Northeastern Program Service Center Jamaica Ny 11432

TN 25 (01-04) HI 01001.277 Structure Notice- State or Neighborhood Government Pension System Will Spend the Premium Surcharge for Medicare Part T - Assignee in Direct Costs Status Northeastern Plan Service Middle 1 Jamaica Center Plaza Jamaica, New York Day: October 16, 1997 BNC#: XXAXXXXAXXXXX David Doe 1212 Oak Street Alexandria, VA ZIP We must charge a premium surcharge on your Medicare medical insurance plan because you possess enrolled afterwards than you could have. Your Condition or regional government retirement system will spend your past due enrollment superior surcharge aftér MMYYYY. Yóu must pay out the simple Medicare medical insurance premium beginning MMYYYY. What We Plan To Perform We will send out your first costs for the basic Medicare Component B high quality within three a few months.

The regular monthly premiums complete $XX.XX. Each bill after that will be for a 3-month period. Make sure you get in touch with us if you do not obtain the 1st expenses within three a few months. If You Differ With The Choice If you disagree with the switch we have made to your regular transaction, you have the right to appeal.

We will critique your case again and think about any fresh facts you have. A person who do not create the 1st choice will decide your situation. You possess 60 days to request for an appeal. The 60 days begin the day after you obtain this letter.

We presume you obtained this notice 5 times after the date on it unless you show us that you did not obtain it within the 5-day time period. You must possess a great cause if you wait more than 60 times to question for an appeal. You possess to request for an charm in writing. We will inquire you to sign a Form SSA-561-U2, known as “Request for Reconsideration.” Get in touch with one of our workplaces if you want help. If You Possess Any Queries If you possess any queries about the State or regional government pension system, make sure you get in touch with that office.

If you possess any questions about Medicare you may call us toll-frée at 1-800-772-1213, or call your regional Social Safety office at 1-912-264-6241. We can remedy most questions over the cell phone.

Queens Eoc Jamaica Ny 11432

You can furthermore create or visit any Public Security Workplace. The workplace that acts your area is located at: Area Office Suite 220 6295 Edsall Road Alexandria, VA 22312 If you do contact or check out an workplace, please possess this letter with you. It will assist us answer your questions. Also if you plan to visit an workplace, you may call forward to create an session. This will help us serve you more rapidly when you get there at the office. Assistant Regional Commissioner, Processing Center Operations To Link to this area - Use this Web address.

SCHOOL ETHICS Commission rate Individual DISCLOSURE Declaration For Appointments Yr 2017This Individual/Relative Disclosure Statement is required annually of all college officials in accordance with N.J.T.A. 18A:12-21 et seq., The School Ethics Action. The Relatives Disclosure Declaration must be filed by April 30th of each calendar year or within 30 days of assuming office or placement if recently elected or appointed. This statement is definitely a general public record. Before completing this declaration, go through all guidelines and definitions. Personal Information First Name: Barbara Middle Name: Drummond (elective) Final Title: Garand College Tackle: 298 Hillside Ave. City: Allendale State: NJ Squat:07401 Place: Table Member College Region or Charter College: Northern Highlands Regional High School Area Region: BERGEN Husband or wife Details (if applicable) First Title: Christopher Middle Title: Pierre Final Title: Garand.

Relatives DISCLOSURE STATEMENT Area II. Comparable Information 1. Is definitely any individual associated to you, or associated to you by relationship, used by the college area or a charter school in which you keep office or are usually utilized? If you are usually an employee of the NJSBA, is any person so related to you employed by any school area or charter school? If yes, make sure you provide the information requested below.

If no therefore certify. I respond to simply no to this issue.

Are usually you or will be any individual related to you or related to you by marriage, a celebration to a agreement with your school district or a charter college? If you are usually an employee of the NJSBA, are usually you or will be any person so associated to you, a celebration to a contract with any school region? If yes, make sure you offer the details requested beneath. If no so certify. I remedy simply no to this question.

Perform you or does any relatives receive compensation from or possess any interest in any business which can be a celebration to a contract with the school area or charter school in which you keep workplace or are used? If you are an worker of the NJSBA, do you or will any comparative receive payment from or keep an attention in any company which can be a party to a agreement with any region? If yes !, provide the namé of each businéss and if appIicable, school district.

lf no so certify. I reply simply no to this query.

FINANCIAL DISCLOSURE Declaration Based on your economic information for work schedule 12 months 2016 This Financial Disclosure Declaration is required annually of all school officials in accordance with In.J.Beds.A. 18A:12-21 et seq., The School Ethics Take action. The Action needs that details pertain to the preceding calendar calendar year.

The Financial Disclosure Declaration must be submitted by April 30th of each calendar year or within 30 times of assuming workplace or position if recently elected or designated. This statement will be a public record. Before completing this declaration, examine all guidelines and definitions.

FinanciaI InformationIf the info has transformed from the preceding calendar season, it will be suggested that the public also offer financial information which is usually present as of five times prior to the date of this filing. Listing the name and address of each source of revenue, gained or unearned, fróm which you ór a associate of your immediate family obtained in extra of $2,000.

If a publicly traded security can be the supply of earnings, the security need not really be reported unless you or a member of your immediate family has an curiosity in the business firm. If you are usually a area employee, be certain to listing the area plank or charter school as a resource of income. Client costs received through a company need not really be individually reported.

Title of Resource Tackle of Source Title of Recipient Romantic relationship Social Security Northeastern System Service Center 1 Jamaica Middle Plaza Jámaica, NY 11432 Christopher P. Garand spouse Vanguard Fiduciary Confidence Co PO Container 1101 Valley Forge, Pennsylvania 19482 Christopher G. Garand spousé TPAF -Dept. 0f Treasury NJ Department of Treasury Condition of NJ Trénton, NJ 08625 Barbara G. Garand self Social Safety Northeastern System ServiceCenter 1 Jamaica Center Plaza Jámaica, NY 11432 Barbara D. Garand personal General Re also Corp. Ret Program 120 Long Ridge Rd Stamford, Ct.

06902 Christopher G. Garand spouse 2. List the name and deal with of each resource of charges/honorariums or gifts/reimbursements or pre-paid expenses getting an aggregate amount going above $250 from any single source, excluding family members, obtained by you or an immediate family associate.

Be sure to listing any compensation received from the area or charter school for like stuff as meeting attendance, college tuition/dues compensation, personal looks, speeches and toasts, or composing. Not really Applicable 3. List the name and deal with of all company institutions in which yóu or a associate of your immediate family held an attention during the previous calendar yr. Not really Applicable SECTION IV. Certification I realize that this accreditation constitutes my manifestation of the accuracy of its material. I hereby certify that these disclosure claims consist of no willful misstatément or omission óf materials fact and make up a complete disclosure with respect to all issues required by In.J.T.A new. 18A:12-21 et seq.

I are conscious that if I fall short to file a declaration or if I file a declaration containing information that I understand to be false, I shall be subject matter to disciplinary action up to and like elimination pursuant to D.J.S i9000.A. Licensed by: Barbara Drummond Garand Date.