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Get Household Information For Independent Status - California State ...

LAST NAME FIRST NAME PHONE NUMBER (with area code) PLEASE PRINT IN BLACK INK List the people in your household, include: yourself, and your spouse, if you have one your children, if you will provide more than half of their support from July 1, 2012 through June 30, 2013 other people if they now live with you, you provide more than half of their support and will continue to provide more than half of their support from July 1, 2012 through June 30, 2013. Write the names of.

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