Attachment to:
Comptroller's Memorandum 2001-57
October 4, 2001
REQUEST FOR INFORMATION REGARDING STATE EMPLOYEES IN THE RESERVES
OF THE ARMED FORCES OF THE UNITED STATES
| Name Of The Employee: |
|
Employee Number: |
|
Social Security Number: |
|
| Home Address & Telephone Number: |
|
| Name, Address & Telephone Number Of Any Contact Person For The Employee: |
|
| Health Insurance Coverage: |
|
Branch of Service: |
|
| Employing Agency & Contact Person In That Agency: |
|
| SEND TO: | |
|
Office of the State Comptroller Policy Services Division 55 Elm Street, Room 221 Hartford, CT 06106 Attn: Carolyn Mercier Fax #: (860)-702-3441 |
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