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Get NC DSS-2435I 2013

Your FNS benefits will stop on ________________________. You may be able to continue to get FNS benefits after that date if you fill out this form and return it to us no later than_______________________. (Local DSS Address) (Household Address) What Do I Need To Do With This Form? You or your authorized representative must complete this form, sign and date the last page. Please answer all questions completely. Bring, mail, or fax to us at the above address. If a signed form is incomplete, you.

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