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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