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Get DC Proof of Residency Form 2009-2024

Provider, legal clinic, or religious organization that serves you (the applicant). (You do not need to fill in Section B if this section is completed.) Organization Name: Organization DC Tax-Exempt ID: Verifier’s Name: Verifier’s Title: Telephone Number: E-mail: Organization Address: City, State, Zip: I understand that the DC HealthCare Alliance is ONLY available to people who live in the District. By signing below, I verify that, to the best of my knowledge, the applicant listed above li.

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