Form Sf 5 – Fill Out and Use This PDF

Form SF-5 is a comprehensive form that contains details of personal information and relevant documentation. It exists to ensure access to pensions and other deferrals in the event the key contributor passes away before receiving the distributions they were owed. This form provides essential data; including a beneficiary's name, address, Social Security number and necessary documents that confirm the right of transfer. As such, ensuring that all proof is included when filing Form SF-5 can facilitate easier tracing of displacements for family members. It's an important process for many households as it can determine financial security for workers’ remaining relatives.

Form Sf 5 PDF Details

Form Sf 5 is an important form that all self-employed individuals must file to report their income and social security taxes. This form is due every year on April 15th, and it's important to make sure you understand the requirements so you can accurately complete and submit your form. The instructions for Form Sf 5 are very detailed, but this article will provide a brief overview of the most important points so you can be sure to have everything you need. Keep in mind that since this is a complex form, it's always best to consult with a tax professional if you have any questions.

Question	Answer
Form Name	Form Sf 5
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	SF 5_Food_Establis hment_Permit_Ap plication wv sf 5 form

Form Preview Example

SF-5		West Virginia Department of Health & Human Resources
Rev 5/08			Department of Health
	APPLICATION FOR A PERMIT TO OPERATE A FOOD ESTABLISHMENT
Food Establishment: Name				Phone		Fax
Mailing Address
Location					Hours of Operation

Applicant: Name		Age ≥ 18?
Mailing Address

Yes

No Phone			Fax
Email

Permit Holder: Permit to be issued to:

Applicant

Corporation

Partnership

Other Legal Entity

Ownership:	Individual	Association	Corporation	Partnership	Other Legal Entity
Provide the Name, Title, and		Address of each person comprising legal ownership (Owners, Officers, Local Resident Agent, etc).

Person Directly Responsible for Establishment (Manager, Person-In-Charge):

Name

Title

Phone

Mailing Address

Immediate Supervisor of Person Directly Responsible (Zone, District, Regional Supervisor):

Name

Title

Phone

Mailing Address

Type Establishment:

Mobile

Stationary

Permanent or

Temporary ( ≤ 14 days)

Restaurant - includes fast food, caterer, commissary, concession stand, bed & breakfast inn, camp, feeding site, etc.

Retail Food Store

- grocery store, convenience store, meat market, etc.

Indicate Number of Checkout Stations:

Retail Food Store Specialty Department - deli, bakery, seafood, etc.

Institution - child care center, hospital, jail, nursing home, personal care home, school, etc.

Bar or Tavern

Vending Machine(s)

Food Bank / Food Pantry

Meals Provided:

Breakfast

Lunch

Dinner

Services Provided:

Sit Down

Take Out

Delivery

Mail Order

Seating Capacity:

Average number of meals served per day:

Yes

Serve Highly Susceptible Population (HSP)?

HSP includes: preschool children, child care facilities, immunocompromised or older adults, nursing home or assisted living facilities, hospitals, etc.

Type Operation: Attach sample menu or list menu on reverse. PHF means Potentially Hazardous Food, those requiring temperature controls.

No PHF	Prepackaged non-PHF only or limited preparation of non-PHF
Limited	One or two main menu items. Cooking, cooling, reheating limited to 1 or 2 PHF. Limited hot and cold holding of PHF.
	Limited advanced preparation for next day service. Raw ingredients require minimal assembly. Includes retail food stores,
	Excluding specialty departments within retail food stores.
Full	Preparing PHF using two or more of the following steps: cooking, cooling, reheating, hot or cold holding, freezing, or thawing.
	Extensive handling of raw ingredients. Advanced prep for next day service. Includes specialty departments in retail food stores.

I hereby certify that the above information is accurate. Further, I agree to comply with Legislative Rule 64 CSR 17, Food Establishments, and to allow the regulatory authority access to the establishment and to records as specified in that rule.

Date		Signature of Applicant

		For Health Department Use Only
Date Received	Reviewed By		Permit Fee

Permit

Issued

Denied Date

Permit No.

Comments

Form Sf 5 – Fill Out and Use This PDF

Form Sf 5 PDF Details

Form Preview Example

Form Sf 5 isn’t the one you’re looking for?

Related Documents