provider Application

Life Settlement Provider Application

 

INSTRUCTIONS: CONNECTICUT APPLICATION FOR LIFE SETTLEMENT PROVIDER LICENSE

 

 

To apply for a life settlement provider license in Connecticut, use the form discussed in this article. This document can be obtained from the website of the government of Connecticut.

 

Connecticut Application For Life Settlement Provider License Step 1: In the left hand portion of section 1, enter the name, mailing address, city, state, zip code, phone number, fax number and email address of the applicant.

 

Connecticut Application For Life Settlement Provider License Step 2: In the right hand portion of section 1, enter the physical address of the applicant, their city, state and zip code.

 

Connecticut Application For Life Settlement Provider License Step 3: In section 2, indicate whether the applicant is an individual, limited liability corporation, corporation, partnership or other with a checkmark. If a corporation, give the date of incorporation and the state in which this occurred. If other, explain.

 

Connecticut Application For Life Settlement Provider License Step 4: In section 3, give the name of a contact person to whom future correspondence from the Insurance Department should be addressed, as well as their phone number, fax number and email address.

 

Connecticut Application For Life Settlement Provider License Step 5: Section 4 details information that must be included in a detailed plan of operation.

 

Connecticut Application For Life Settlement Provider License Step 6: Sections 5 through 13 detail other information that must be submitted along with this application.

 

Connecticut Application For Life Settlement Provider License Step 7: On the fourth page, answer all questions by checking "Yes" or "No" as applicable.

 

Connecticut Application For Life Settlement Provider License Step 8: The fifth page is a certification of accuracy which must be completed by the applicant. Enter your signature on the first blank line.

 

Connecticut Application For Life Settlement Provider License Step 9: Print your name on the second blank line.

 

Connecticut Application For Life Settlement Provider License Step 10: Enter your title on the third blank line.

 

Connecticut Application For Life Settlement Provider License Step 11: The fifth page must be presented to a notary public, who will affix their seal.

 

Connecticut Application For Life Settlement Provider License Step 12: Pages 6 through or 9 contain a biographical affidavit which must be completed by the affidavit. Page 10 contains a certificate of accuracy regarding this affidavit.

 

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Health Insurers

Health Insurers

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Form cep 14 Certification by Replacement Candidate

Form cep 14 Certification by Replacement Candidate

 

INSTRUCTIONS: CONNECTICUT CITIZENS' ELECTION PROGRAM – REPLACEMENT PARTICIPATING CANDIDATE (SEEC Form CEP 14)

 

 

When a Connecticut candidate withdraws from an election, a SEEC form CEP 14 is used to certify their replacement. This document can be obtained from the website of the government of Connecticut.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 1: Section A concerns identifying information. Enter the election date in box 1, the office sought in box 2 and the district number.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 2: Enter the candidate name in box 4.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 3: Enter the candidate residence address in box 5.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 4: Enter the candidate mailing address, if different, in box 6.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 5: Enter the candidate treasurer telephone number in box 7.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 6: Enter the candidate email address in box 8.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 7: Enter the treasurer name in box 9.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 8: Enter the treasurer residence address in box 10 and their mailing address, if different, in box 11.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 9: Enter the treasurer telephone number in box 12 and their email address in box 13.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 10: Enter the deputy treasurer name in box 14, their residence address in box 15, and their mailing address, if different, in box 16.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 11: Enter the deputy treasurer telephone number in box 17 and their email address in box 18.

 

Connecticut Citizens' Election Program – Replacement Participating Candidate SEEC Form CEP 14 Step 12: Enter the committee name in box 19, the party nominating the candidate in box 20, and the name of the candidate being replaced in box 21. Complete the rest of the form as instructed.

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SEEC Form B-3 Certification of Committee Established By or On Behalf of a Registered Lobbyist

SEEC Form B-3 Certification of Committee Established By or On Behalf of a Registered Lobbyist

 

INSTRUCTIONS: CONNECTICUT CERTIFICATION OF COMMITTEES ESTABLISHED BY OR ON BEHALF OF A REGISTERED LOBBYIST (SEEC Form B-3)

 

 

When any political committee is established by or on behalf of a registered lobbyist in Connecticut, a form B-3 must be submitted on November 15th in the year of its formation and by that same date on a biennial basis afterwards. This document can be found on the website of the government of Connecticut.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 1: Enter the committee name in the first section.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 2: Enter the first name of the treasurer in the first blank box of the section designation for this information.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 3: Enter the treasurer's middle initial in the second blank box.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 4: Enter the treasurer's last name in the third blank box.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 5: Enter the treasurer's suffix, if applicable, in the fourth blank box.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 6: The next section concerns the treasurer's residence address. Enter their street address in the first blank box of this section, their city in the second blank box, their state in the third blank box and their zip code in the fourth blank box.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 7: If the treasurer's mailing address is different from their residential address, provide it in the next section.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 8: In the next section designated for this purpose, enter the treasurer's phone number.

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 9: Provide the treasurer's email address where indicated. 

 

Connecticut Certification Of Committees Established By Or On Behalf Of A Registered Lobbyist SEEC Form B-3 Step 10: The treasurer should sign and date the form.

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Form JD-CV-39 Application For Case Referral – Complex Litigation Docket

Form  JD-CV-39 Application For Case Referral - Complex Litigation Docket

 

INSTRUCTIONS: CONNECTICUT APPLICATION FOR REFERRAL OF CASE TO THE COMPLEX LITIGATION DOCKET (CLD) (Form JD-CV-39)

 

 

To apply to refer a Connecticut case to the complex litigation docket, a form JD-CV-39 must be completed. This document can be obtained from the website of the Connecticut Judicial Branch.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 1: Enter the name and address of the applicant, the juris number, and the applicant's telephone number.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 2: In box 1, enter the case name.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 3: In box 2, enter the juris number.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 4: In box 3, enter the name of the judicial district in which the case is pending.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 5: In box 4, enter the return date of the original complaint.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 6: In the table provided on line 5, enter the name of each plaintiff, as well as the name, address and telephone number of all plaintiff counsel. Provide the same information for all defendants their counsel in the table on line 6.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 7: On line 7a, indicate with a check mark whether the opposing counsel opposes transfer to CDL. On line 7b, indicate with a check mark whether the opposign counsel opposes transfer to the CDL location requested on this application.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 8: On line 8, briefly describe the nature of the case.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 9: List any cases with which the case is consolidated on line 9.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 10: Answer questions 10 through 14 as directed.

 

Connecticut Application For Referral Of Case To The Complex Litigation Docket (CLD) JD-CV-39 Step 11: The bottom portion of the form certifies a copy of this document has been mailed to all involved parties and attorneys.

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Form JD-CV-67 Continuation of Parties

Form JD-CV-67 Continuation of Parties

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