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Get MA SNAP-9B 2013-2024

, SSN - - (Print Full Name) EBT Card # of (Street, City, State, Zip Code) am in need of replacement food because food I purchased with my Supplemental Nutrition Assistance Program (SNAP) benefits, in the amount of $ , was destroyed in a household disaster/misfortune. The household disaster/misfortune that occurred on / /.

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