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Get HHSA CA MC 262 2007-2021

Yes No If yes: Appraised value $ _____________ Monthly payment: $ ______________ Interest rate: ___________% 9. Do you have any checks or money on hand in banks, savings and loans, or credit unions, etc. (checking or savings accounts), or a patient trust account, or a trust or agreement where money or property is being held for your benefit or being held for you by anyone, or being kept anywhere for you? ................

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