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PARIS MATCH DUPLICATE BENEFITS OUT-OF-STATE INQUIRY Inquiry Date NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES SFN 1050 12-2013 Clear Fields The State of North Dakota Department of Human Services is requesting verification of current and/or past public assistance benefits regarding the person listed in Section A below and the members of their family/household for whom they received assistance in your state. Please complete the information below begin.

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