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Form 1239 verification of bank accounts

Form 1239 verification of bank accounts-2026

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The document is a request for verification of bank accounts for a depositor being considered for medical assistance. It includes sections for the depositor's information, account details, and a request for balances as of specific dates. The form requires completion by both an eligibility specialist and a bank representative.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This is essential for record-keeping.
Fill in the name and address of the bank where the account is held, along with their office telephone number.
In the 'Name of Depositor' section, input the full name of the individual whose bank account is being verified.
Enter the account number in the designated field, ensuring accuracy for verification purposes.
Provide any comments or additional information that may assist in processing this request.
The eligibility specialist should sign and date the form to authorize this request.
For bank representatives, complete all required fields regarding account details, including balances and types of accounts.

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Versions	Form popularity	Fillable & printable
2010	4.8 Satisfied (226 Votes)
2009	4 Satisfied (56 Votes)

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form 1239

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