Form Md 35 1 PDF Details

If you're like most small business owners, you're always looking for ways to save money and increase profits. One way to do both is to file your taxes as a self-employed individual. This designation offers certain tax benefits that can help reduce your taxable income. To make the most of these benefits, it's important to understand the different forms associated with self-employment tax filing. Form Md 35 1 is one such form, and in this article we'll take a closer look at what it is and how it can help you save money on your taxes.

QuestionAnswer
Form NameForm Md 35 1
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessurgical assistance fund form, ufa md35, surgical assistance md 35, fdny fund form

Form Preview Example

UFA/UFOA Surgical Assistance Fund

MD-35-1 (11/97) 109-991518-190

9 METROTECH CENTER BROOKLYN, N.Y. 11201-3857

APPLICATION FOR BENEFIT IN SURGICAL ASSISTANCE FUND

DATE _________________

Retired ( )

Widow ( ) Name _____________________________________________Social Security No.______________________

Address: _________________________________________________________Telephone No: _____________________

TownState Zip Code

Rank: ___________________ Unit No. ____________________ Div. __________ Date Retired ____________________

Name of Patient ___________________________________________Age of Patient __________ Years

Relationship to Member ______________________________________ If child, give Date of Birth _________________

Name of Doctor ____________________________________________________________________________________

Office Address ________________________________________________________________Zip __________________

Name of Hospital ___________________________________________________________________________________

Address: _____________________________________________________________________Zip __________________

Doctor Used: HIP _______________ GHI _______________ Private ______________ Others _______________

Date/Dates of Operation: _____________________________________________________________________________

One of the following must accompany this claim:

An Official Medical Document, such as a Hospital Operation Report. MD-48, GHI bill, Anesthesia bill, a statement from the Doctor, etc., that states the name of the patient, diagnosis, full nature of the procedure and the date the procedure was performed. (Coded medical evidence cannot be used by this office)

NOTE: Receipt of claims will only be acknowledged when claimant encloses a stamped, self-addressed post card with claim.

ANESTHESIA AND/OR SERVICES OF ANESTHESIOLOGISTS ARE NOT COVERED BY THE FUND. CLAIMS 1 YEAR OR OLDER WILL NOT BE CONSIDERED UNDER ANY CIRCUMSTANCES.

ONLY DEPENDENT CHILDREN UNDER 19 YEARS OF AGE (INCLUDING FULL TIME STUDENTS) ARE ELIGIBLE FOR BENEFITS.

X ___________________________

(SIGNATURE OF MEMBER)

-------------------------------------------------------DO NOT FILL IN BELOW--------------------------------------------------------

(For S.A.F. Use Only)

Date of Entrance in Fund _________________________ Benefits Received since June 30 ___________$ _____________

Case No. __________________________________________ Date ___________________________________________

Amount to be Paid by Fund ______________________________ Basic Fee Rate ________________________________

Amount Deducted from Basic Fee Rate _________________________Check No. ________________________________

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fund md35 writing process shown (portion 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Retired Widow Name Social, An Official Medical Document such, SIGNATURE OF MEMBER, DO NOT FILL IN BELOW, For SAF Use Only, and Date of Entrance in Fund Benefits with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling in segment 2 in fund md35

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