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Get NC DSS-2435R 2016

Nefits 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_____________________. (DSS Address) (Household Address) What Do I Need To Do With This Form? You or your authorized representative must entirely complete this form, sign and date the last page. You have the right to receive an application upon request. If you cannot complete this form you will only need to provide a signature,.

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