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Get Knology Lifeline Service Authorization Form

The purpose of verifying your participation in these programs and will not be used for any other purpose. All information will be held in a confidential file. 1. I participate in at least one of the following programs (check all that apply). (NOTE: You will need to enclose proof of your participation for the past three months. This can be a photocopy of your card or authorization form): __ Food Distribution Program (United tribes of Kansas and NE Nebraska, Inc.) __ Food Stamps __ Medicaid __ Ge.

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