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*INS_MAINT_CANCEL*MIDAMERICA CARPENTERS REGIONAL COUNCIL HEALTH FUND 12 E. Erie Street, Chicago, Illinois 60611 Phone (312)7879455, option #4 Fax (312)9513986 Email: retirement@carpenterbenefits.orgRETIREE
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How to fill out dependent removal form

01
Obtain a copy of the dependent removal form from the appropriate department or office.
02
Fill out your personal information, including your name, address, and contact information.
03
Provide the name and information of the dependent you wish to remove from your records.
04
Include any necessary supporting documentation, such as a birth certificate or court order.
05
Sign and date the form before submitting it to the designated individual or office.

Who needs dependent removal form?

01
Individuals who have dependents listed on their records and wish to have them removed.
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The dependent removal form is a document used to officially remove a dependent from your tax return or benefits plan, indicating that the individual no longer qualifies as a dependent.
Individuals who have previously claimed dependents on their tax returns or benefits plans and need to update their status by removing a dependent are required to file the dependent removal form.
To fill out the dependent removal form, you need to provide your personal information, the details of the dependent being removed, including their name and Social Security number, and indicate the effective date of the removal.
The purpose of the dependent removal form is to ensure accurate tax reporting and eligibility for benefits by updating the status of dependents that are no longer eligible.
The dependent removal form must include your personal information, the dependent's full name, Social Security number, relationship to you, and the reason for their removal.
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