GHRS1 - Alabama Department of Finance – State ...
Revised 01/2020
GHRS 1
BOARD MEMBERS INFORMATION FORM
(PLEASE PRINT)
NAME:
SS#: - - AGENCY NUMBER:
AGENCY NAME:
DOB:______________ WORK CNTY:__________________ SEX:____________
DATE OF APPOINTMENT _____/_____/_____
**LGFS ACCOUNTING CODES**
LABOR DIST OVRD OPT: ______ LABOR DIST PROF CD: ______ FUND: _________
AGENCY: ORG/SUBORG: / APPR-UNIT:
ACTIVITY: FUNC: _______ OBJ/SUBOBJ: /
JOB: REPT CATEGORY:
**ADDRESS**
STREET ADDRESS:
CITY: STATE ______ZIP: -
COUNTRY: ___________________________ TELEPHONE NUMBER: ________________________
PLEASE COMPLETE THE GHRS EFT AND TAX FORMS.
FORWARD TO:
GHRS
RSA UNION BUILDING
100 NORTH UNION STREET, SUITE 282
MONTGOMERY, AL 36130
OR FAX TO (334)242-3905
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