Ga epd consumer confidence report certification form consumer confidence report certification forms are due to epd offices annually no later than october 1st. community water system name: ga water system i.d. number: (ga) - report year the...
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Print clear page georgia form individual income tax return georgia department of revenue 1 500(rev. 1/09) please print your numbers like this in black or blue ink: please check box if you do not want a booklet next year. 2008 affix label here...
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E do not ma il! pleas state of georgia department of revenue keep these instructions and worksheet with your records instructions 1. download (free) the latest version of adobe reader x http://.adobe.com/products/acrobat/readstep2.html 2. complete...
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Print form georgia department of transportation oversize permit unit if you have any questions, please call () 774-1460 for assistance mailing address: georgia department of transportation oversize permit unit p. o. box 17937 atlanta, ga...
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B. j. walker, commissioner georgia department of human resources office of regulatory services health care section two peachtree street nw suite 33-250 atlanta georgia 30303-3142 (404) 657-5400 fax (404) 657-5442 instructions for x-ray...
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Print form visit us at .humana.com or .humanadental.com humana employee enrollment form - 2-19 employees georgia the offering company(ies) listed below, severally or collectively, as the content may require, are referred to in this application as...
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Form g-2rp(rev. 12/11) print clear withholding on sales or transfers of real property and associated tangible personal property by nonresidents 2. seller's social security or fei number 9. date of sale $ $ $ check here if multiple sellers 1....
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Asbestos disposal manifest form please complete and return with completion form. i. project information: asbestos project: project address: city: state: georgia county: project dates: removal contractor (agent name): license no/expiration: removal...
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Dt18123 children's healthcare of atlanta laboratory outpatient requisition form group # time: name date of birth mrn# account/har# patient identification stat insurance info: bill to: insurance: pre-cert # order for collection date: phone results...
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Human resources - official application p.o. box 130 2121woodland street springfield, tennessee 37172 (615) 384-5588 (615) 384-9749 .rcstn.net robertson county schools bus driver application name last first middle home number ( ) - maiden cell...
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Virginia r. diamond, chairman mary vail ware commonwealth of virginia william l. dudley, jr., commissioner director criminal injuries compensation fund post office box 26927 richmond, virginia 23261 lawrence d. tarr, commissioner james szablewicz,...
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T-107a (revised 08-2005) odometer discrepancy affidavit purchaser's statement of facts: this is to certify that on , i (date) (purchaser's full legal name) (purchaser's address including city, state & zip) acquired the following vehicle: (year &...
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Separation from employment withdrawal request 401(a) plan state of alaska supplemental annuity plan 98214-03 when would i use this form? when i am requesting a withdrawal and i am no longer employed by the employer/company sponsoring this plan....
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Bf-05q01 march 2002 page 1 of 4 blue flash express application for employment blue flash express 23356 old scenic highway zachary, la 70791 in compliance with federal and state equal employment opportunity laws, qualified applicants are considered...
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City of savannah zoning board of appeals application 5515 abercorn street savannah, georgia 31405 phone: (912) 651-6530 / tdd: (912) 651-6702 / fax: (912) 651-6543 .savannahga.gov all information must be completed in full before this application...
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