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VIRGINIA DEPARTMENT OF SOCIAL SERVICES (Model Form) Page 1 of 6 SWORN STATEMENT OR AFFIRMATION FOR FOSTER AND ADOPTIVE PARENTS, ADULT HOUSEHOLD MEMBERS Please Print Last Name Current Mailing Address.

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IRS 8453-OL 2006 IRS Instructions 6198 2020 MD MHIP BRC6600-9N 2012 GA Emory Sleep Center Request For Services 2015

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