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.