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Get CO JDF 211 2014-2021

Age Relationship Gross Monthly Income (See Information on page 3) Monthly Expenses (See Information on Page 3) Self (wages, salary, commission) $ Rent or Mortgage $ Spouse/Partner/Other Household Members Parents (if same household) $ Groceries $ $ Utilities $ Unemployment Benefits $ Clothing $ Social Security/Retirement Funds $ Maintenance/Alimony $ Maintenance/Alimony $ Child Support $ Other Income (identify) $ Medical/Dental.

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