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Get Sc Dss Employment Verification Form

Certify that I am a: Roomer (An individual to whom the household furnishes lodging for compensation, but not meals.) Boarder (An individual paying a reasonable amount for meals or meals and lodging must be considered boarders.) in the household of the above named recipient, at the following address: I pay $ per Week Month Other: (Explain) I eat meals a day with this household. Your Printed Name: Your Signature: Telephone No.: DSS Form 2454 (NOV 09) Date:.

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