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Rected to Marti Tosta, Manager of the CMIPS II Policy Support Unit, at (916) 229-4000. Sincerely, Original Document Signed By: EVA L. LOPEZ Deputy Director Adult Programs Division Attachment APPLICATION FOR SOCIAL SERVICES To The Applicant: This form is subject to verification. Note: Retain your copy of this application. *Social Security Number: It is mandatory that you provide your Social Security Number(s) as required in 42 USC 405 and MPP 30-769.71. This information will be used in eligibil.

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