CON_form~1.docx
DOCX document 106 KB Posted
- Solicitation number
- BD-18-1067-MCD01-MCD01-26742
- Issued by
- Massachusetts
About this file
The document provided is a Change of Name form from the Massachusetts Commission for the Deaf and Hard of Hearing (MCDHH) Department of Interpreter and CART Services. This form is used by vendors to request a name change on their account with MCDHH. Vendors must submit legal documentation, such as a marriage license or court order, to verify the name change and provide a copy of their updated Social Security card. MCDHH will then process the name change and update their internal systems accordingly.
The related state and local contract opportunity is for "MCD06 ASL Interpreters and Transliterators for the Deaf and Hard of Hearing". This bid document provides access to MCDHH's contracting documents, including a checklist and instructions. Contract packages must be submitted by U.S. mail to MCDHH within two weeks of downloading the documents from the site. The contract's MBPO number is PO-18-1067-MCD01-MCD01-13286, and the contract is for the Commonwealth of Massachusetts, specifically Suffolk County and the City of Boston.
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Text version
The Commonwealth of Massachusetts Executive Office of Health and Human Services Massachusetts Commission for the Deaf and Hard of Hearing 600 Washington Street Boston, Massachusetts 02111 Tel. (617) 740-1600
TTY (617) 740-1700
VP (617) 326-7546
Fax (617) 740-1880 www.mass.gov/mcdhh
Department of Interpreter and CART Services / A & F Change of Name
To: MCDHH Business Department;
From: __________________________________________ Effective date of name change: ____________________
Please change my name from:
PREVIOUS NAME
Name:
To:
NEW NAME
New Name:
Type of Legal Document (court paper, divorce, marriage, etc:
email:
| Home Phone: |
| Work Phone: |
Signature of Vendor Date
Please wait for the letter confirming your name change has been processed and approved before submitting PVs and invoices using your new name to any state agencies.
Please attach a copy or marriage license or court document verifying name change and a copy of your new Social Security card reflecting your name change.
INTERNAL USE ONLY
MMARS updated – By: ______________________
Date sent to OSC: ____________________________
Approved by OSC – date: ____________________
Avianco updated – By: ______________________
Letter sent to Interpreter: ____________________
DATE RECEIVED
Effective 4/6/12 image1.wmf oleObject1.bin
File details come from the government source that posted it. Updated .