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Photo :: Kuva - Garage's Street Cars ry

Photo :: Kuva - Garage's Street Cars ry 2025

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The document is a legal notice from a Colorado District Court requiring an employer to enroll the children of an Obligor in a health insurance plan and to deduct premiums from the Obligor's wages. It outlines the obligations of the employer regarding enrollment, premium deductions, and consequences for non-compliance, as well as procedures for notifying the court about changes in employment or insurance status.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the court address and case details at the top of the form. Ensure you accurately fill in the names of the petitioner and co-petitioner/respondent, along with their respective contact information.
In the 'NOTICE TO EMPLOYER' section, provide the employer's name and address. This is crucial for ensuring proper communication regarding health insurance deductions.
Fill in the Obligor’s details, including their full name, social security number, and address. This information is essential for identifying who is responsible for health insurance premiums.
List each child’s full name, date of birth, and social security number in the designated fields. This ensures that all relevant dependents are covered under the health insurance plan.
Complete any additional sections as required, such as certification of mailing. Make sure to sign and date where indicated to validate your submission.

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