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SECTION I EMERGENCY ASSISTANCE The type of EMERGENCY ASSISTANCE I am requesting is The reason I need emergency assistance is SECTION II ADDITIONAL ALLOWANCES I am requesting the following allowance s for special need s c d e f g Back rent g Additional allowance for fuel g Repair of essential household items g Back mortgage and/or taxes g Property repairs g Pregnancy allowance g Replacement of clothing lost as a result of a disaster g Restaurant allowance because I cannot prepare meals where I a ...

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