Fillable STATE OF ALASKA MANDATORY 14-DAY QUARANTINE FOR ALL (City Of Thorne Bay)

Fill Online, Printable, Fillable, Blank STATE OF ALASKA MANDATORY 14-DAY QUARANTINE FOR ALL (City Of Thorne Bay) Form

Use Fill to complete blank online CITY OF THORNE BAY (AK) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

STATE OF ALASKA MANDATORY 14-DAY QUARANTINE FOR ALL (City Of Thorne Bay)

On average this form takes 5 minutes to complete

The STATE OF ALASKA MANDATORY 14-DAY QUARANTINE FOR ALL (City Of Thorne Bay) form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 17 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City Of Thorne Bay

BROWSE CITY OF THORNE BAY (AK) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
STATE OF ALASKA
Department of Health & Social Services
TRAVEL DECLARATION FORM
MANDATORY DECLARATION
FOR ALL PASSENGERS
Due to the rapid spread of COVID-19 and the high incidence of travel-related infection, the State of Alaska
has instituted a mandatory 14-day quarantine for all incoming passengers. The potential for widespread
transmission of COVID-19 by infected individuals entering Alaska threatens the health and well-being of
Alaskans, as well as the infrastructure and security of the state. In an abundance of caution and to assist
in flattening the curve regarding the spread of COVID-19 in Alaska, the State of Alaska, under its authority
to protect the public health, is implementing advanced protocols to ensure all travelers arriving in Alaska
participate in 14 consecutive days of self-quarantine to begin immediately upon arrival, allowing for travel from
an airport or portage to the designated quarantine location.
MANDATORY 14-DAY QUARANTINE FOR
ALL INCOMING PASSENGERS
Travelers 18 years of age and over must complete and sign their own form.
PLEASE LIST THE SPECIFIC PLACES TRAVELED WITHIN THE PREVIOUS 14 DAYS.
1.
______________________________________________ 2. ________________________________________
3.
______________________________________________ 4. ________________________________________
FULL NAME (PRINT)
_____________________________
HOME ADDRESS _______________________________________________________________________________
CITY __________________________________ STATE _________________________ ZIP ____________________
QUARANTINE ADDRESS: _______________________________________________________________________
CITY __________________________________ STATE __________________________ ZIP ____________________
PHONE NUMBER _____________________________ DATE OF ARRIVAL _______________________________
SIGNATURE:____________________________________________DATE __________________________
Certicate: Read and Sign: I swear or affirm, under penalty of perjury, that: the above information I provided
on this document is true and correct. I swear I will comply with the self-quarantine regulations as set out in
Health Mandate _____.
WARNING: If you provide false information on this form, you may be convicted of a Class B felony under
AS 11.56.200 and/or a Class A misdemeanor under AS 11.56.210. Additionally, due to the imminent danger
to the public by the spread of Coronavirus, if you violate the self-quarantine regulations set forth in the
mandate, you may also be convicted of a class A misdemeanor which is punishable by a fine of up to
$25,000, or imprisonment of not more than one year, or both pursuant to Alaska Statute 12.55.035 and
Alaska Statute 12.55.135.
SUBMIT THIS FORM
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

STATE OF ALASKA MANDATORY 14-DAY QUARANTINE FOR ALL (City Of Thorne Bay)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 5 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document