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Get CA MID Cares Application Form 2020

R household and income information. City 3. Please verify the required documentation has been attached: Zip Code Proof of total monthly income **MID will not accept bank statements as proof of gross income.** Mailing Address (if different than service address) IRS Form 4506-T for all adults City State MID Account Number Contact Phone Number Are you 60 years or older? Yes No Zip Code 4. Sign and date the application. Return the application and required documentation.

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