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AST, FIRST, MIDDLE) WALK-IN HOME TELEPHONE DCN MESSAGE TELEPHONE HOME ADDRESS (STREET, CITY, STATE, ZIP CODE) COUNTY MAILING ADDRESS (IF DIFFERENT FROM ABOVE) I AM HOMELESS Yes No You have the right to immediately file a Food Stamp application as long as it contains your name, address, and signature. Complete the rest of the application by taking it home and bringing, mailing, or faxing it back to the office. You can complete all of the form and give it to us now. You will not receive ex.

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