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Get AFES DDC/ACK 2008-2024

Yee (Last, First, M.I.): Social Security #: Mailing Address (where reimbursement is to be sent): Is this a New Address? Yes City & State: Zip Code: No *E-mail Address (please print clearly): * You will receive notification by e-mail when your claim is received and another when a payment is sent. You will also receive e-mail notification of direct deposits. Please be sure your e-mail address is legible.* It is hereby acknowledged by (“Dependent Day Care Provider”) that it is in complia.

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