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Get Afes Ddc/ack 2006

Ployee (Last, First, M.I.) Social Security # Address City & State Is this a New Address? Yes No Zip Code *Email Address (print clearly): * You will receive notification by e-mail when your claim is received and another when a payment is sent. You will also receive e-mail notification of direct deposits. Please be sure your e-mail address is legible.* It is hereby acknowledged by (“Dependent Day Care Provider”) that it is in compliance with any and all applicable federal, state and l.

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