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Get A19-1a Dcs Paternity.doc. Transaction Request Form (ca504) - Dshs Wa

L Division of Child Support Fiscal Unit PO Box 45445 Olympia WA 98504-5445 DATE: INSTRUCTIONS TO VENDOR OR CLAIMANT: Submit this form to obtain payment for materials, merchandise or services. Show complete detail for each item. VENDOR'S CERTIFICATE: I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise or services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provid.

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