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Get CA SOC 426A (SP) 2012

O INSTRUCCIONES: • Use una pluma de tinta negra o azul. Escriba claramente la información con letra de molde. • Usted (o su representante autorizado legalmente) tiene que llenar las dos páginas de este formulario para comunicarle al Condado a quién usted ha escogido para proporcionarle sus servicios. • Usted (o su representante autorizado legalmente) tiene que firmar la declaración que aparece a continuación para indicar que entiende y está de acuerdo con todos los términos y c.

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