Documents
Instructions
Updated: 7/2020
Purpose
To notify the issuer of a disclosed annuity of the state's rights as the preferred remainder beneficiary.
Procedure
Number of Copies
Prepare an original and one copy of Form H0059.
Transmittal
Send the original of Form H0059 to the issuer of the annuity. File the copy in the case record.
Detailed Instructions
Date — Self-explanatory.
Eligibility Specialist— Self-explanatory.
Office Address — Self-explanatory.
Phone Number — Self-explanatory.
Addressee — Enter the name and address of the annuity issuer.
Name of Applicant — Enter the applicant's name.
Date of Birth — Enter the applicant's date of birth.
Contract No. — Enter the contract number.