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Get FORM - DFA - EA - 1 - Application For Emergency Assistance - Wvdhhr

Stocks/bonds life ins. etc. Amount If more space is required please attach another sheet EMERGENCY INFORMATION Do you have an eviction or foreclosure notice If yes how much is needed to avoid evictions/foreclosure YES NO Do you have a utility notice of service termination If yes what utility or utilities Are you in need of telephone service and is everyone who lives in your home 65 years or older or disabled or temporarily incapacitated for at le.

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