Hudgens Details

Form Gid 391 Al, also known as the Alabama Individual Income Tax Return, is a form used by taxpayers to report their annual income to the Alabama Department of Revenue. This form is due by April 15th each year, and must be filed online unless you are exempt from e-filing. In order to complete Form Gid 391 Al, you will need your Social Security number, your driver's license number or state ID number, and your email address. Be sure to review the instructions carefully before filing your return. If you have any questions, please contact the Alabama Department of Revenue at (800) 222-3234.

You'll find it useful to understand how much time you will need to prepare this form gid 391 al and exactly how lengthy the form is.

QuestionAnswer
Form NameForm Gid 391 Al
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names

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OFFICE OF COMMISSIONER OF INSURANCE

COMMISSIONEROF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER

Ralph T. Hudgens, Commissioner

www.oci.ga.gov

Phone: 855-235-5174E-mail: GAInslicensing@psionline.com

Request For Clearance Letter

AGENTS LICENSING

GID-391-AL AUG2014

1.

General Instructions

A.A clearance letter is used by Georgia resident licensees who wish to cancel their Georgia license and apply for a license in a new resident state.

B.The fee for each clearance letter is $10.00.

C.You must submit your Georgia Insurance License with this request. If you have not submitted your license with this request, explain why your license is not included with this request.

I have included my original license card with this request.

I have not included my original license with this request because:

D.Return this request along with payment to: PSI SERVICES LLC / GEORGIA INSURANCE DEPT.

2.Licensee Instructions

Print your complete name as it appears on your Georgia insurance license.

Licensee:

 

Last Name

First Name

 

 

 

MI

Suffix (Jr., Sr.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (Suite number, floor number, etc…)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code 5-digits

+4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Address (Suite number, floor number, etc…)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code 5-digits

+4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residential Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

License Fee and Clearance Letter Request

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License Number

Social Security Number

 

 

 

National Producer Number

Insert the number of clearance letters requested. Multiply the number of clearance letters requested per license type by the fee of $10.00 per letter. Enter the total in the “Total Amount Enclosed” space.

NOTE: If you hold more than one license, a request for a clearance letter for one license type implies cancellation of all licenses held.

 

Clearance Letter(s) requested for

 

 

 

 

 

 

the following license type(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number Of

 

 

FEE

 

TOTAL AMOUNT

 

 

Clearance Letters Requested

 

(per letter requested)

 

ENCLOSED

 

 

 

 

X

$ 10.00

$

 

 

 

 

 

 

 

 

 

 

WARNING: By requesting a clearance letter, you are canceling your current Georgia license for all license types.

Licensee Signature

Date

MAIL FEES TO:

Bank of America Lockbox Services

Lockbox 742983, 6000 Feldwood Road, College Park, GA 30349

TOTAL OF ALL FEES DUE $

This office does not discriminate in employment, programs or services. Disabled persons can contact 404-656-2056 to obtain this document in another format.

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