Catherine M. Miklitsch, Support Magistrate In the Matter of a Support Proceeding Docket #: F Galina Ross, SSN: XXX-XX-5692, Respondent.
|
|
- Suzan Ball
- 5 years ago
- Views:
Transcription
1 F.C.A. 413,416,433, 438, 439, 440, , 471;Art.5-B /2002 At a term of the Family Court of the State of New York, held in and for the County of Rockland, at 1 South Main St., Suite 300 Floor 3, New City, NY 10956, on December 7, 2009 PRESENT: Catherine M. Miklitsch, Support Magistrate In the Matter of a Support Proceeding MOTHER File #: Docket #: F Galina Ross, SSN: XXX-XX-5692, Petitioner, CSMS #: BR05224P1 - against Eric Ross, SSN: XXX-XX-1789, ORDER OF SUPPORT Respondent. NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY RESULT IN INCARCERATION FOR CRIMINAL NON-SUPPORT OR CONTEMPT. YOUR FAILURE TO OBEY THIS ORDER MAY RESULT IN SUSPENSION OF YOUR DRIVER'S LICENSE, STATE-ISSUED PROFESSIONAL, TRADE, BUSINESS AND OCCUPATIONAL LICENSES AND RECREATIONAL AND SPORTING LICENSES AND PERMITS; AND IMPOSITION OF REAL OR PERSONAL PROPERTY LIENS. SPECIFIC WRITTEN OBJECTIONS TO THIS ORDER MAY BE FILED WITH THIS COURT WITHIN 30 DAYS OF THE DATE THE ORDER WAS RECEIVED IN COURT ORBY PERSONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. The above-named Petitioner having filed a petition in this Court on June 17, 2009, alleging that Eric Ross is chargeable with the support of: Name MOTHER Date of Birth SON 9/26/1998 Galina Ross having appeared; Eric Ross having appeared before this Court to answer the petition, having been advised by the Court of the right to counsel, and to show why dn order of support and other relief prayed for in the petition should not be granted; and Eric Ross having denied the allegations of the petition; and The matter having duly come on to be heard before this Court; NOW, after examination and inquiry into the facts and circumstances of the case and after hearing the proofs and testimony offered in relation thereto, the Court finds that:
2 Page: 2 of Eric Ross is the non-custodial party, whose pro rata share of the basic child support obligation is $ monthly ($ for basic payment plus $46.97 for additional expenses) for the following child: Name The Child Date of Birth Social Security # 9/26/1998 XXX-XX-6019 And the Court finds further that: The non-custodial party's pro rata share of the basic child support obligation is neither unjust nor inappropriate; NOW, after examination and inquiry into the facts and circumstances of the case and after hearing the proofs and testimony offered in relation thereto, it is ORDERED AND ADJUDGED that effective June 17, 2009, Eric Ross is chargeable with the support of and is possessed of sufficient means and able to earn such means to provide the payment of the sum $ monthly to Galina Ross payable through the Support Collection Unit, such payments to commence on January 1,2010, for and toward the support of Eric Ross' child; Mother Ross pay additional expenses as follows: IT IS FURTHER ORDERED that Galina Expense Payment Unreimbursed Health Related 43% Payable/Payee 1st Pay Date Direct 6/17/2009 Direct 6/17/2009 ' V Child Care 43% Father IT IS FURTHER ORDERED that Eric Ross pay additional expenses as follows: Expense Payment Payable/Payee 1st Pay Date Unreimbursed Health Related 57% Direct 6/17/2009 Child Care 57% Direct 6/17/2009 Health Insurance Premium $46.97 monthly Support Collection Unit/ Galina MotherRoss 1/1/2010 IT IS FURTHER ORDERED AND ADJUDGED that the Respondent is additionally responsible for his pro rata share for health care expenses previously incurred by the Petitioner or $17.10 and this shall be paid to the Support Collection Unit by April 15, 2010; and IT IS FURTHER ORDERED that the remaining claims for health care expenses previously incurred by the Petitioner are hereby dismissed without prejudice; IT IS FURTHER ORDERED that all payments payable through the Support Collection Unit shall be made by check or money order payable to and mailed to: NYS Child Support Processing Center, PO Box 15363, Albany, NY The county name and account number for the matter must be included with the oavment for identification Durooses.1 mother
3 Father Page: 3 of IT IS FURTHER ORDERED AND ADJUDGED that Eric Ross is additionally responsible for the support so ordered from June 1,2009 to December 31,2009 and that Eric Ross pay or cause to be paid the sum of $2,002.94; IT IS FURTHER ORDERED that the above-stated amount is to be paid as follows: payments of $ weekly commencing on April 1, 2010, to Galina Ross payable through the Support Collection Unit; IT IS FURTHER ORDERED that the payor, custodial party and any other individual parties immediately notify the Support Collection Unit, PO Box 307, Building L, Sanatorium Road, Pomona, NY of any changes in the following information: residential and mailing addresses, social security number, telephone number, driver's license number; and name, address and telephone numbers of the parties' employers; And the Court having determined that the health insurance availability for each party is as follows: MOTHER Galina Ross: Health insurance is available through an employer or organization; Eric Ross: Health insurance is not offered through an employer or organization; MOTHER IT IS THEREFORE ORDERED that Galina Ross continue the following dependents under the below-named plan as long as it remains available: Dependents CHILD Health Insurance Plan Benefits Current available plan Dental Such coverage shall include all plans covering the health, medical, dental, optical and prescription drug needs of the dependents named above and any other health care services or benefits for which the legally-responsible relative is eligible for the benefit of such dependents; provided, however, that the group health plan is not required to provide any type or form of benefit or option not otherwise provided under the group health plan except to the extent necessary to meet the requirements of Section 1396(g-l) of Title 42 of the United States Code. The legally-responsible relative(s) shall assign all insurance reimbursement payments for health care expenses incurred for his/her eligible dependent(s) to the provider of such services or the party having actually incurred and satisfied such expenses, as appropriate; IT IS FURTHER ORDERED that the parties shall execute and deliver to each other any forms, documents, or instruments to assure timely payment of any health insurance claim for the child; IT IS FURTHER ORDERED that the legally-responsible relative(s) immediately notify the other party and the Support Collection Unit of any change in health insurance benefits, including any termination of benefits, change in the health insurance benefit carrier or premium, or extent and availability of existing or new benefits; IT IS FURTHER ORDERED that upon a finding that the above-named legally-responsible relative(s) willfully failed to obtain health insurance benefits as ordered, such relative(s) will be
4 Page: 4 of presumptively liable for all health care expenses incurred on behalf of the above-named dependent(s) from the first date such dependent(s) was/were eligible to be enrolled to receive health insurance benefits after the issuance of such order or execution directing the acquisition of such coverage; IT IS FURTHER ORDERED that a copy of this order be provided promptly by the Support Collection Unit to the New York State Case Registry of Child Support Orders established pursuant to Section 11 l-b(4-a) of the Social Services Law. Dated: &y*zd ^* *-&i O NOTICE OF ENTRY PLEASE TAKE NOTICE that the within is a true copy of the order entered in trie office of the Clerk of the Family Court of trie State of New York in the coounty fflocklana OTOY J\\ \CY\\Q ENTER /-) (-±En:.s.jr> Catherine M. Miklitsch, Support Magistrate NOTE: ( A J i M U i M OF CHILD SUPPORT SHALL BE ADJUSTED BY THE APPLICATION OF A COST OF LIVING ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER THIS ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED, UPON THE REQUEST OF ANY PARTY TO THE ORDER OR PURSUANT TO PARAGRAPH (2) BELOW. UPON APPLICATION OF A COST OF LIVING ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT, AN ADJUSTED ORDER SHALL BE SENT TO THE PARTIES WHO, IF THEY OBJECT TO THE COST OF LIVING ADJUSTMENT, SHALL HAVE THIRTY-FIVE (35) DAYS FROM THE DATE OF MAILING TO SUBMIT A WRITTEN OBJECTION TO THE COURT INDICATED ON SUCH ADJUSTED ORDER. UPON RECEIPT OF SUCH WRITTEN OBJECTION, THE COURT SHALL SCHEDULE A HEARING AT WHICH THE PARTIES MAY BE PRESENT TO OFFER EVIDENCE WHICH THE COURT WILL CONSIDER IN ADJUSTING THE CHILD SUPPORT ORDER IN ACCORDANCE WITH THE CHILD SUPPORT STANDARDS ACT. (2) A RECIPIENT OF FAMILY ASSISTANCE SHALL HAVE THE CHILD SUPPORT ORDER REVIEWED AND ADJUSTED AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER SUCH ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED WITHOUT FURTHER APPLICATION OF ANY PARTY. ALL PARTIES WILL RECEIVE NOTICE OF ADJUSTMENT FINDINGS. (3) WHERE ANY PARTY FAILS TO PROVIDE, AND UPDATE UPON ANY CHANGE, THE SUPPORT COLLECTION UNIT WITH A CURRENT ADDRESS TO WHICH AN ADJUSTED ORDER CAN BE SENT, AS REQUIRED BY SECTION 443 OF THE FAMILY COURT ACT, THE SUPPORT OBLIGATION AMOUNT CONTAINED THEREIN SHALL BECOME DUE AND OWING ON THE DATE THE FIRST PAYMENT IS DUE UNDER THE TERMS OF THE ORDER OF SUPPORT WHICH WAS REVIEWED AND ADJUSTED OCCURRING ON OR AFTER THE EFFECTIVE DATE OF THE ORDER REGARDLESS OF WHETHER OR NOT THE PARTY HAS RECEIVED A COPY OF THE ADJUSTED ORDER.
5 F.C.A. 413,416,439(e) 4-SM-3 11/2008 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ROCKLAND In the Matter of a Support Proceeding File #: Docket*: F Galina Ross, Petitioner, CSMS #: BR05224P1 - against FINDINGS OF FACT Eric Ross, Respondent. Catherine M. Miklitsch, being the Support Magistrate before whom the issues of support in the above-entitled proceeding were assigned for determination, makes the following findings of fact: Galina Ross filed a petition on June 17,2009 seeking to establish support for the following: GR Name, Date of Birth Social Security # 9/26/1998 Galina Ross and Eric Ross were married on May 14, 1998, and are still husband and wife. The following child resides with Galina Ross:. Galina Ross has submitted the following proof of income, expenses, and/or support of others: GR financial statement, pay stubs, 2008 tax returns, 2008 W-2, and child care, health care expenses. ER Ross has submitted proof of income, expenses, or support of others: financial affidavit, Eric 2008 tax return and W-2, and a job search. Eric Ross is liable for the support of the above named child by virtue of marriage. An itemization of income and deductions of the parents and calculation of pro rata shares is annexed as Appendix A. The basic child support obligation for support of the following child is $1, monthly ($1, for basic payment plus $46.97 for additional expenses): Name Date of Birth 9/26/1998 MM/ Dd Social Security # Galina Ross is the custodial party, whose pro rata share of the basic child support obligation is $ monthly. Eric Ross is the non-custodial party, whose pro rata share of the basic child support obligation is $ monthly ($ for basic payment and $46.97 for additional expenses).
6 Page: 2 4-SM-3 The court has determined that child support shall be paid by Eric Ross to Galina Ross in the amount of $ monthly ($ for basic payment plus $46.97 for additional expenses). The non-custodial parties' pro rata share of the basic child support obligation is neither unjust nor inappropriate. Health insurance availability for each party is as follows: GR ER Galina Ross: Health insurance is available through an employer or organization; Eric Ross: Health insurance is not offered through an employer or organization. Health insurance coverage is to be provided as follows: Galina Ross is directed to continue health insurance coverage under the current available plan for the child, with contribution or premium of $82.40 monthly paid by Galina Ross. This plan contains the following benefits: Dental. The allocation between the parties of costs of medical premiums or contributions is prorated in the same proportion as each party's income is to the combined income. The Petitioner has the ability to earn $38, annually. The Respondent had no stated income from wages as of the filing of the petition or the date of the hearing. The Respondent has the ability to earn $ gross weekly based upon year to date income of $16, for 2008 earnings from Citigroup Global Markets based upon the testimony of the representative of the Support Collection Unit as of April 23, 2008 which covered seventeen (17) weeks. The Respondent is not working but the Court finds this reflects his ability to earn. The Respondent did submit a job search which reflected he contacted J P Morgan for a personal banker position in Nyack,, Montvale, Queens, Bronx, and Manhattan, and for an enterprising vault messaging engineer, as well as a database engineer/architect Lead oracle, Lead SQL Server; Chase; Veris Marshwinds-business analyst; VishalMehta, lmamopartners.com,;a recruiter; Search EDP Inc.;,a recruiting agency; Algomod Techologies Corporation, an IT recruiter; Software Guidance, a recruiter; trineaspects.com; i tmmi.com, svsservices.com;; Blue Wolf; Jack Schwartz; Alex Oak Ridge Staffing; Robert Half Staffing; pinnacleus; Noly Vega; Bernadette McHugh; Eliza Gonzalez; American Cybersystems; Interactive Brokers; Gain Capital;KForce Technology Staffing; Infotechnologies; Laura Santoro; ; David Wojdy Edgewater Group; and a few others. The Respondent lost his employment in early He received unemployment benefits during The Respondent testified he has a doctoral degree in computer engineering from the Moscow Scientific Research facility. The Petitioner disputed he had a degree. The Respondent did not mention that he had an MBA. In Exhibit Cthere are communications between Mr. Ross and Bernadette McHugh and which questio^elpar^mne date of receipt of his MBA because he listed one year on a resume and another year in the . He was also questioned about a claim of ten years when the resume listed 1990 to 1997 for his years at Enhance. In a letter he stated he had ten years experience as VP at Enhance but his clarification listed his VP from 1992 to 1997 for five years. The Respondent's credibility is at issue in this case. The Respondent's own,submitted documents reflect that he has not been accurate and precise regarding his background awexperience. The tenor of that exchange indicates a concern from an employment recruiter regarding the
7 Page: 3 4-SM-3 Respondent's veracity. The Court finds the Respondent's job search was harmed by his own lack of veracity and precision. The Respondent has assets including real estate, bank accounts, and other assets including stocks, bonds, or an IRA account. His financial affidavit, dated July 20,2009, listed monthly expenses of $8, monthly including his house and condo expenses. The Respondent shall pay $ per month toward basic support and $46.97 per month toward health insurance payable to the Support Collection Unit, Petitioner beneficiary, effective January 1, The Respondent owed $ per moth toward basic support and $46.97 per month toward health insurance or $ per month from June 1,2009 through December 31,2010 for seven months or $4, He paid $ on August 13, 2009, $ on September 4, 2009, and $ on November 9, 2009 for a total of $1, to the Support Collection Unit. The Respondent testified he Paid $1, toward the mortgage in the months of June, July, and August The court finds one third of these payments should be attribted to child support or $1, The arrears were $2, as of December 7, 2009 and the arrears shall be paid in the sum of $ per month to the Support Collection Unit, Petitioner beneficiary, effective April 1, The Petitioner incurred health care expenses for the child of $30.00 for Dr. Tucci, $ from Portsmouth Regional Hospital, $50.00 from Haverstraw Pediatric or $ but she only proved she paid Dr. Tucci. The Court could not determine what sums were due from Sports Physical Therapy, Joseph Deutsch, M.D. and Hudson Radiology because the lack of data as to the date of insurance, insurance payment, and payment by the Petitioner. The Respondent owed 57% of $30.00 or $17.10 and this shall be paid to the Support Collection Unit by April 15, The remaining claims are dismissed without prejudice. Dated: February 28, 2010 \ Catherine M. Miklitsch, Support Magistrate
8 File: Docket: F Petitioner: Galina Ross Respondent: Eric Ross Appendix A Itemization of Income and Deductions of Custodial and Non-Custodial Parents [FCA 413(l)(b), 413(1) (c), 413(l)(f), 416] Dated: CSMS: 2/28/2010 BR05224P1 Incomes and Deductions: Galina Ross: Income: Salary (1) Total: Deductions: Medicare (1) Social Security (1) Total: Eric Ross: Income; Salary (1) Total: Deductions: Medicare (1) Social Security (1) Total: $38, annually $38, annually $ annually $2, annually $2, annually $51, annually $51, annually $ annually $3, annually $3, annually AGI: $35, annually AGI: $47, annually Combined AGI; $82, annually Calculated Pro Rata Share: Number of Children in Custody of Galina Ross: 1 Calculations for Child in Custody of Galina Ross (1) The child support percentage for 1 child is 17% Galina Ross Eric Ross Total Annual Adjusted Gross Income $35, $47, $82, Pro Rata % 43% 57% Annual Pro Rata Share $6, $7, $14, Basic Support Payment $ monthly
9 Additions to Basic Support: Expense Expense Amount Galina Ross Eric Ross Health Insurance Premium - $82.40 monthly $35.43 monthly $46.97 monthly Dental Unreimbursed Health Related 43% 57% Child Care 43% 57% Total; $ annually $ annually $ annually Basic Child Support Obligation: Combined Galina Ross Eric Ross Basic Support Payment $1, monthly $ monthly $ monthly Total Additional Expenses $82.40 monthly $35.43 monthly $46.97 monthly Total Child Support Payment $1, monthly $ monthly $ monthly Page: 2 Appendix A The court has determined that the support payable by Eric Ross to Galina Ross shall be $ monthly ($ for basic payment plus $46.97 for additional expenses). Retroactive Calculations: Calculated From Date: 6/17/2009 Calculated To Date: 2/28/2010 Balance Due: Payable Via SCU: $4, Retro/Arrears Payments: Payments Via SCU: Amount: $50.00 weekly First payment date: March 26, 2010 Number of payments: 91 Final Payment: $38.28
F.C.A. 413, 416, 424, 425, Form , 439(a), 440, 449; D.R.L. 240 (Order on Support Agreement) 12/2012
F.C.A. 413, 416, 424, 425, Form 4-2 439, 439(a), 440, 449; D.R.L. 240 (Order on Support Agreement) 12/2012 At a term of the Family Court of the State of New York, held in and for the County of, at, New
More informationF.C.A , 424-a; Art. 5-B Form FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF... In the Matter of a Proceeding for Support
F.C.A. 413-1, 424-a; Art. 5-B Form 4-17 D.R.L. 236-B, 240 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF... In the Matter of a Proceeding for Support (Financial Disclosure Affidavit) 9/99 Docket No. (Commissioner
More informationIN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR. Case No. 0X DR xxxx N
IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR LEE COUNTY, FLORIDA CIVIL ACTION D. S., vs. F. S., Former wife & respondent, Former husband & petitioner, Case No. 0X DR xxxx N ORDER GRANTING
More informationSTATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF LAKE COUNTY
FINANCIAL DECLARATION FORM STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF LAKE COUNTY IN RE THE MARRIAGE OF: CAUSE NO. and Petitioner, Respondent.,, FINANCIAL DECLARATION OF I. PERSONAL INFORMATION HUSBAND*
More informationCHECKLIST OF FORMS TO BE COMPLETED
Fairfield County Court of Common Pleas Domestic Relations Division CONTEMPT CHECKLIST OF FORMS TO BE COMPLETED Forms to be completed by the requesting party, unless otherwise specified: 1. Motion and Affidavit
More informationMotion for Modification of Child Support Order
Petitioner vs Respondent Case Number Motion for Modification of Child Support Order Failure to provide the Petitioner s, Respondent s, and Attorney s complete information WILL delay the filing of this
More information: PACSES: PLAINTIFF : : : : : DOCKET: : : : DEFENDANT. the day of, 20 at the Domestic Relations Office,
PACSES PLAINTIFF VS. DOCKET DEFENDANT I hereby acknowledge that I have received a copy of pertinent instructions in this cause on the day of, 20 at the Domestic Relations Office, Cumberland County, Pennsylvania.
More informationDECISION AFTER FAIR HEARING JURISDICTION ISSUE FINDINGS OF FACT. In the Matter of the Appeal of
STATE OF NEW YORK OFFICE OF TEMPORARY AND DISABILITY ASSISTANCE REQUEST: October 11, 2006 CASE #: Pxxxxxx AGENCY: Nassau FH #: 4647997J In the Matter of the Appeal of SJ from a determination by the Nassau
More informationIN THE COMMONWEALTH COURT OF PENNSYLVANIA
IN THE COMMONWEALTH COURT OF PENNSYLVANIA In Re: Petition of the Venango County : Tax Claim Bureau for Judicial : Sale of Lands Free and Clear : of all Taxes and Municipal Claims, : Mortgages, Liens, Charges
More informationCOURT OF APPEALS OF VIRGINIA. Present: Chief Judge Moon, Judges Benton and Elder Argued at Richmond, Virginia
COURT OF APPEALS OF VIRGINIA Present: Chief Judge Moon, Judges Benton and Elder Argued at Richmond, Virginia SHARONE DENI BOISSEAU MEMORANDUM OPINION * v. Record No. 2407-95-2 PER CURIAM OCTOBER 22, 1996
More informationNYS BOARD OF REAL PROPERTY SERVICES RP-467-Ins (8/06)
NYS BOARD OF REAL PROPERTY SERVICES RP-467-Ins (8/06) INSTRUCTIONS FOR THE APPLICATION FOR THE PARTIAL REAL PROPERTY TAX EXEMPTION FOR SENIOR CITIZENS EXEMPTION (AND FOR ENHANCED SCHOOL TAX RELIEF [STAR]
More informationNYS BOARD OF REAL PROPERTY SERVICES
NYS BOARD OF REAL PROPERTY SERVICES RP-467-Ins (9/08) LP INSTRUCTIONS FOR THE APPLICATION FOR THE PARTIAL REAL PROPERTY TAX EXEMPTION FOR SENIOR CITIZENS EXEMPTION (AND FOR ENHANCED SCHOOL TAX RELIEF [STAR]
More informationIN THE CIRCUIT COURT FOR THE SECOND JUDICIAL CIRCUIT COUNTY, ILLINOIS. Pre-Judgment Post-Judgment I. INTRODUCTION
IN THE CIRCUIT COURT FOR THE SECOND JUDICIAL CIRCUIT COUNTY, ILLINOIS IN RE THE MARRIAGE OF: ) ), ) ) Petitioner, ) and ) No. ), ) ) Respondent. ) FINANCIAL AFFIDAVIT Pre-Judgment Post-Judgment I. INTRODUCTION
More informationDISSOLUTION OF MARRIAGE: FINANCIAL DECLARATION FORM STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF LAKE COUNTY
DISSOLUTION OF MARRIAGE: FINANCIAL DECLARATION FORM STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF LAKE COUNTY In Re: The Marriage / Matter of: Case No. (Select: Mother, Father, Wife, Husband) and (Select:
More informationBOWDOIN COLLEGE FLEXIBLE BENEFITS PLAN HEALTH CARE REIMBURSEMENT PLAN DEPENDENT CARE REIMBURSEMENT PLAN SUMMARY PLAN DESCRIPTIONS
BOWDOIN COLLEGE FLEXIBLE BENEFITS PLAN HEALTH CARE REIMBURSEMENT PLAN DEPENDENT CARE REIMBURSEMENT PLAN SUMMARY PLAN DESCRIPTIONS Effective as of January 1, 2018 Bowdoin College One College Street Brunswick,
More informationPOLICY AND REGULATIONS MANUAL HEALTH AND RELATED BENEFITS
Page Number: 1 of 24 TITLE: HEALTH AND RELATED BENEFITS PURPOSE: To provide an overview of the health and related benefits offered to Benefit Eligible Employees, Benefit Eligible Retirees, and their Benefit
More informationFINANCIAL INFORMATION FOR VETERAN S BENEFITS QUALIFICATION VOELZ LAW, LLC
FINANCIAL INFORMATION FOR VETERAN S BENEFITS QUALIFICATION The requested information is necessary for us to evaluate and to use in making recommendations regarding Veteran s Benefits qualification. Please
More informationINSTRUCTIONS FOR FEE WAIVER
INSTRUCTIONS FOR FEE WAIVER 1. After you have completed the fee waiver form, take it to a notary public the form must be notarized. NOTE: Make sure your phone number is at the top of the first page. 2.
More informationCase Information Statement - Client Intake Form.
Case Information ment - If you have a question about this form, please contact your attorney's office. PART A - CASE INFORMATION Your Attorney s Information Attorney's Name Address DeTorres & DeGeorge,
More informationPOST-DISSOLUTION DECREE FINANCIAL DECLARATION FORM
POST-DISSOLUTION DECREE FINANCIAL DECLARATION FORM STATE OF INDIANA: CIRCUIT AND SUPERIOR COURTS OF PORTER COUNTY In accordance with Local Rule 2200.1 of the Porter Superior Court and Indiana Trial Rules
More informationCircuit Court for Frederick County Case No.: 10-C IN THE COURT OF SPECIAL APPEALS
Circuit Court for Frederick County Case No.: 10-C-01-000768 UNREPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND No. 00047 September Term, 2017 WILLIAM BENNISON v. DEBBIE BENNISON Leahy, Reed, Shaw Geter,
More informationMARYMOUNT MANHATTAN COLLEGE. Qualified Medical Child Support Order And National Medical Support Notice Administrative Procedures
MARYMOUNT MANHATTAN COLLEGE Qualified Medical Child Support Order And National Medical Support Notice Administrative Procedures Introduction 1. A group health plan subject to the Employee Retirement Income
More informationCHAPTER 9 CHILD SUPPORT GUIDELINES
CHAPTER 9 CHILD SUPPORT GUIDELINES Rule 9.1 Guidelines adopted. The supreme court has undertaken to prescribe uniform child support guidelines and criteria pursuant to the federal Family Support Act of
More informationAPPENDIX I FORMS (6/30/03) 197
APPENDIX I FORMS The following forms are listed in this appendix: Form 1. Petition (Other Than in Small Tax Case) *Form 2. Petition (Small Tax Case) *Form 3. Entry of Appearance *Form 4. Substitution of
More informationand Financial Disclosure Statement of:
PRINT in BLACK ink Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use Enter the name of the petitioner. If joint petitioners, enter the
More informationFASHION INSTITUTE OF TECHNOLOGY Office of Human Resources 236 West 27 th St. 11 th Floor New York City * Fax
FASHION INSTITUTE OF TECHNOLOGY Office of Human Resources 236 West 27 th St. 11 th Floor New York City 10001-5992 212.217.3670 * Fax 212.217.3652 INSTRUCTIONS FOR THE ADDITION OF DOMESTIC PARTNERS TO F.I.T.
More informationINCOME WITHHOLDING FOR SUPPORT ORIGINAL INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS IN RE THE MARRIAGE PARENTAGE SUPPORT ALLOCATION OF PARENTAL CIVIL UNION RESPONSIBILITIES vs. Gen No. INCOME WITHHOLDING FOR
More informationIN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT IN AND FOR PINELLAS COUNTY, STATE OF FLORIDA FAMILY LAW DIVISION CASE NO.
In Re: The Marriage Of IN THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT IN AND FOR PINELLAS COUNTY, STATE OF FLORIDA FAMILY LAW DIVISION CASE NO. and Petitioner,, Respondent. / STANDARD FAMILY LAW INTERROGATORIES
More informationINSTRUCTIONS FOR FEE WAIVER
INSTRUCTIONS FOR FEE WAIVER 1. After you have completed the fee waiver form, take it to a notary public the form must be notarized. NOTE: Make sure your phone number is at the top of the first page. 2.
More information[Appendix V] FAMILY PART CASE INFORMATION STATEMENT
[Appendix V] FAMILY PART CASE INFORMATION STATEMENT Attorney(s): Office Address Tel. No./Fax No. Attorney(s) for: vs. Plaintiff, SUPERIOR COURT OF NEW JERSEY CHANCERY DIVISION, FAMILY PART COUNTY Defendant.
More informationIN THE SUPREME COURT OF FLORIDA IN RE: AMENDMENTS TO THE FLORIDA FAMILY LAW RULES OF PROCEDURE, CASE NO. SC
The Florida Supreme Court adopted amendments to the Florida Family Law Rules proposed by the Florida Bar s Family Law Rules Committee (committee) to implement 2008 legislative changes to equitable distribution.
More informationJOEL K. MITCHELL Attorney-at-Law
JOEL K. MITCHELL Attorney-at-Law MITCHELL LAW OFFICE THE PROFESSIONAL CENTER 1318 W Main Street 1408 S Denver Avenue Collinsville OK 74021 Tulsa OK 74119 Phone: (918) 371-1896 Cell: (918) 230-5844 Fax:
More informationFOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE. Tuition Classification Decision Approved Denied Date. Effective, 20 Decision Made By:
FOR OFFICE USE ONLY - DO NOT WRITE IN THIS SPACE Tuition Classification Decision Approved Denied Date Effective, 20 Decision Made By: Covell Decision yes no Remarks: ******************************************************************************************************
More informationMediation Intake Form Lorain Road North Olmsted, OH Phone: Fax:
Full Name s Maiden Name Home Address Home Phone No. Pager or Cell No. E-mail address What County do you reside in? How long have you lived there? Social Security No. Birth Date Employer Employer Address
More informationWELFARE BENEFITS PLAN
SUMMARY PLAN DESCRIPTION EFFECTIVE JULY 1, 2016 WELFARE BENEFITS PLAN SPONSORED BY THE STRUCTURAL IRON WORKERS LOCAL #1 WELFARE FUND TABLE OF CONTENTS PAGE ELIGIBILITY... 1 Initial Eligibility... 1 Deferred
More informationFORM 6 OPENING DISCOVERY INTERROGATORIES IN THE CIRCUIT COURT OF COLE COUNTY, MISSOURI
FORM 6 OPENING DISCOVERY INTERROGATORIES IN THE CIRCUIT COURT OF COLE COUNTY, MISSOURI In re: the Marriage of ), and ) ) ), ) ) Petitioner, ) Case No. ) v. ) ), ) ) Respondent. ) OPENING INTERROGATORIES
More informationORDER FOR TOTAL DISABILITY w/second Injury Fund
w/second Injury Fund SOCIAL SECURITY NUMBER: DOB: SSN FEDERAL EMPLOYER NUMBER NJ REG NUMBER PETITIONER RESPONDENT ATTORNEY FOR RESPONDENT GENDER: MALE FEMALE ADDRESS (Including County): ADDRESS (Including
More informationBANKRUPTCY CLIENT FORM We accept the following forms of payment: cash or check. Cell Phone:
Name: Spouse s Name: Business Names: Mailing Address: Home Phone: Fax: Email: BANKRUPTCY CLIENT FORM We accept the following forms of payment: cash or check. City: Have you filed bankruptcy before? Yes
More informationTOWN OF MILTON, N.H. WELFARE DEPARTMENT
TOWN OF MILTON, N.H. WELFARE DEPARTMENT APPLICATION FOR ASSISTANCE ALL INTERVIEWS FOR ASSISTANCE ARE BY APPOINTMENT FOR AN APPOINTMENT CALL 603-652-4501 Ext. 9 Town of Milton, N.H. Application for Assistance
More informationUniform Support Affidavit Instructions for Form 6F
Uniform Support Affidavit Instructions for Form 6F The Uniform Support Affidavit must be completed when the payment of child support is an issue. It provides basic information about expenses and ability
More informationSupreme Court of the State of New York Appellate Division: Second Judicial Department
Supreme Court of the State of New York Appellate Division: Second Judicial Department D54628 G/hu AD3d WILLIAM F. MASTRO, J.P. MARK C. DILLON JOHN M. LEVENTHAL CHERYL E. CHAMBERS ROBERT J. MILLER, JJ.
More informationEmployees (SCL) To be eligible for the benefits described in this book, you must be one of the following:
About Your Benefits Stamford Public Schools (BOE) offers certified teachers, administrators, and instructional staff - who are members of the following unions a comprehensive benefits program that includes
More informationORANGE COUNTY TRANSPORTATION AUTHORITY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION
ORANGE COUNTY TRANSPORTATION AUTHORITY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS I ELIGIBILITY 1. When can I become a participant in the Plan?... 1 2. What are the eligibility requirements
More informationIN THE SUPREME COURT OF IOWA
IN THE SUPREME COURT OF IOWA No.12 0338 Filed December 20, 2013 IOWA MORTGAGE CENTER, L.L.C., Appellant, vs. LANA BACCAM and PHOUTHONE SYLAVONG, Appellees. On review from the Iowa Court of Appeals. Appeal
More informationChecklist for Medical Flexible Spending Account
Person to Contact with Questions: Telephone Number: ( ) Email Address: Internal Group Number or Billing Number (if any): Group s Full Name: Group s Address: Checklist for Medical Flexible Spending Account
More informationSTATE OF ILLINOIS UNITED STATES OF AMERICA COUNTY OF DUPAGE COUNTY IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
IN RE THE MARRIAGE OF: ) ) Harold J Jones ) CASE NUMBER PETITIONER ) -VS- ) 44-32323 ) Marianne P Jones ) RESPONDENT ) COMPREHENSIVE FINANCIAL STATEMENT PURSUANT TO LOCAL COURT RULE 15.01.3 INSTRUCTIONS
More informationUNIVERSITY OF CALIFORNIA SECTION 125 PLAN. (Amended and Restated Effective as of January 1, 2014)
EXECUTION COPY UNIVERSITY OF CALIFORNIA SECTION 125 PLAN (Amended and Restated Effective as of January 1, 2014) TABLE OF CONTENTS INTRODUCTION...1 ARTICLE 1 DEFINITIONS...2 1.1 Benefit Program... 2 1.2
More informationUNCITRAL ARBITRATION RULES
UNCITRAL ARBITRATION RULES (as revised in 2010) Section I. Introductory rules Scope of application* Article 1 1. Where parties have agreed that disputes between them in respect of a defined legal relationship,
More informationBEFORE THE DISCIPLINARY BOARD OF THE SUPREME COURT OF PENNSYLVANIA : : : : : : : : No. 691, Disciplinary Docket No.
BEFORE THE DISCIPLINARY BOARD OF THE SUPREME COURT OF PENNSYLVANIA In the Matter of DAVID E. SHAPIRO PETITION FOR REINSTATEMENT No. 691, Disciplinary Docket No. 2 Supreme Court No. 74 DB 1989 - Disciplinary
More informationRENTAL APPLICATION. Property Applying For: * When do you want or need to move in: Have you Viewed this Property?
Southern Homes 205 E. Madison Ave. Athens, TN 37303 Office (423) 744-3515 Fax (423) 744-3516 RENTAL APPLICATION Date: Property Applying For: * When do you want or need to move in: Have you Viewed this
More information[1] Mrs V, who is the first respondent in these proceedings, is the wife of
SOUTH GAUTENG HIGH COURT, JOHANNESBURG Case No. 2003/20813 2007/9126 In the matter between: V v. V & Ors MEYER, J [1] Mrs V, who is the first respondent in these proceedings, is the wife of Mr V. He is
More informationINCOME WITHHOLDING FOR SUPPORT
INCOME WITHHOLDING FOR SUPPORT INCOME WITHHOLDING ORDER/NOTICE FOR SUPPORT (IWO) AMENDED IWO ONE-TIME ORDER/NOTICE FOR LUMP SUM PAYMENT TERMINATION OF IWO Date: Child Support Enforcement (CSE) Agency Court
More informationDISCLOSURE STATEMENT (Pursuant to Rule )
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - DOMESTIC RELATIONS DIVISION IN RE The Marriage Custody Parentage Support of: [ ] Petitioner / [ ] Counter-Respondent, -vs- [ ] Respondent
More informationFINANCIAL ASSISTANCE POLICY
FINANCIAL ASSISTANCE POLICY I. PURPOSE/OBJECTIVE The mission at DeKalb Medical is to deliver high quality healthcare services that improve the health and well-being of the patients served by DeKalb Medical.
More informationPLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR NORTHWEST LABORERS EMPLOYERS HEALTH & SECURITY TRUST FUND REVISED EDITION APRIL 2010
PLAN DOCUMENT AND SUMMARY PLAN DESCRIPTION FOR NORTHWEST LABORERS EMPLOYERS HEALTH & SECURITY TRUST FUND REVISED EDITION APRIL 2010 1 NORTHWEST LABORERS-EMPLOYERS HEALTH & SECURITY TRUST FUND INTRODUCTION
More informationSonia Rankin, Fair Hearing Representative; Francis Hendricks, Esq., Representative
STAT! OF NEW YORK DEPARTMENT OF SOCIAL SERVICES REQUEST January 4, 1993 CASE# CENTER# Nassau FH# 1918944M In the Matter of the Appeal of K S from a determination by the Nassau County Department of Social
More informationIN THE SUPERIOR COURT OF FULTON COUNTY STATE OF GEORGIA FAMILY DIVISION., ) ) Petitioner, ) ) Civil Action File No. and ) ), ) ) Respondent.
IN THE SUPERIOR COURT OF FULTON COUNTY FAMILY DIVISION, Petitioner, Civil Action File No. and, Respondent. REQUIRED DOCUMENTS TO BE PRODUCED No later than thirty (30 days from the filing of the Complaint,
More informationCASE NO. 1D Appellant challenges an order entered by the circuit court that adopted a
IN THE DISTRICT COURT OF APPEAL FIRST DISTRICT, STATE OF FLORIDA SENCOA DAMAIR CRAWFORD, v. Appellant, NOT FINAL UNTIL TIME EXPIRES TO FILE MOTION FOR REHEARING AND DISPOSITION THEREOF IF FILED CASE NO.
More informationDELAWARE CHILDREN S CARE PLAN
DELAWARE CHILDREN S CARE PLAN About DCCP Available through Highmark Blue Cross Blue Shield Delaware (Highmark Delaware), the Delaware Children s Care Plan (DCCP) provides comprehensive health benefits
More informationIN THE COMMONWEALTH COURT OF PENNSYLVANIA
IN THE COMMONWEALTH COURT OF PENNSYLVANIA B.B. In re J.K., SEALED Petitioner No. 2022 C.D. 2014 Submitted April 24, 2015 v. Department of Public Welfare, Respondent BEFORE HONORABLE BERNARD L. McGINLEY,
More informationTiger Oats Provident Fund DETERMINATION IN TERMS OF SECTION 30M OF THE PENSION FUNDS ACT OF 1956
IN THE TRIBUNAL OF THE PENSION FUNDS ADJUDICATOR In the complaint between: CASE NO: PFA/GA/493/99/NJ D S Dijane Complainant and Tiger Oats Provident Fund Respondent DETERMINATION IN TERMS OF SECTION 30M
More informationLIQUIDATION UNDER CHAPTER 7 QUESTIONS AND ANSWERS ABOUT CHAPTER 7 BANKRUPTCIES
LIQUIDATION UNDER CHAPTER 7 QUESTIONS AND ANSWERS ABOUT CHAPTER 7 BANKRUPTCIES 1. What is a chapter 7 bankruptcy case and how does it work? A chapter 7 bankruptcy case is a proceeding under federal law
More informationPatient Membership Agreement. Wellscape Direct MD, LLC
Wellscape Direct MD, LLC This is an Agreement between you, the Member, and Wellscape Direct MD, LLC, a Massachusetts limited liability company located at 30 Lancaster Street in Boston, Massachusetts. Wellscape
More informationGroup Administration Manual. For all group sizes Missouri and Wisconsin MUEENABS Rev. 9/12
Group Administration Manual For all group sizes Missouri and Wisconsin 23631MUEENABS Rev. 9/12 Member services information for your convenience Health coverage inquiries Anthem Blue Cross and Blue Shield
More informationPOLICY WEST WINDSOR-PLAINSBORO REGIONAL SCHOOL DISTRICT
1122/page 1 of 10 1122 BENEFITS COVERING NON-AFFILIATED ADMINISTRATIVE EMPLOYEES CATEGORY A Certain employees of the district are not represented by any bargaining unit for the establishment of salary
More informationFonseca, Edward v. Rimax Contractors, Inc.
University of Tennessee, Knoxville Trace: Tennessee Research and Creative Exchange Tennessee Court of Workers' Compensation Claims and Workers' Compensation Appeals Board Law 1-18-2019 Fonseca, Edward
More informationAGENCY FOR WORKFORCE INNOVATION TALLAHASSEE, FLORIDA
AGENCY FOR WORKFORCE INNOVATION TALLAHASSEE, FLORIDA PETITIONER: Employer Account No. - 2889644 GLORIA DEI ACADEMY 7601 SW 39TH STREET DAVIE FL 33328-2716 RESPONDENT: State of Florida Agency for Workforce
More informationCONSULTATION AGREEMENT AND ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND INSTRUCTIONS
CONSULTATION AGREEMENT AND ACKNOWLEDGEMENT OF RECEIPT OF DISCLOSURES AND INSTRUCTIONS This Agreement is entered into on this day of, 20, by and between, (hereinafter referred to as the whether one or more)
More informationMOTION TO REVIEW CHILD SUPPORT
MOTION TO REVIEW CHILD SUPPORT Use this form if: You have a pending divorce, separate maintenance, paternity, or family support case and you want the Court to change support; You have a final Judgment
More informationADRIAN PUBLIC SCHOOLS CAFETERIA PLAN SUMMARY PLAN DESCRIPTION. Amended as of January 1, 2017
ADRIAN PUBLIC SCHOOLS CAFETERIA PLAN SUMMARY PLAN DESCRIPTION Amended as of January 1, 2017 TABLE OF CONTENTS I ELIGIBILITY...1 Page 1. When can I become a participant in the Plan?...1 2. What are the
More informationCUSTODIAL AGREEMENT ROTH IRA
Page 1 of 9 IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions
More informationPersonnel Practices and Compensation Plan
CENTRAL BUCKS SCHOOL DISTRICT Personnel Practices and Compensation Plan Administrative Staff Non-Bargaining Unit Professional Staff July 1, 2016 June 30, 2019 100 Recognition The benefits and practices
More informationLOCAL FORM 4 August 1, IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA [insert correct division name] DIVISION
LOCAL FORM 4 August 1, 2010 IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA [insert correct division name] DIVISION In re: Case No. - - - Chapter 13 Debtor(s DETAILS OF
More informationCIRCUIT COURT OF ILLINOIS. Sixth Judicial Circuit Champaign County
CIRCUIT COURT OF ILLINOIS Sixth Judicial Circuit How to do a Wage Deduction Proceeding If you already have a money judgment against someone, you are the Petitioner. The other party, who owes you the money,
More informationCOMAR Requirements for Filing and Amending Claims
COMAR 14.09.02 -- Requirements for Filing and Amending Claims 14.09.01.01 Definitions A. In this chapter, the following terms have the meanings indicated. B. Terms Defined. (1)"Apostille" means a certificate
More informationCLERMONT COUNTY INSURANCE CONSORTIUM CCIC FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION
CLERMONT COUNTY INSURANCE CONSORTIUM CCIC FLEXIBLE BENEFITS PLAN SUMMARY PLAN DESCRIPTION TABLE OF CONTENTS I ELIGIBILITY 1. When can I become a participant in the Plan?... 1 2. What are the eligibility
More informationebay California Voluntary Plan
ebay California Voluntary Plan Statement of Coverage For California Employees of ebay Effective for Benefit Periods commencing on or after January 1, 2018 ELIGIBILITY & EFFECTIVE DATE OF COVERAGE All California
More informationMoffitt Cancer. Policy: Charity Care/Financial Assistance. Policy Statement. Purpose. Scope. Procedures. Effective: 04/2018 Page 1 of 10
Responsible Office: Business Office Category: Finance Authorized: Vice President, Revenue Cycle Policy Number: ADM-C032 Management Review Frequency: 3 years Effective: 04/2018 Policy Statement This Policy
More informationFamily Assistance Program
Family Assistance Program The Children s Cardiomyopathy Foundation (CCF) Family Assistance Program was established in 2011 through the generous donations of CCF family members. The fund was set up to assist
More informationFAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM)
IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: and, Petitioner,, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (Under $50,000 Individual Gross Annual
More informationFLEX PLAN ENROLMENT GUIDE
Frequency Asked Questions are located on Page 6 FLEX PLAN ENROLMENT GUIDE The University of Winnipeg is committed to providing a comprehensive health benefits program to our employees. The Flex Plan includes
More informationOther Coverage Questionnaire
PO Box 94059 Seattle, WA 98111 Other Coverage Questionnaire In order to pay your claims in a timely manner, we need information about other health plan coverage you may have even if you have none. Please
More informationSCOPE: This policy adheres to the common element Scope statement presented in Finance and Revenue Cycle Policy on Policies.
PURPOSE: To define eligibility, application and approval processes for Financial Assistance. Financial Assistance is offered to uninsured, underinsured, and medically indigent patients who indicate an
More informationINDIVIDUAL VISION CARE POLICY. VSP Vision Care, Inc QUALITY DRIVE RANCHO CORDOVA, CA TABLE OF CONTENTS REQUIRED PROVISIONS 3
**NOTICE: THIS IS A LIMITED BENEFIT POLICY. PLEASE READ CAREFULLY! IT DOES NOT PAY ANY BENEFITS FOR LOSS FROM SICKNESS. THIS POLICY PROVIDES RESTRICTIVE COVERAGE FOR VISION CARE SERVICES AND VISION CARE
More informationBOX ELDER COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION
BOX ELDER COUNTY CAFETERIA PLAN SUMMARY PLAN DESCRIPTION Restatement TABLE OF CONTENTS I ELIGIBILITY 1. When can I become a participant in the Plan?... 1 2. What are the eligibility requirements for our
More informationARBITRATION RULES OF THE PDRCI (Effective as of 1 January 2015)
ARBITRATION RULES OF THE PDRCI TABLE OF CONTENTS Section I: Introductory Provisions Model Arbitration Clause: Article 1 - Scope of Application Article 2 - Notice and Calculation of Period of Time Article
More informationFrequently Asked Questions
Page 1 of 22 Anthem Blue Cross and Blue Shield High-deductible Health Plans and Health Savings Accounts Frequently Asked Questions November 30, 2004 Page 2 of 22 Anthem Blue Cross and Blue Shield High-Deductible
More informationSURA/JEFFERSON SCIENCE ASSOCIATES, LLC
SURA/JEFFERSON SCIENCE ASSOCIATES, LLC COMPREHENSIVE HEALTH AND WELFARE BENEFIT PLAN Summary Plan Description Amended and Restated Effective April 1, 2011 YOUR SUMMARY PLAN DESCRIPTION This document is
More informationIN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF KANSAS STANDING ORDER NO ORDER ADOPTING FORM CHAPTER 13 PLAN
IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF KANSAS STANDING ORDER NO. 10-2 ORDER ADOPTING FORM CHAPTER 13 PLAN The Bench Bar Committee has recommended the adoption of a form Chapter 13 Plan,
More informationReimbursement Request
Reimbursement Request Eligibility to Receive Reimbursements You can access your HCSP account for the reimbursement of eligible medical expenses when you separate from service at any age, retire, or are
More informationSTANDARD INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS
STANDARD INTERROGATORIES FOR ORIGINAL OR ENFORCEMENT PROCEEDINGS 1. BACKGROUND INFORMATION: a. State your full legal name and any other name by which you have been known. b. State your present residence
More informationIN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA., ) ) Petitioner, ) ) Civil Action File No. vs. ) ), ) ) Respondent. ) ) ANSWERS TO INTERROGATORIES
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA, Petitioner, Civil Action File No vs, Respondent ANSWERS TO INTERROGATORIES No later than thirty (30 days from the filing of the Complaint, each party is
More informationCase No.: Division:, Petitioner,, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (Under $50,000 Individual Gross Annual Income)
IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA Case No.: Division: and, Petitioner,, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT (SHORT FORM) (Under $50,000 Individual Gross Annual
More informationPrince William County JDR Model Interrogatories (Support) IN THE JUVENILE AND DOMESTIC RELATIONS DISTRICT COURT OF PRINCE WILLIAM COUNTY
V I R G I N I A: IN THE JUVENILE AND DOMESTIC RELATIONS DISTRICT COURT OF PRINCE WILLIAM COUNTY, ) Petitioner, ) ) v. ) Case No. JA ) ) Respondent, ) To:{Party} c/o: {Counsel} I N T E R R O G A T O R I
More informationLIFELINE DISCOUNT PROGRAM APPLICATION
LIFELINE DISCOUNT PROGRAM APPLICATION THINGS TO KNOW You must be a current AT&T Internet customer. If you are not currently an AT&T Internet customer on a plan with a speed of 12MB or greater at an eligible
More informationInstructions for Mississippi Medicaid Provider Disclosure Form (Section C 2)
Instructions for Mississippi Medicaid Provider Disclosure Form (Section C 2) The Code of Federal Regulations set forth in 42 CFR. 455.100 106 requires that all providers disclose specified information
More informationVIRGIN ISLANDS SOCIAL SECURITY (NATIONAL HEALTH INSURANCE) REGULATIONS, 2015 ARRANGEMENT OF REGULATIONS PART I PRELIMINARY PART II REGISTRATION
VIRGIN ISLANDS SOCIAL SECURITY (NATIONAL HEALTH INSURANCE) REGULATIONS, 2015 ARRANGEMENT OF REGULATIONS Regulation PART I PRELIMINARY 1. Citation and commencement. 2. Interpretation. PART II REGISTRATION
More informationSUPREME COURT OF THE STATE OF NEW YORK COUNTY OF X Plaintiff,
SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ---------------------------------------------------------------------X Plaintiff, - against - STATEMENT OF NET WORTH DATED: Index No. Date Action Commenced:
More informationCOBRA Provisions of the 2009 Stimulus Bill (The American Recovery and Reinvestment Act of 2009) March 11, 2009
COBRA Provisions of the 2009 Stimulus Bill (The American Recovery and Reinvestment Act of 2009) March 11, 2009 The economic stimulus legislation (The American Recovery and Reinvestment Act of 2009 (( ARRA
More informationAscension Health FLEXIBLE SPENDING ACCOUNT PLAN SUMMARY PLAN DESCRIPTION ("SPD") St. Thomas Health Services
Ascension Health FLEXIBLE SPENDING ACCOUNT PLAN SUMMARY PLAN DESCRIPTION ("SPD") St. Thomas Health Services TABLE OF CONTENTS INTRODUCTION TO THE FLEXIBLE SPENDING ACCOUNT PLAN SUMMARY PLAN DESCRIPTION...
More information