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Complete and include this form with your paper submission. This information only will be used to communicate in writing about the submission, if needed.A statement of denial is a limitation on authority as provided in section 29-1023, subsections D and E. 5 - Statement of partnership authority or statement of denial. The statement of denial may include denial of a person's authority or status as a partner. The letter must include an acknowledgment that a Form. Enter the name and mailing address to which any correspondence regarding this filing should be sent. Forms and fees for CT Partnership entities. Form 601 Statement of Partnership Authority. Keep a copy of your completed Medicare enrollment package for your records.