Medical Exemption Statement
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REQUEST FOR MEDICAL OR RELIGIOUS EXEMPTION TO …
www.rochester.eduMedical or religious exemption statement: Please continue your statement on page 2 . May 2021 . Page 1 of 2 . I hereby affirm the truthfulness of the above or attached statement. If the University grants a medical or religious exemption , I agree (or my student agrees, if under 18) to abide by the on -campus protocols and
Application For Tinted Window Exemption - New York DMV
dmv.ny.govcertain medical conditions can be used to justify an exemption from the limits on light transmittance. A list of these conditions is on page 2. INSTRUCTIONS: To request a medical exemption, send the following items to the address at the bottom of this page: 1. This completed application: l. Page 1 is to be completed by the requestor. l. Page 2 ...
Personal Beliefs Exemption Procedures
www.azdhs.govReligious Beliefs Exemption for a child(ren) who attends an Arizona child care facility. It also does not affect the ability of a parent to request a medical exemption (temporary or permanent) which must be signed by a licensed healthcare provider (physician or nurse practitioner). The course is available for anyone to view.
2020 Instructions for Form FTB 3853 - California
www.ftb.ca.govfor an exemption. For more information, get the following new health care forms, instructions, and publications: # Form FTB 3849, Premium Assistance Subsidy # Form FTB 3853, Health Coverage Exemptions and Individual Shared Responsibility Penalty # Form FTB 3895, California Health Insurance Marketplace Statement