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Plan. b. Provide documentation from your employer that sets forth the following: 1. Cost to insure yourself only, if there is a cost; 2. Cost to insure your spouse; and 3. Cost to insure your child(ren). 4. Is the insurance (geographically) accessible to the children? 6. OTHER INCOME Do you have any sources of income other than as described in Interrogatory No. 3? (Y/N) . If yes, state each source of income and the amount received from each source in this year and in each of the last 3.

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