Application For Cold And Certification Of Residency - Alaska Division Of Personnel And Labor Relations

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Application for COLD and Certification of Residency
Division of Personnel and Labor Relations
DOT/ Marine Human Resource Service Center
PO Box 110201
Juneau, AK 99811-0201
TDD: (907) 465-4052
Fax:
(907) 465-2019
Alaska State Law AS 23.40.210 provides that collective bargaining agreements include a pay plan with a Cost of Living
Differential (COLD) between the salaries paid to employees residing in Alaska and employees residing outside of Alaska.
The Department of Transportation and Public Facilities verifies residency status of all current AMHS employees with the
Permanent Fund Dividend Division in the Department of Revenue. This is done on an annual basis. You must complete and
submit this form certifying that you are a resident of the State of Alaska in order to be eligible for COLD. Submission of this
certification is a requirement of all Alaska Marine Highway employees.
LAST NAME
FIRST NAME
MI
SOCIAL SECURITY NO.
MAILING ADDRESS
CITY
STATE
ZIP CODE
PHYSICAL RESIDENCE ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
MESSAGE NUMBER
A “resident of the State of Alaska” means you are physically present in the state with the intent to permanently remain
and make a home in the state. You may not be claiming residency outside the state or obtaining benefits under a claim of
residency outside the state. The required presence of an employee at a work station, including an Alaska Marine Highway
vessel, where room and board are provided or reimbursed by the employer will not be considered a physical presence in the
state or physical absence from the state for the purpose of determining eligibility for cost of living differential.
See, AS 01.10.055 (Definition of State Resident) and AS 23.40.210 (Authorization for COLD)
Please check all boxes that apply:
I am now and intend to remain an Alaskan resident. I have been an Alaskan resident
since _______________________________.
Since claiming COLD, I have not claimed residency in another state.
.
I am not an Alaskan resident, and am not applying for COLD
Revised 02/18/2009

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