Form GEN019 "Alaska Cost-Of-Living Allowance (Cola) Evidence of Residency Requirements" - Alaska

What Is Form GEN019?

This is a legal form that was released by the Alaska Department of Administration - a government authority operating within Alaska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2012;
  • The latest edition provided by the Alaska Department of Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form GEN019 by clicking the link below or browse more documents and templates provided by the Alaska Department of Administration.

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Download Form GEN019 "Alaska Cost-Of-Living Allowance (Cola) Evidence of Residency Requirements" - Alaska

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Alaska Cost-of-Living Allowance (COLA)
Evidence of Residency Requirements
FOR OFFICE USE ONLY
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, Alaska 99811-0203
FAX: (907) 465-3086
Name (Last, Maiden, First, M.I.)
Social Security Number or RIN
Please submit as many items as possible from the list below that will substantiate your residency in Alaska.
Copies are acceptable.
1. Valid Alaska Driver's license (copy).
2. Current Resident Fishing or Hunting License (copy).
3. Alaska Voter Registration or voting records (copy).
4. Proof of a substantial ownership or leasehold interest in applicant’s residence in Alaska.
Acceptable documents as proof of substantial ownership in applicant's residence in Alaska may include the
following items:
a) Electric or heating bills/invoices in retiree's name for the Alaska residence.
b) Monthly bills/invoices which indicate the applicant maintains residence at the Alaska address of record.
c) Other documents which indicate the residence is inhabited by and used as a primary residence by the
applicant.
d) Rent receipts.
e) Credit card receipts from local stores.
f)
Property tax receipts.
5. A current Alaskan telephone listing in the applicant’s or the applicant’s spouse’s name.
6. Employment / unemployment records.
7. Travel Records.
8. Affidavits of other persons who had reason to know of your intent to remain an Alaska resident. Proof (such as
the presence of household goods owned by you) the residence referred to above is inhabited by and used as a
primary residence by the applicant. Affidavits of Residency forms attached.
Other information deemed relevant. Please list documentation and attach photocopies.
Please provide the following information:
Did you receive an Alaska Permanent Fund Dividend in the past five years: (enter year and check Yes or No)
Year
Year
Year
Year
Year
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
The burden is on the applicant or recipient to provide the administrator with documentation or
other information necessary to support eligibility for the Alaska Cost-of-Living Allowance.
PLEASE REVIEW THE COLA REGULATION ON THE REVERSE OF THIS FORM.
Signature
Date
GEN019 (Rev. 03/12)
g:/publications/forms/general/gen019.indd
Alaska Cost-of-Living Allowance (COLA)
Evidence of Residency Requirements
FOR OFFICE USE ONLY
Division of Retirement and Benefits
Juneau: (907) 465-4460
Toll-Free: (800) 821-2251
P.O. Box 110203
TDD: (907) 465-2805
alaska.gov/drb
Juneau, Alaska 99811-0203
FAX: (907) 465-3086
Name (Last, Maiden, First, M.I.)
Social Security Number or RIN
Please submit as many items as possible from the list below that will substantiate your residency in Alaska.
Copies are acceptable.
1. Valid Alaska Driver's license (copy).
2. Current Resident Fishing or Hunting License (copy).
3. Alaska Voter Registration or voting records (copy).
4. Proof of a substantial ownership or leasehold interest in applicant’s residence in Alaska.
Acceptable documents as proof of substantial ownership in applicant's residence in Alaska may include the
following items:
a) Electric or heating bills/invoices in retiree's name for the Alaska residence.
b) Monthly bills/invoices which indicate the applicant maintains residence at the Alaska address of record.
c) Other documents which indicate the residence is inhabited by and used as a primary residence by the
applicant.
d) Rent receipts.
e) Credit card receipts from local stores.
f)
Property tax receipts.
5. A current Alaskan telephone listing in the applicant’s or the applicant’s spouse’s name.
6. Employment / unemployment records.
7. Travel Records.
8. Affidavits of other persons who had reason to know of your intent to remain an Alaska resident. Proof (such as
the presence of household goods owned by you) the residence referred to above is inhabited by and used as a
primary residence by the applicant. Affidavits of Residency forms attached.
Other information deemed relevant. Please list documentation and attach photocopies.
Please provide the following information:
Did you receive an Alaska Permanent Fund Dividend in the past five years: (enter year and check Yes or No)
Year
Year
Year
Year
Year
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
r
Yes
r
No
The burden is on the applicant or recipient to provide the administrator with documentation or
other information necessary to support eligibility for the Alaska Cost-of-Living Allowance.
PLEASE REVIEW THE COLA REGULATION ON THE REVERSE OF THIS FORM.
Signature
Date
GEN019 (Rev. 03/12)
g:/publications/forms/general/gen019.indd
Alaska Cost-of-Living Allowance (COLA) Regulations
(a) The Alaska cost-of-living allowance established under AS 39.35.480/AS 14.25.142 accrues from the first day of the
month after written application from the member, on a form prescribed by the administrator, is either hand delivered to
the division of retirement and benefits, or is mailed to the division of retirement and benefits and postmarked from within
Alaska.* If a mailed application has a postmark on which the date is missing or illegible, the postmark day is rebuttably
presumed to be five working days before the day the application is received by the division.
*Please note: Private meter postmarks will not be accepted.
(b) Except as otherwise provided by AS 39.35.480/AS 14.25.142, a member must be domiciled and physically present
in Alaska to receive a cost-of-living allowance under AS 39.35.480/AS 14.25.142.
(c) For the purposes of this chapter, a person domiciled in the state is a person who
(1) maintains his or her principal place of residence in the state of Alaska;
(2) demonstrates at all times during an absence an intent to return to Alaska and remain a resident of Alaska; and
(3) does not claim residency outside the state or obtain benefits of residency in another state or nation.
(d) The administrator’s determination of an applicant’s residency will be based on the totality of relevant circumstances. Intent
is demonstrated by establishing and maintaining customary ties indicative of Alaska residency. Acts that are required
by law or contract or that are routinely performed by temporary residents of the state are not sufficient to demonstrate
residency. The burden is on the applicant or recipient to provide the administrator with documentation or other information
necessary to support eligibility for the Alaska cost-of-living allowance. The following may be used as evidence of domicile:
(1) the applicant’s written or oral statements at the time in question, including statements made to obtain a license to
drive, fish, hunt, or engage in another activity regulated by a governmental entity;
(2) the affidavits of other persons who had reason to know of the applicant’s intent;
(3) voter registration and voting records;
(4) proof of a substantial ownership or leasehold interest in applicant’s residence in Alaska;
(5) proof such as the presence of household goods owned by applicant, that the residence referred to in (4) of this
subsection is inhabited by and used as a primary residence by applicant;
(6) an Alaskan telephone listing in the applicant’s or the applicant’s spouse’s name;
(7) the duration of continuous residence in the state;
(8) employment and unemployment records;
(9) permanent fund dividend or longevity bonus records;
(10) travel records;
(11) other information that the applicant deems relevant.
(e) In the event a recipient’s eligibility for the Alaska cost-of-living allowance is in question, the division will notify the recipient
by certified mail that evidence of domicile is required. The recipient must provide evidence as outlined in (d) of this
section within 30 days of receipt of the division’s notice. Failure of the recipient to provide evidence of domicile by either
hand delivering or mailing evidence, which must be received or postmarked within 30 days after the recipient’s receipt
of the division’s notice, will result in the removal of the Alaska cost-of-living allowance.
(f) Upon receipt of evidence confirming that the recipient satisfies the requirements under (a) - (d) of this section, the Alaska
cost-of-living allowance will be reinstated retroactively to the date it was removed, if the recipient has not been out of
state for a continuous period that exceeds 90 days from the date of the recipient’s departure.
Authority: AS 39.35.240, AS 14.25.142
GEN019 (Rev. 03/12)
g:/publications/forms/general/gen019.indd
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