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O. Box 15 Springfield IL 62705 NAME SS last four digits First Last MAILING ADDRESS APT CITY ZIP CODEPHONE NUMBER OF ADULTS NUMBER OF CHILDREN Include your food delivery address if it is different from your mailing address or Post Office Box. Income source and monthly amount Employed at wage SSI LINK Pension Other Toys will be available for all children ages 12 and under living in the home. Release. I hereby authorize Friend-In-Deed to investigate this application for assistance. I understa ...

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