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Form 940 (Schedule R) for Murrieta California: What You Should Know

MUNICIPALITIES, INCLUDING PUBLIC LIBRARY SYSTEMS; DEPARTMENT OF PUBLIC HEALTH. 2 All residents must report to the Department of Human Services in accordance with the following schedule: All clients, regardless of age or sex, can have their medical records processed upon request. This service is available on a walk-in basis, and in either of 2 formats: 1.)  1. A copy from your physician must be submitted to the Department of Human Services by email or mail at the address  2. Information must be submitted through  3. A copy of your birth certificate must be printed and signed at a Department of Human Services facility in addition to the original. 4. Your Social Security Number must be provided on the application. 2.) Medical records: All clients must provide proof of a valid, primary care doctor's letter stating this is your present medical provider. Such proof may be a letter from your physician, a letter from the local hospital, or an official document like a hospital birth certificate/certification. All clients must provide proof of one year of uninterrupted continuous coverage with a current, valid insurance policy for those with  medical or dental coverage, or a statement from the insurance company with payment information.  All patients and their primary care doctors or dentist's office must have an active, letter from the insurance company stating what the policy provides and specifying all costs of services as the total is determined. 3 You must provide a current utility bill that includes your name, address, and Social Security number at the time a service was delivered . There is a 4 fee for each item, up to a maximum of 50 for any single service. Payment can be made by check, money order, or credit card. All customers are responsible for payment. 4 The following individuals must submit proof that the City is the parent: 1. A parent, spouse, child, or guardian of a minor or a legal guardian has signed this form and has completed all the required fields. 5. The City is the parent for the following services: All clients must provide proof that the City is the parent for the following services:  The amount of your personal services tax is determined on the individual return. When filing this document, a check or money order mailed to the appropriate address must accompany the form.

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