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Get Dp458 2008-2024

If you need language assistance, free of charge, please call 1-888-565-9435. TO: FROM: DEPARTMENT OF PUBLIC WELFARE BUREAU OF HEARINGS AND APPEALS (THE COUNTY MH/MR PROGRAM OR ADMINISTRATIVE ENTITY WILL FORWARD THIS APPEAL TO THE APPROPRIATE BUREAU OF HEARINGS AND APPEALS OFFICE LISTED ON PAGE 3) NAME OF APPELLANT: DATE: DAY TELEPHONE NUMBER: ( ) MAILING ADDRESS: SIGNATURES: APPELLANT: WITNESS: WITNESS: (If APPELLANT Makes Mark) (If APPELLANT Makes Mark) I hereby request a Fair Hea.

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