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Get MI BCAL-3704-CWL 2015-2024

Number and Name) PLEASE MAIL TO  City Licensing Consultant (Name, Address, Phone) Michigan Department of Health and Human Services Division of Child Welfare Licensing PO Box 30650 Lansing, MI 48909 State Zip Code License Application Type Child Foster Care (24-Hour Care) PATIENT INFORMATION (To be Completed by Patient) (Please Print or Type) Name (Last, First, Middle, Jr., II, etc.) Date of Birth Telephone Number Address (Street Number and Name) City State Zip Code RELEASE OF IN.

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