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Get Applicationredtermination For Elderly And Disabled Programs Form

Question completely and accurately. You may have someone help you complete the application. 1. 2. 3. 4. 5. Send veri cation of the gross (before taxes) amount of your monthly income. Send a copy of your Social Security card. If you have Medicare, Send a copy of your Medicare card. Sign the application. Mail the application to the District Of ce serving your county. (See attachment for the address of the District Of ces.) Anyone who makes or causes to be made a false statement, misrepres.

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