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Get IA DHS 470-2881 2010

S Benefits, Pensions or Retirement Child Support or Alimony Money from Friends or Relatives Other: (Including irregular or one time payments) Explain: Will the amount of other money stay about the same as shown on the proof you are sending? ❏ Yes ❏ No If no, explain _____________________________________________________________________________ Resources (Assets) ❏ Yes Does anyone have a car, truck, boat, camper, motorcycle or other vehicle? If yes, list make, model, year below. ❏ N.

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