Examples of Legal Spouse in a sentence
Signature of Applicant/Legal Representative* Date Signed NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Medicaid Enrollment and Exchange Integration Authorization for Verification of Resources (Legal Spouse) This form authorizes Medicaid to request records from financial institutions for the spouse of an individual applying for Medicaid.
Dependents Documents Required (copy) Legal Spouse State-or County-Issued Marriage Certificate Domestic Partner Notarized “Declaration of Domestic Partnership” At least two of the documents listed in Section 5.1, b.
Legal Spouse or Domestic Partner (Last, First, Middle Initial)Social Security NumberGenderMFDate of BirthHusband/WifeDom.
ELIGIBILITYThe following are Covered Persons under this Plan, pursuant to eligibility criteria established by Client: • Enrollee• Legal Spouse of Enrollee• Domestic Partner• Any child of Enrollee, including a natural child from date of birth, legally adopted child from the date of placement for adoption with the Enrollee, or other child for whom a court or administrative agency holds the Enrollee responsible.
Association dues deduction and COPE deductions, provided that at least five teachers participate on an ongoing basis.
ELIGIBILITYThe following are Covered Persons under this Plan, pursuant to eligibility criteria established by Client: • Enrollee• Legal Spouse of Enrollee• Any child of Enrollee, including natural child from the date of birth, legally adopted child from the date of placement for adoption with the Enrollee, or other child for whom a court or administrative agency holds the Enrollee responsible.
Dependents Documents Required (copy) Legal Spouse State-or County-issued Marriage Certificate Domestic Partner Notarized “Declaration of Domestic Partnership” At least two of the documents listed in Section 5.1, b.
Acceptable documentation is outlined below.Acceptable Supporting Documentation(All financial information and Social Security numbers should be markedout.)• Legal Spouse –A copy of the first page of the most recently filed federal income tax return Form 1040 that indicated “married filing jointly” or “married filing separately” (spouses name must appear on the line provided after “married filing separately”).
The Summary of Vision Plan Benefits Section lists your Covered Services.Eligible Dependent Means (a) your Legal Spouse; (b) your Child(ren); and(c) any other dependents who meet the criteria for eligibility set forth in the Summary of Vision Plan Benefits Section.
If you and your Legal Spouse are both eligible for coverage under this Plan, you may be enrolled together on one application or separately on individual applications, but not both.