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AFFIDAVIT OF EXTENDED DEPENDENT ELIGIBILITY MDC (AGE 26 30) Florida Statute 627.6562 MIA MIDADE COUNTY EMPLOYEE INFORMATION Name: ___ Armed Member ID #:___ Contact Phone: ___ Date of Birth: ___ Email:
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How to fill out affidavit of extended dependent

01
Obtain the affidavit form from the appropriate source (e.g. online, courthouse, legal advisor).
02
Read and understand all instructions provided on the form.
03
Fill out all sections of the affidavit clearly and accurately.
04
Make sure to include all required information such as the dependent's name, relationship to the applicant, and reason for dependency.
05
Sign and date the affidavit in the presence of a notary public or other authorized official.
06
Submit the completed affidavit to the relevant authority or organization as instructed.

Who needs affidavit of extended dependent?

01
Individuals who have dependents that do not meet the standard definition of dependence according to established criteria.
02
Those seeking to extend dependent benefits or rights to a non-traditional dependent.
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Affidavit of extended dependent is a form that verifies a dependent's eligibility for extended coverage under a health insurance plan.
The primary policyholder is required to file the affidavit of extended dependent for any dependents seeking extended coverage.
To fill out the affidavit of extended dependent, the primary policyholder must provide the dependent's information, relationship to the policyholder, and any other required details.
The purpose of the affidavit of extended dependent is to ensure that only eligible dependents receive extended coverage under the health insurance plan.
On the affidavit of extended dependent, the primary policyholder must report the dependent's name, date of birth, relationship to the policyholder, and any other requested details.
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