Fillable Carrier Alert Fillable Form

Fill Online, Printable, Fillable, Blank Carrier Alert Fillable Form Form

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Carrier Alert Fillable Form

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Country of origin: US
File type: PDF

U.S.A. forms for Lexington-Fayette Urban County Government

BROWSE LEXINGTON-FAYETTE URBAN COUNTY GOVERNMENT (KY) FORMS

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Carrier Alert
Personal Information
Name
Address Zip
Phone
Email
Alert Categories
Medical Need
Single Adult
Elderly
Other:
If mail is not picked up daily we will notify you or your emergency contacts.
Emergency Contacts
1. Name
Address
Phone
Relationship
2. Name
Address
Phone
Relationship
Authorization
I hereby authorize the Postal Service to notify the community partners (Department of Social Services and
Department of Public Safety) to alert the emergency contact persons named, and to take other emergency action to
give me aid when there is reason to believe that I am in need of help.
Applicant Name
Date
LFUCG Staff
Date
Would you like more information on any of the other Lexington CARES programs?
Yes
Please fold and return sealed form to your local Post Office, Letter Carrier , or mail it to the address located on the
bottom of this form.. To complete the form on-line, visit www.bereadylexington.com. Click on Forms and select
the ‘Carrier Alert’ form in the list. Thank you for your participation.
(Fold on dotted line so address shows on outside for mailing. Fold top of paper down inside this fold and secure)
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Carrier Alert
United States Postal Service
Lexington KY 40511
Lexington Dept of Social Services
200 E Main St, #328
Lexington KY 40507
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Carrier Alert Fillable Form

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Completed 13 July 2020

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