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F (First, Middle Initial, Last) Person Is Not in School Grade Birth Date Check If a Foster Child (Legal Responsibility of Welfare Agency or Court)* *If all children in the household are foster children, skip to Part 5 to sign this form. Check if NO Income (Must be checked if no income) PART 2. BENEFITS If any member of your household receives SNAP, TANF, or FDPIR, provide the name and case number for the ONE person who receives benefits and skip to Part 5. If no one receives these benefits,.

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