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Get MI Payroll/Service Note - Macomb County

___________ Print Full Name Print Full Name FI Name: _________________________________ Stuart Wilson CPA PC Pay Period: ____/____/____ Support Coordinator/Agency: _______________________________Agency Phone: _________________ Date Start Time AM / PM Stop Time AM / PM Hours Units ____/____/____ Check One 1:1 1:1 CLS 2:1 H2015 3:1 Respite 2:1 T1005 3:1 Service Note - Narrative Statement of Supports Provided My signature below certifies that I have reviewed this information and .

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