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NON-PUBLIC ASSISTANCE APPLICANT/RECIPIENT IMPORTANT: If you are receiving ADC or Medicaid, do not complete this application because you became eligible for child support services when you signed the ADC/Medicaid application. I, , request child support services from the Wayne CSEA (Child Support Enforcement Agency). I understand and agree to the following: A. I am a resident of the county in which services are requested and no other Ohio county has jurisdiction ove.

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