Effective Date: 
1/2007

Documents


Instructions

Updated: 7/2007

Purpose

To notify the issuer of a disclosed annuity of the state's rights as the preferred remainder beneficiary.

Procedure

Number of Copies

Prepare an original and one copy of Form H0059.

Transmittal

Send the original of Form H0059 to the issuer of the annuity. File the copy in the case record.

Form Retention

Keep the case record copy according to the retention requirements of the case record.

DETAILED INSTRUCTIONS

Date — Self-explanatory.

Eligibility Specialist— Self-explanatory.

Office Address and Telephone Number— Self-explanatory.

Addressee — Enter the name and address of the annuity issuer.

Name of Applicant — Enter the applicant's name.

Date of Birth— Enter the applicant's date of birth.

Contract Number — Enter the contract number.

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