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[PDF File]Application for Lump-Sum Death Payment
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Social Security Administration. APPLICATION FOR LUMP-SUM DEATH PAYMENT* Form Approved OMB No. 0960-0013. Page 1. TOE 120/145/155 I apply for all insurance benefits for which I am eligible under Title II (Federal Old-Age, Survivors, and Disability Insurance) of the Social Security Act, as presently amended, on the named deceased's Social ...
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[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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7T Full No ELE – National School Lunch Program (NSLP). Code Benefits SOC Program/Description 7U Full No ELE (Title XIX). CF adults from age 19 through 65 years old who are citizens or lawfully present, and neither blind nor disabled. Full-scope, no cost Medi-Cal coverage. ... Aid Codes Master Chart (aid codes) ...
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[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,
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[PDF File]Application For Supplemental Security Income (SSI)
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APPLICATION FOR SUPPLEMENTAL SECURITY INCOME (SSI) Form Approved OMB No. 0960-0229. ... ZIP Code County. 3. Claimant's Residence Address (If different from applicant's mailing address) City and State ZIP Code. ... District of Columbia and Northern Mariana Islands) 30 consecutive days prior to the filing date? ...
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[PDF File]Authorization to Disclose information to Social Security ...
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Page 2 of 2. Explanation of Form SSA-827, "Authorization to Disclose Information to the Social Security Administration (SSA)" We need your written authorization to help get the information required to process your claim, and to determine your capability of
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[PDF File]Request for Withdrawal of Application
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REQUEST FOR WITHDRAWAL OF APPLICATION Page 1 of 2 TOE 420 OMB No. 0960-0015. IMPORTANT NOTICE - This is a request to withdraw your application. If we approve it, the decision we made on your application will have no legal effect. You will forfeit all rights attached to an application, including the rights of appeal.
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[PDF File]CM-010 Civil Case Cover Sheet
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CITY AND ZIP CODE: BRANCH NAME: CASE NAME: CIVIL CASE COVER SHEET Complex Case Designation Unlimited Limited (Amount (Amount Counter Joinder demanded Filed with first demanded is appearance by defendant exceeds $25,000) $25,000 or less) (Cal. Rules of Court, rule 3.402) Items 1–6 below must be completed (see instructions on page 2). 1.
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[PDF File]Request Pertaining to Military Records, SF 180 (11-15)
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The Standard Form 180, Request Pertaining to Military Records (SF180) is used to request information from military records. ... mail from inquire@nara.gov or write to the Code 6 address on page 2 of the SF 180. ... District of Columbia, or Puerto Rico, where he or she served. PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT
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[PDF File]Form W-9 (Rev. October 2018)
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City, state, and ZIP code. Requester’s name and address (optional) 7. List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN).
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Zip code school district locator