Washington Form Af 595 PDF Details

Washington form AF 595 is a document used by businesses in the United States to apply for registration, update information, and make changes to their business. This form collects important data from the applicant like company name, address, type of business entity, EIN number and contact information. It also requires applicants to provide details about their employees and payroll taxes withheld from them. Completing this form correctly is critical as any mistakes could lead to costly consequences for the business owner. In this blog post we will discuss how to fill out Washington Form AF 595 accurately and efficiently.

QuestionAnswer
Form NameWashington Form Af 595
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesAF 595 washington county ohio job and family services form

Form Preview Example

Washington County Department of Job and Family Services

1115 Gilman Avenue

Marietta, Ohio 45750

(740) 373-5513

DATE: __________________________

RE: ______________________________

_________________________________

______________________________

(Name of Business)

(Social Security Number)

_________________________________

______________________________

(Address)

(Case Manager)

_________________________________

______________________________

(City, State, Zip)

(Case Number Unit)

I am aware of my responsibilities to report completely and fully all facts which bear upon my eligibility for public assistance. I realize if the requested information reveals I have improperly reported my situation, the information may be given to the prosecuting attorney for possible civil action or criminal prosecution.

By my signature below, I hereby authorize the following information to be released to determine eligibility for Public Assistance benefits.

(Signature)

(Date)

Employer: Please answer all highlighted or underlined questions. Thank You.

1.

Date employment began: ___________________________

Date 1st pay due or received: __________________

2.

Date employment ended: ___________________________

Date last pay due or received: _________________

3.

Reason for termination: ____________________________

 

4.

Position: ___________________________

How often is employee paid: __________________

5.Average number of hours scheduled per week: _____________

(Please give best estimate if new position)

6. Hourly Rate: ___________

 

If salary, monthly amount: _________________________________

7. Please report below gross earnings paid on each pay date from ___________ to ___________

____________

________

____________

________

___________

___________

(Date paid)

(Amount)

(Date paid)

(Amount)

(Date paid)

(Amount)

____________

________

____________

________

___________

___________

(Date paid)

(Amount)

(Date paid)

(Amount)

(Date paid)

(Amount)

____________

________

____________

________

___________

___________

(Date paid)

(Amount)

(Date paid)

(Amount)

(Date paid)

(Amount)

______________________________________________________________________________________

(SIGNATURE OF PERSON SUPPLYING INFORMATION)

(PHONE)

(DATE)

Please provide all information requested. This information will be used to:

[] Determine eligibility for: [] ADC [] Medicaid [] Food Stamps [] Other Programs, specify: __________

[] Other use, specify: ___________________________________

[ ]original

[ ] copy

AF-595

How to Edit Washington Form Af 595 Online for Free

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This PDF form will require particular data to be filled out, hence you need to take some time to fill in what is asked:

1. It is advisable to fill out the Washington Form Af 595 accurately, therefore pay close attention when working with the parts including all these blanks:

Washington Form Af 595 completion process described (step 1)

2. After this array of fields is finished, you're ready add the needed specifics in original, copy, Address I am aware of my, Amount, Amount, Amount, If salary monthly amount, Date paid, Date paid, Date paid, DATE, Amount, Amount, and Amount in order to progress further.

The best ways to fill in Washington Form Af 595 portion 2

It's very easy to make a mistake while filling out your Date paid, hence be sure you look again before you'll submit it.

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