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State of New Hampshire770

State of New Hampshire770 2025

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The document outlines the Reimbursement Agreement and Acknowledgment for financial assistance applicants in New Hampshire, detailing the responsibilities of applicants regarding reimbursement to the State for financial assistance and Medicaid costs. It explains the conditions under which liens may be placed on real property, claims against estates may be filed, and the rights of applicants concerning these processes. The document emphasizes the importance of understanding these obligations as a condition for eligibility in various assistance programs.

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Click ‘Get Form’ to open the State of New Hampshire770 in the editor.
Begin by entering your name and your spouse's name in the designated fields. Ensure that you print clearly for legibility.
Fill in your address and county information accurately. This is crucial for processing your application.
Read through the financial assistance acknowledgment section carefully. Initial each statement to confirm your understanding of the reimbursement obligations.
Sign and date the form at the bottom, ensuring that both you and your spouse (if applicable) provide signatures.
If required, have a Justice of the Peace or Notary Public witness your signatures before submitting.
Finally, return the completed form to the Centralized Scanning Unit at the provided address.

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Versions	Form popularity	Fillable & printable
2019	4.2 Satisfied (35 Votes)
2015	3.9 Satisfied (34 Votes)

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What is the shape of New Hampshire?

Roughly shaped like a right-angled triangle, New Hampshire covers an area of 24,214 km, making it somewhat smaller than Belgium. It is the 5th smallest US state by area.

What is New Hampshires nickname?

The Granite State New Hampshire / Nickname

What are 5 interesting facts about New Hampshire?

New Hampshires motto, Live Free or Die, reflects its role in the American Revolutionary War; its nickname, The Granite State, refers to its extensive granite formations and quarries.

What is the state of New Hampshire known for?

NH is known as The Granite State. The Old Man of the Mountain was a very famous rock formation on the side of a mountain that looked like the profile of an old man. It finally collapsed in 2003, but the image is still on our license plates today. Our state animal is the white-tailed deer.

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