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Get CA Stanislaus Foundation Enrollment Form

Security No. State Zip Birthdate Mo Day Yr …Male …Female Employer Department Employee # …Hourly …Salary …Husband Note if Step-Child’s Name is Different …Wife Last Name First Initial _________________________________________________ …Domestic Partner Date of Birth …Son Last Name …Daughter ________________________________________________ …Step-Child Date of Birth …Son Last Name …Daughter ________________________________________________ …Step-Child Date of Bi.

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