PAYMENT INSTRUCTIONS for CIVIL PENALTY of EXECUTIVE ORDER 14B

(Executive Order 14B – Booster Mandate)

Below are instructions for making payment to the Connecticut Department of Public Health (DPH).

1. ACH remittance should be made using the banking information below:

Bank Name: Bank of America

Address: 175 Addison Road, Windsor, CT 06095

Contact: Anna Maria Piccione

Account Name: State of Connecticut Regular Account

Account #: 0000054763

ABA Routing #: 011900254

Memo/Reference: DPH + Provide the Civil Penalty Number

2. Check payments should be made using the information below:

Payable to: Treasurer, State of Connecticut

P.O. Box 340308

Hartford, CT 06134-0308

Attention: Fiscal Office, MS#13APR

Memo/Reference: Provide the Civil Penalty Number

Please note: YOU MUST INCLUDE THE CIVIL PENALTY NUMBER ON THE REMITTANCE ADVICE

Important Note: Failure to include the civil penalty number may result in delay or inability of the State to recognize your payment pursuant to the collection of this fine.