Dhhs Form Hhs 95 PDF Details

If you are a current or former employee of the DHHS, you may be familiar with Form HHS 95. This form is used to report wages and other compensation information. In this blog post, we will provide an overview of Form HHS 95 and explain how to complete it. We will also discuss common errors that occur when completing the form. Finally, we will provide tips for ensuring accuracy when reporting wages and compensation. Stay tuned!

QuestionAnswer
Form NameDhhs Form Hhs 95
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdivorce pdf form nebraska application for certified copy of dissolution of marriage

Form Preview Example

APPLICATION FOR CERTIFIED COPY OF DISSOLUTION OF MARRIAGE (DIVORCE) CERTIFICATE

This office has been registering dissolutions of marriage (divorces) occurring in Nebraska since 1909. For records occurring prior to 1909, or if you wish to obtain the divorce decree, contact the District Court in the county where the divorce was granted.)

PLEASE TYPE OR PRINT LEGIBLY

Full name of husband _________________________________________________________________________________

Full name of wife _____________________________________________________________________________________

City or county where granted ____________________________________________________________________________

Month, day, and year granted ___________________________________________________________________________

For what purpose is this record to be used? ________________________________________________________________

If this is not your divorce certificate, how are you related to the person listed on the record? __________________________

WARNING: Section 71-649, Nebraska Revised Statutes: It is a felony to obtain, possess, use, sell, furnish, or attempt to obtain any vital record for purposes of deception.

SIGNATURE _____________________________________________

Type or print name_________________________________________

Street Address____________________________________________

City, State, Zip ___________________________________________

Daytime Telephone Number _________________________________

Email Address ___________________________________________

Today’s Date _____________________________________________

Please enclose a photocopy of your photo ID (i.e. current driver’s license) when mailing in this request.

Fees are subject to change without notice. Please call our 24-hour recorded message at (402) 471-2871 to verify fees.

Number of certified copies________ x $16.00 each = $________ Total

(Please make checks payable to Vital Records)

Mail to:

Bring to:

Vital Records

Vital Records

PO Box 95065

1033 O Street, Suite 130

Lincoln, NE 68509-5065

Lincoln, NE 68508-3621

(Please enclose a stamped,

 

self-addressed business

 

size envelope.)

 

FOR OFFICE USE ONLY

 

q Check q MO

q Cash

Amount Received ________________________

Date Received __________________________

By Whom Received ______________________

PROOF OF IDENTIFICATION;

 

DL

STATE ID

OTHER

______________________________________

HHS-95 (55097) 6/14

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In an effort to fill out this document, make sure you provide the necessary details in every single blank:

1. While completing the Dhhs Form Hhs 95, ensure to include all of the essential fields within the corresponding area. This will help speed up the process, making it possible for your information to be handled without delay and correctly.

The best way to fill in Dhhs Form Hhs 95 part 1

2. Once your current task is complete, take the next step – fill out all of these fields - Email Address, PROOF OF IDENTIFICATION, Todays Date, DL STATE ID OTHER, Please enclose a photocopy of your, Fees are subject to change without, Number of certified copies x each, and Mail to Bring to Vital Records with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Dhhs Form Hhs 95 conclusion process described (step 2)

You can easily make errors when filling out your Todays Date, and so be sure you go through it again prior to when you submit it.

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