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STATE OF LOUISIANA OFFICE OF GROUP BENEFITS RETIREMENT ELIGIBILITY ATTESTATION FORM Agency NumberAgency NamePrimary Plan Participant/Employee NameDate of HireSection 1 Primary Plan Participant/ Employee

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The State of Louisiana office refers to the administrative and governmental agencies operating within the state of Louisiana responsible for various functions, including business registrations, tax collection, and regulatory compliance.

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To fill out forms for the State of Louisiana office, you must obtain the appropriate form from their official website, provide the required information accurately, and submit the completed form either online or via mail as specified in the filing instructions.

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