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Tax & Finance
dcss 0054 health insurance information
Dcss 0054 - Fill Online, Printable, Fillable, Blank | PDFfiller
Insurance is provided or available by the Noncustodial Parent or employer. SECTION II is about the other parent s insurance. Employers complete Sections I and III only. Please sign and date the completed form* SECTION I YOUR HEALTH INSURANCE Yes No Do you currently have Health Insurance coverage Health Insurance Company or Union provide Union Local number Insurance Company s Address Street Apartment Number or Unit...
Health Insurance Dcss 0054 Fillable - Fill Online, Printable, Fillable ...
Items 1 - 9 ... Health insurance dcss 0054 fillable form. Description. submitted on the Health Insurance Information (DCSS 0054) form which will be included in the ...
Dcss 0053 - Fill Online, Printable, Fillable, Blank | PDFfiller
Specify day of the week Vacation Visitation If Yes please specify dates/times Yes No Summer Visitation Overnight Visitation Court-ordered custody/visitation arrangement Additional Information I declare to the best of my knowledge and belief that the above information is true and correct. I am aware that this information may be provided to the other parent for their verification and that either party may be required...
Dcss 0569 - Fill Online, Printable, Fillable, Blank | PDFfiller
COMPLETING THE DECLARATION OF SUPPORT PAYMENT HISTORY You are asked to complete a month-by-month year-by-year breakdown of the amounts of support that were due ordered by the court and the amount of each payment that was made. In the Amount Paid column indicate a dollar amount of support paid in that month. If more than one payment was made in a given month put the total dollar amount of support paid. Put the dollar...
Dcss 0095 - Fill Online, Printable, Fillable, Blank | PDFfiller
Personal information from individuals. Information requested on this form including your Social Security Number is used by the Department of Child Support Services DCSS for purposes of identification and communication with you. The DCSS is required under Section 466 a 13 of the Social Security Act to collect the Social Security Number of any individual who is subject to a divorce decree support order or paternity...
Dcss 0069 Form - Fill Online, Printable, Fillable, Blank | PDFfiller
The Notice prints locally. Declaration FL 150 the Visitation Verification DCSS 0053 the Health Insurance Information DCSS 0054 and the Childcare Verification ...
Dcss 0373 - Fill Online, Printable, Fillable, Blank | PDFfiller
Does not apply print N/A. Before you begin please read the Child Support Handbook. This book explains the services available through the local child support agency. Also read the Notice of Child Support Services Program* This notice explains your responsibility to the local child support agency and the local child support agency s responsibility to you. the child ren s attorney. Please complete all the forms in...
Child Care Verification - Fill Online, Printable, Fillable, Blank | PDFfiller
Fill Child Care Verification, download blank or editable online. ... SUPPORT SERVICES HEALTH INSURANCE INFORMATION DCSS 0054 (04/27/05) County: ...
Fillable Dcss 0373 - Fill Online, Printable, Fillable, Blank | PDFfiller
DCSS-0054: Health Insurance Information - read more ... Dcss 0054 form Fill Online, Printable, Fillable,. ... Step 1 - Department of Child Support ServicesDCSS ...
Dcss 0053 - PDF Filler
Fill Dcss 0053, download blank or editable online. ... Get dcss 0053 form ... SUPPORT SERVICES HEALTH INSURANCE INFORMATION DCSS 0054 (04/27/05) ...
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