Form Dr 500 066 – Fill Out and Use This PDF

Form Dr 500 066 signifying the verification letter of your tax credit form is an essential step of filing taxes with the IRS. This document serves as written proof to demonstrate correct completion and submission. If necessary, this document may be required for audit purposes. Make sure you have a printed copy for your records in accordance with US Treasury Department regulations.

Form Dr 500 066 PDF Details

Did you know that the IRS has a new form specifically for 501(c) organizations? Form Dr 500 066 is for exempt organizations to request an advance ruling on their tax-exempt status. This form must be completed and submitted by your organization if it wants to seek a determination from the IRS about whether it qualifies for exemption under IRC 501(c). Knowing what this form is and how to complete it can help your organization avoid any delays in getting its tax-exempt status approved. Let's take a closer look at Form Dr 500 066 and what you need to do to fill it out properly.

Question	Answer
Form Name	Form Dr 500 066
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	impairments, physiatrist, osteopathy, foregoing

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Commercial Driver License

Intrastate Medical Waiver Application

Use this form to apply for an intrastate medical waiver if you have or are applying for a commercial driver license (CDL) and do not meet the minimum federal medical/vision standards. This form is not for drivers that do not have a CDL. Send this form and a complete copy (the DOT medical card is not sufﬁcient) of your most current Medical Examination Report to:

Medical Unit, Driver Records

Department of Licensing

PO Box 9030

Olympia, WA 98507-9030

Fax: (360) 570-7893

Allow 7-10 business days for processing. Incomplete applications will not be processed.

PRINT or TYPE Driver name (Last, First, Middle initial)

Driver license number

Date of birth

(Area code) Telephone number

Describe the disqualifying medical condition(s) for this waiver

Certiﬁcation

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

I understand that false statements on this application may result in cancellation of my commercial driving privilege.

Signature

Date

Physician use only–This section must be completed by a licensed medical doctor (MD), a doctor of osteopathy (DO), a board certiﬁed physiatrist (doctor of physical medicine), or an orthopedic surgeon. An optometrist or an ophthalmologist signature is acceptable for vision impairments and a certiﬁed nurse practitioner can sign only for monocular vision, color blindness, or hearing impairments.

PRINT or TYPE Medical examiner name and title

Ofﬁce street address

City		State	ZIP code

(Area code) Telephone number	Professional license number

Certiﬁcation

The above driver’s medical condition is not likely to interfere with the ability to safely operate a commercial motor vehicle

and is likely to remain stable for:

the next two years

other

Not more than two years

Medical examiner signature	Date

Title

DR-500-066 (R/1/12)WA

We are committed to providing equal access to our services. If you need accommodation, please call (360) 902-3900 or TTY (360) 664-0116.

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2. Soon after the prior part is completed, proceed to enter the suitable information in these - City, State, ZIP code, Area code Telephone number, Professional license number, Certiﬁcation The above drivers, the next two years, other, Not more than two years, X Medical examiner signature, Title, Date, DR RWA, and We are committed to providing.

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Form Dr 500 066 – Fill Out and Use This PDF

Form Dr 500 066 PDF Details

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