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DOC:01)222577VOL 1095AMENDED AND RESTATED DECLARATION OF COVENANTS, CONDITIONS AND RESTRICTIONS FOR CI ELO RIO RANCH PHASE I, PHASE II AND PHASE ill APG418DOC 00222577VOL 1095PGTABLE OF CONTENTS ARTICLEPAGEARTICLE
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To fill out vol 1095 pg 418, follow these steps: 1. Start by entering the name of the employer or plan sponsor at the top of the form.
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Fill in the covered individual's personal information, including their full name, address, and Social Security number.
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Indicate the months the individual was covered by the health insurance plan.
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Check the applicable box to indicate the type of coverage provided.
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