Certificate B 328 Form PDF Details

Certificate B 328 form is a United States federal government form that is used to report and pay withholding taxes on wages. The certificate must be completed by both the employer and the employee, and it must be filed with the Internal Revenue Service (IRS) each quarter. In this blog post, we will discuss what information is required on the certificate, and we will provide a detailed guide on how to complete it. We will also highlight some of the benefits of filing withholding taxes quarterly. Let's get started!

QuestionAnswer
Form NameCertificate B 328 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesct dmv medical card self certification, cdl medical card ct, ct dmv cdl medical card fax number, ct dmv medical card

Form Preview Example

MEDICAL EXAMINER'S CERTIFICATE

STATE OF CONNECTICUT - DMV

B-328 Rev. 10-2008

On The Web At ct.gov/dmv

I CERTIFY THAT I HAVE EXAMINED (PRINT NAME OF INDIVIDUAL BELOW)

In accordance with the Federal Motor Carrier Safety Regulations (49 CFR 391.41-391.49) and with knowledge of the driving duties, I find this person is qualified; and, if applicable, only when:

Please keep this card

Wearing Corrective Lenses

Wearing Hearing Aid

Qualified by operation of 49 CFR 391.64

Driving within an exempt intracity zone (49 CFR 391.62)

Accompanied by a Skill Performance Evaluation Certificate (SPE)

Accompanied by a ____________________________ waiver/exemption

for your record do not mail to the DMV.

The information I have provided regarding this physical examination is true and complete. A complete examination form with any attachment embodies my findings completely and correctly, and is on file in my office.

 

SIGNATURE OF MEDICAL EXAMINER

TELEPHONE NUMBER

DATE

 

X

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF MEDICAL EXAMINER (PLEASE PRINT)

ISSUING STATE

 

MEDICAL CERTIFICATE EXPIRATION DATE

 

 

 

 

 

 

 

 

MEDICAL EXAMINER'S LICENSE OR CERTIFICATE NO.

MD

DO

Physician

Advanced

 

 

 

 

Chiropractor

Assistant

Practice Nurse

SIGNATURE OF DRIVER

DRIVER'S LICENSE NUMBER

STATE

 

X

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS OF DRIVER

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