Customize Alaska Gen020

Fill Out Your Alaska Gen020 Form

The Alaska Gen020 form is an important document used to verify residency for retirees seeking the Cost-of-Living Allowance (COLA) in Alaska. This affidavit confirms that the applicant maintains their principal residence in the state and intends to remain a resident. Completing this form accurately is crucial for ensuring eligibility for benefits, so take a moment to fill it out by clicking the button below.

Alaska Gen020 Sample

Alaska Cost-of-Living Allowance (COLA)

Afidavit of Residency		ＩＲＵ＃ＲＩＩＬＦＨ＃ＸＶＨ＃ＲＱＯ＼＃
Afidavit of Residency

	Division of Retirement and Beneits	Juneau: 465-4460
Toll-Free: 1-800-821-2251	PO Box 110203	TDD: (907) 465-2805
alaska.gov/drb	Juneau, Alaska 99811-0203	Fax: (907) 465-3086

Name (First, M.I., Maiden, Last)

Social Security Number (last 4 digits)

Physical Address (Street Address, City, State)

Mailing Address (City, State, ZIP+4)

COLA is for retirees who reside in the State of Alaska. Resides means domiciled and physically present in the state.

2 AAC 36.210 (TRS) and 2 AAC 35.240 (PERS) states a person domiciled in the state is a person who:

(1)maintains his or her principal place of residence in the State of Alaska;

(2)demonstrates at all times during an absence an intent to return to Alaska and remain a resident of Alaska;

(3)does not claim residency outside the state or obtain beneits or residency in another state or nation.

The administrator’s determination of an applicant’s residency will be based on the totality of relevant circumstances. Intent is demon- strated by establishing and maintaining customary ties indicative of Alaska residency.

AS 39.35.670 (PERS) and AS 14.25.210 (TRS) — A person who knowingly makes a false statement, or falsiies or permits to be falsiied a record of this system, in a attempt to defraud the system, is guilty of a Class A Misdemeanor and upon conviction is punishable by a ine of not more than $500 or by imprisonment for not more than 12 months, or by both.

This form must be certiied by an adult Alaska resident not related to the applicant who can verify the applicant’s Alaska residency.

CERTIFICATION: I certify the above applicant is a resident of Alaska and intends to remain a resident of Alaska. I further certify the applicant resides in the above physical address which is his/her true, ixed permanent home and principal residence. I have irst hand knowledge the applicant’s household goods are maintained in this residence and it is inhabited primarily by the applicant.

Print name of person certifying this form

Telephone Number

Mailing Address

Signature of certiier, witnessed by one of the following: DRB Representative or Division of Personnel Staff

Signature

__________________________________ Title ____________________________ Date

/______

OR, SIGNATURE WITNESSED BY A NOTARY

On this

day of

20 ,

personally appeared before me whose identity

I proved on the basis of satisfactory evidence to be the signer of the participant's signature above, and he/she acknowledged that he/she executed it.

	Notary Public ____________________________________________________________
NOTARY SEAL OR	State of _________________________	and Borough/County of __________________
POSTMASTER

STAMP	Residing at ______________________	Commission Expires ____________________
REQURIED

GEN020 (Rev. 3/11)

g:/publications/forms/general/gen020.indd

Common mistakes

Incomplete Personal Information: Failing to provide all required details, such as the full name or Social Security number, can lead to delays or denials.
Incorrect Physical Address: Entering an incorrect or outdated physical address may result in confusion regarding residency status.
Missing Mailing Address: Not including a mailing address can hinder communication from the Division of Retirement and Benefits.
Improper Certification: The form must be certified by an adult Alaska resident who is not related to the applicant. Failing to follow this rule can invalidate the application.
Signature Issues: The signature of the certifier must be witnessed correctly. Omitting this step can lead to complications.
Notary Requirements Ignored: If the form requires notarization, neglecting to have it notarized can result in rejection.
Failure to Demonstrate Intent: Applicants must show intent to remain in Alaska. Not providing sufficient evidence can weaken the application.
Incorrect Understanding of Residency: Misinterpreting what it means to be a resident of Alaska can lead to incorrect claims on the form.
Submitting Without Review: Failing to double-check the form for errors before submission can lead to unnecessary delays and complications.

Detailed Steps for Filling Out Alaska Gen020

After gathering the necessary information, you are ready to fill out the Alaska Gen020 form. This form is essential for verifying your residency in Alaska, which is a requirement for receiving the Cost-of-Living Allowance (COLA). Follow these steps to ensure that you complete the form accurately.

Start by entering your Name in the designated fields: First, Middle Initial, Maiden Name, and Last Name.
Provide your Social Security Number, specifically the last four digits.
Fill in your Physical Address, including Street Address, City, and State.
Next, enter your Mailing Address, including City, State, and ZIP+4.
Ensure that you review the residency requirements outlined in the form. This will help confirm your eligibility.
Find an adult Alaska resident who is not related to you. This person will certify your residency.
The certifier should print their Name, provide their Telephone Number, and fill in their Mailing Address.
The certifier must sign the form and indicate their title, along with the date.
If required, have the signature witnessed by a DRB Representative, Division of Personnel Staff, or a Notary Public.
Finally, double-check all entries for accuracy before submitting the form to the appropriate office.

Dos and Don'ts

When filling out the Alaska Gen020 form, it is important to follow specific guidelines to ensure accuracy and compliance. Here are seven things you should and shouldn't do:

Do provide your full legal name as it appears on official documents.
Do include your Social Security number, specifically the last four digits.
Do ensure your physical address is complete and accurate, including street address, city, and state.
Do certify your residency with a witness who is an adult Alaska resident and not related to you.
Don't claim residency in Alaska if you maintain a principal residence in another state.
Don't provide false information or omit relevant details, as this could lead to legal consequences.
Don't forget to have the form signed and witnessed properly to validate your application.

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