ࡱ                >  	               ]          _          \       `	               J   bjbj                  	 *p      n                                                                                                                       *      *      *      *  l   n*           a     F+    ,.      ,.      ,.      ,.      3    5     A6  \   Z  ,  `      `      `      `      `      `  $   6b  h  d     `  ]                         6                      2  0  3      6      6      `                          ,.              ,.  W  :a     8      8      8      6  
         ,.            ,.      W=  2          8                                                      6      Z              8              8                                                                          8      ,.      :+     Dls        *      6     8              9  T  Pa  0   a      8      4e      6    4e      8                                                                              4e                    8  4   6      6      8      6      6                                      6      6      6      `      `                                      8  
                                   6      6      6      a      6      6      6      6                            d  *                        *                                                         6a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             M I S S O U R I   D E P A R T M E N T   O F   S O C I A L   S E R V I C E S  F A M I L Y   S U P P O R T   D I V I S I O N  F I N A N C I A L   I N F O R M A T I O N   R E Q U E S T       D A T E     F O R M T E X T      D A T E   \ @   " M M / d d / y y y y "    0 6 / 1 7 / 2 0 0 5    0 5 / 0 5 / 2 0 0 4    C O U N T Y   O F F I C E     F O R M T E X T            C A S E   N A M E     F O R M T E X T             A D D R E S S     F O R M T E X T            C A S E   N U M B E R     F O R M T E X T             C I T Y ,   S T A T E ,   Z I P     F O R M T E X T             A D D R E S S     F O R M T E X T             P H O N E     F O R M T E X T         -    F O R M T E X T         -    F O R M T E X T                F O R M T E X T             F I N A N C I A L   I N S T I T U T I O N   N A M E     F O R M T E X T            C A S E W O R K E R     F O R M T E X T             A D D R E S S     F O R M T E X T             L O A D   N O .     F O R M T E X T             I N S T R U C T I O N S   T O   F I N A N C I A L   I N S T I T U T I O N   W e   a r e   d e t e r m i n i n g   e l i g i b i l i t y   o r   c o m p l e t i n g   a n   a s s e s s m e n t   o f   a s s e t s   i n   t h e   a b o v e   r e f e r e n c e d   c a s e .     W e   h a v e   p r o v i d e d   t h e   s o c i a l   s e c u r i t y   n u m b e r s ,  names and known account numbers for members of the case.  This request is for financial information on all accounts of these persons.  A self-addressed stamped envelope is enclosed for your convenience.AUTHORIZATION FOR RELEASE OF INFORMATIONHEAD OF HOUSEHOLD/PAYEE NAME FORMTEXT                                                                                                                                                                                                                                       S O C I A L   S E C U R I T Y   N O .     F O R M T E X T         -    F O R M T E X T        -    F O R M T E X T           S I G N A T U R E  D A T E   S I G N E D    S P O U S E / O T H E R   J O I N T   O W N E R     F O R M T E X T            S O C I A L   S E C U R I T Y   N O .     F O R M T E X T         -    F O R M T E X T        -    F O R M T E X T           S I G N A T U R E  D A T E   S I G N E D   N A M E     F O R M T E X T            S O C I A L   S E C U R I T Y   N O .     F O R M T E X T         -    F O R M T E X T        -    F O R M T E X T           S I G N A T U R E  D A T E   S I G N E D   F I N A N C I A L   I N F O R M A T I O N   R E Q U E S T E D   P l e a s e   p r o v i d e   i n f o r m a t i o n   f o r   t h e   a c c o u n t   n u m b e r s   l i s t e d   a n d   a n y   o t h e r   C h e c k i n g   A c c o u n t s ,   S a v i n g s   A c c o u n t s ,   C e r t i f i c a t e s   o f   D e p o s i t ,   C h r i s t m a s   F u n d s .     T r u s t   A c c o u n t s ,   a n y   t y p e   o f   I n d i v i d u a l   R e t i r e m e n t   A c c o u n t s ,   o r   o t h e r   a c c o u n t s   o f   t h e   p e r s o n s   n a m e d   a b o v e .     A C C O U N T   N U M B E R     F O R M T E X T               F O R M T E X T               F O R M T E X T               F O R M T E X T               F O R M T E X T        
                    	  	  2	  4	  6	  8	  L	  N	  R	  n	  p	  	  	  	  	  	  濵{q]{I{  &j    h0Q CJ OJ QJ UmH nH u 'j  h0Q h0Q CJ OJ QJ Uh0Q CJ OJ QJ  j    h0Q CJ OJ QJ UhgK CJ mH nH uj  hgK hgK CJ Uh CJ mH nH u
hgK CJ  j    hgK CJ UhgK CJ OJ QJ  hgK 5CJ OJ QJ hgK OJ QJ  hgK CJ OJ QJ  hgK  j    hgK Uj    hgK UmH nH u   
  X                  P	                                                                                                                                                                                                                                                                                                                                                                                                               $If     < $If   ^
  $If   ^    J                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    P	  R	  n	  	  	  	              v            p            v            p                                                                                                                                                     $If   
  $If   ^ ~  kdV  $$If   l r BA #*                                                                                                                                                   4 
l a   	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  	  
  

  
  $
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  :
  <
  >
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  p
  쪠xnhXnHnj    hgK CJ UmH nH u jb  hgK hgK CJ U
hgK CJ  j    hgK CJ U&j    h0Q CJ OJ QJ UmH nH u 'j  h0Q h0Q CJ OJ QJ Uh0Q CJ OJ QJ  j    h0Q CJ OJ QJ UhgK  j    h0Q CJ UmH nH u j  h0Q h0Q CJ U
h0Q CJ  j    h0Q CJ UhgK CJ OJ QJ  hgK CJ OJ QJ 	  	  	  
  $
  L
  N
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  
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                                                              _                                                                             G  kd  $$If   l  0 &*            d                               4 
l a    $If   
  $If   ^ G  kdG  $$If   l  0 &*            d                               4 
l a   
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  
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             񵫥siUsAsisi &j    hgK CJ OJ QJ UmH nH u 'jv  hgK hgK CJ OJ QJ UhgK CJ OJ QJ  j    hgK CJ OJ QJ UhgK  j    h0Q CJ UmH nH u j-  h0Q h0Q CJ U
h0Q CJ  j    h0Q CJ UhgK CJ OJ QJ  &j    h0Q CJ OJ QJ UmH nH u 'j  h0Q h0Q CJ OJ QJ Uh0Q CJ OJ QJ  j    h0Q CJ OJ QJ U 
  
  
  
  N  P  R  z  |                                                                                          _                                                     G  kd  $$If   l  0 &*          d                               4 
l a  
  $If   ^ G  kd  $$If   l  0 &*              d                                  4 
l a    $If    
      $  &  (  *  >  @  B  J  L  N  R  T  h  j  l  v  x  z  |                      ݿݿݡ{kgWk               jq  h0Q h0Q CJ UhgK  j    h0Q CJ UmH nH u j  h0Q h0Q CJ U
h0Q CJ  j    h0Q CJ U
hgK CJ  hgK CJ OJ QJ  'j,  hgK hgK CJ OJ QJ UhgK CJ OJ QJ  &j    hgK CJ OJ QJ UmH nH u j    hgK CJ OJ QJ U'jR  hgK hgK CJ OJ QJ U         *  R  T  f                                                                                                        _                                         G  kd#  $$If   l H0 #* H$                                      4 
l a   G  kdw   $$If   l  0 * N                                      4 
l a    $If   
  $If   ^ 
    
          *  ,  @  B  D  N  P  f  h  |  ~                    g  h  k    ˧vj^TvT              hgK CJ OJ QJ  hgK @ CJ OJ QJ  hgK @CJ OJ QJ  hgK 5CJ OJ QJ j    hgK CJ UmH nH u j
"  hgK hgK CJ U
hgK CJ  j    hgK CJ Uj!  h0Q h0Q CJ U
h0Q CJ  hgK  hgK CJ OJ QJ  j    h0Q CJ UmH nH u j    h0Q CJ Ujq  h0Q h0Q CJ U                                   w            m                                                                                                                                                              
  $If   ^ 4  kd!$  $$If   l  * *                          4 
l a    $( $If   ^a$D  kd#  $$If   l  * *        	
                   4 
l a  p
                              
      6  8  L  N  P  V  X  Z  \  p  r  t  x  z  |  ~      ǡїqaqQ   j (  hgK hgK CJ Uj'  hgK hgK CJ Uj    hgK CJ UmH nH u j &  hgK hgK CJ U
hgK CJ  j    hgK CJ Uj    h0Q CJ UmH nH u j%  h0Q h0Q CJ U
h0Q CJ  j    h0Q CJ UhgK CJ OJ QJ  hgK  hgK 5CJ OJ QJ hgK CJ OJ QJ  hgK 5CJ OJ QJ          6                                                                                                                                                                                                                                                                                                  	  $$If   a$  $If   
  $If   ^D  kd|$  $$If   l  * *        	
                   4 
l a  p
                                    (  *  T  V  j  l  v  x  z                              ýÝ}pý`   jX-  h0Q h0Q CJ Uj,  hgK CJ Ujg+  hgK CJ Uj*  hgK CJ U
hgK CJ  j    h0Q CJ UmH nH u j)  h0Q h0Q CJ U
h0Q CJ  j    h0Q CJ UhgK  hgK CJ OJ QJ  hgK CJ OJ QJ  j    hgK CJ UmH nH u j    hgK CJ U %      ,  T                                                        x                                                                                                                                                         	  $$If   a$  $If   
  $If   ^ m  kd*)  $$If   l  \ j&"*                                                                                                      4 
l a            H                                                        x                                                                                                                                                         	  $$If   a$  $If   
  $If   ^ m  kd,  $$If   l  \ j&"*                                                                                      4 
l a           H  J  ^  `  b  h  j  l  n                             "  $  .  0  r  t      &  ˻ѫ˞ˎѫۊukuk`k`k                  hgK 5CJ OJ QJ hgK CJ OJ QJ  hgK CJ OJ QJ  hgK 5CJ OJ QJ hgK  j/  hgK hgK CJ UjR/  hgK CJ Uj    hgK CJ UmH nH u jH.  hgK hgK CJ U
hgK CJ  j    hgK CJ UhgK CJ OJ QJ  j    h0Q CJ UmH nH u j    h0Q CJ U "    "  $  (                          C            6                                                  $$If   ^a$D  kd1  $$If   l  * *        	
                   4 
l a  p
     
  $If   ^ m  kd1  $$If   l  \ j&"*                                                                                      4 
l a   &  (  *  .  J  L  N  b  d  f  p  r  t  v                                    @  @  @  @  @  @  @  8@  :@  <@  @@  ĹȫĠĕĊĈ}wqk          
hgK CJ  
hgK CJ  
hgK CJ  j4  hgK UUj(4  hgK Uj3  hgK Uj83  hgK Uj    hgK UmH nH u j2  hgK UhgK  j    hgK UhgK CJ OJ QJ  hgK CJ OJ QJ  hgK CJ OJ QJ  
hgK CJ  hgK 5CJ OJ QJ  ((  *  ,  .  L  t        @                                                                                                                                                                                                                                                                                                                               	  $$If   a$
  $If   ^ 4  kd+2  $$If   l H * *                        4 
l a   	              T Y P E   O F   A C C O U N T        F O R M T E X T                  F O R M T E X T                  F O R M T E X T                  F O R M T E X T                  F O R M T E X T               N A M E S   O N   A C C O U N T        C U R R E N T   B A L A N C E  I F   0 ,   E N T E R   D A T E   C L O S E D   A N D   A M O U N T   W I T H D R A W N         B A L A N C E   A S   O F       F O R M T E X T                   A M O U N T   O F  I N T E R E S T   E A R N E D          D A T E   I N T E R E S T   P A I D          P E R I O D   C O V E R E D          I N T E R E S T   R A T E        D I R E C T   D E P O S I T   R E Q U E S T     P l e a s e   m a k e   m y   a s s i s t a n c e   p a y m e n t   b y   d i r e c t   d e p o s i t   t o   m y   ( c h e c k i n g )   ( s a v i n g s )   a c c o u n t .  D I R E C T   D E P O S I T    N A M E   T Y P E D     F O R M T E X T            S I G N A T U R E  D A T E     F O R M T E X T             B A N K   O F F I C I A L       P l e a s e   e n t e r   t r a n s i t   r o u t i n g   n u m b e r ,   a c c o u n t   n u m b e r   a n d   t y p e   o f   a c c o u n t   f o r   d i r e c t   d e p o s i t   b e l o w :   T R A N S I T   R O U T I N G   N U M B E R  A C C O U N T   N U M B E R  T Y P E   O F   A C C O U N T   C H E C K   A N D   G I V E   D E T A I L S   O N   B A C K   I F   A N Y   O F   T H E   A B O V E   L I S T E D   P E R S O N S   H A V E   A N Y   O F   T H E   F O L L O W I N G                     L A R G E   W I T H D R A W A L S                             S A F E   D E P O S I T   B O X                         L O A N S   O W E D                                         S T O C K S                                                                 B O N D S                                       T R U S T   D E E D S   O W E D    A N Y   A D D I T I O N A L   I N F O R M A T I O N   O R   C O M M E N T S   C O N C E R N I N G   I N V E S T M E N T S   O R   O T H E R   T R A N S A C T I O N S   W H I C H   Y O U   M A Y   H A V E   H A D   W I T H   T H E   A B O V E   P E R S O N S   W I L L   B E   A P P R E C I A T E D .     P L E A S E   L I S T   O N   B A C K   O R   A T T A C H   S E P A R A T E   S H E E T .    S I G N A T U R E   O F   P E R S O N   C O M P L E T I N G   F O R M                                       T I T L E  T E L E P H O N E   N U M B E R  D A T E   M O   8 8 6 - 0 6 8 4   ( 1 0 - 9 8 ) / E   0 5 - 2 0 0 4  P E R M A N E N T   ( I M - 7 )                                                                                                                                                                                                                                                                                                                                                                          @  @  @  @  :@  <@  >@  @@  h@  j@  k            a            a            a            [            R            R            R            [                   	  $$If   a$  $If   
  $If   ^   kd5  $$If   l  ֈ #*                                                                                                                   4 
l a   	@@  B@  V@  X@  Z@  d@  f@  h@  j@  n@  p@  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  @  A  A  A   A  "A  &A  FA  HA  RA  TA  ſſſſ{q{                 hgK CJ OJ QJ  hgK CJ OJ QJ  j8  hgK CJ Uj7  hgK CJ Uj7  hgK CJ Uj6  hgK CJ U
hgK CJ  
hgK CJ  hgK CJ OJ QJ  j    hgK CJ UmH nH u j5  hgK hgK CJ U
hgK CJ  j    hgK CJ U )j@  l@  n@  @  @  @  @  @  @  @  @  @  @  @  @   A                                                                                                                                                                                                                                                                                                                                                                                                                     $If   	  $$If   a$  A  "A  $A  &A  HA  JA  LA  NA  PA  RA  k            a            a            a            X            X            X            X            X                               	  $$If   a$
  $If   ^   kd8  $$If   l  ֈ #*                                                                                                                   4 
l a   	RA  TA  tA  A  A  A  A  A  A  k            a            a            [            [            [            [            [                                                        $If   
  $If   ^   kd^9  $$If   l  ֈ #*                                                                                                                   4 
l a   TA  A  A  A  A  A  A  A  A  B  B   B  "B  ,B  .B  0B  bB  dB  nB  pB  tB  B  B  B  B  B  B  B  B  B  B  B  B  B   C  0C   D  D  D  D  D  .D  ȷ܁si h0Q CJ OJ QJ  j    h0Q CJ OJ QJ UhgK 5CJ OJ QJ hgK CJ
 OJ QJ  'j:  hgK 5>*CJ OJ QJ UhgK 5>*CJ OJ QJ  !j    hgK 5>*CJ OJ QJ UhgK CJ OJ QJ  hgK CJ OJ QJ  
hgK CJ  hgK CJ OJ QJ  hgK CJ OJ QJ  hgK CJ OJ QJ )A  A  A  A  "B  $B  &B  (B  *B  ,B  k            a            a            a            [            [            [            [            [                                       $If   
  $If   ^   kd:  $$If   l  ֈ #*                                                                                                                   4 
l a   	,B  .B  0B  DB  dB  fB  hB  jB  lB  nB  k            a            a            a            [            [            [            [            [                                       $If   
  $If   ^   kdl;  $$If   l  ֈ #*                                                                                                                   4 
l a   	nB  pB  rB  tB  B  B  B  B  B  B  k            a            a            a            [            [            [            [            [                                       $If   
  $If   ^   kd'<  $$If   l  ֈ #*                                                                                                                   4 
l a   	B  B  B  B  B  B  B  B  B  B  k            a            a            a            [            [            [            [            [                                       $If   
  $If   ^   kd<  $$If   l  ֈ #*                                                                                                                   4 
l a   	B  B  B  B  B  B  B  B  B  B  k            a            a            a            [            [            [            [            [                                       $If   
  $If   ^   kd=  $$If   l  ֈ #*                                                                                                                   4 
l a   	B   C  C  C   D  k            a            [            [                                                                                                                            $If   
  $If   ^   kdX>  $$If   l  ֈ #*                                                                                                                   4 
l a    D  D  D  @D  TD  ^D  D  D  lE                                                                          [            O                                x $If   ^ Z  kd2A  $$If   l  F * j                                                            4 
l a     $If      $If   ^ 4  kd?  $$If   l  * *                        4 
l a   .D  0D  2D  <D  >D  @D  RD  TD  \D  ^D  `D  tD  vD  D  D  D  D  jE  lE  nE  E  E  F  F  F  F  F  F  G   H  H  ݿ|qg||g|WW|                    j    hgK CJ UmH nH u hgK CJ OJ QJ  hgK 5CJ OJ QJ 
hgK CJ  !j@  hgK CJ OJ QJ UhgK CJ OJ QJ  j    hgK CJ OJ QJ UhgK CJ OJ QJ  hgK CJ OJ QJ  hgK CJ OJ QJ  &j    h0Q CJ OJ QJ UmH nH u j    h0Q CJ OJ QJ U'jn?  h0Q h0Q CJ OJ QJ U lE  nE  E  E  E  E  F                                                  e                                                                                                                         Z  kd0B  $$If   l  F * j                                                      4 
l a  
  $If   ^ 4  kdA  $$If   l p * *                        4 
l a   F  F  G   H  H  I  I  
J                                                              M            C                       
  $If   ^ 4  kdC  $$If   l H * *                      4 
l a    $$If   ^a$ 4  kd.C  $$If   l  * *                          4 
l a    $If    4  kdB  $$If   l  * *                        4 
l a   H  I  I  I  J  
J  *J  ,J  4J  6J  8J  rJ  tJ  J  J  J  J  J  J  ƵƦƵƝ}ƌy                                                                                                                                                    hgK  hgK CJ OJ QJ mH nH u hgK 5CJ OJ QJ mH nH u hgK mH nH uhgK CJ OJ QJ mH nH u hgK 5CJ OJ QJ mH nH u hgK CJ OJ QJ mH nH uj    hgK CJ UmH nH u hgK 5CJ OJ QJ hgK CJ OJ QJ mH nH u 
J  ,J  6J  8J  tJ  J  J  J                                                              I            G                                   G  kdkD  $$If   l 80 ^*                  ,                                          4 
l a  	  $$If   a$ Z  kdC  $$If   l F ^#*          ~	                                                       4 
l a  
  $If   ^ ( / =!"#$%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          D d ?  
             ,                                  0   
      
  #    A              b J  k2 &     D       n  k2PNG

   IHDR        3]F   gAMA  |Q   	pHYs    +  IDAThޭoIvǫ,L0`q:`8,	/PPf@;6X,IffH{=tX;^_^Ո̻`G0o>y$gٿ\~8U\l>(dwQyvw>Lncf]_GA왲X{zH7mM:sbz!1ϵmSI)M}lb"ʢ8X|Ѿc;A*Ve E/kQvLкH]3	1q\zCH/[f^XUXG1ND!0WsP@N*IxLƉQ4cnuhYAi`gt0G{s;LgA<.ӛfy5^=et#-2Ҭ$]xc
W~&5r)-LȻ($7&^Y@CLXr
@u
:1?n0<S(nN?c2(oL1=0W:6ʚ٦lN$/a?wmO+fM?,g1dvS<ϰ=;EXӹoT*,~-:mk5ugqѱm2bOPYˮ)?n!Q#c曛LOڇo6th)E>lIn - WжSQ[mBCRȋtnkpGOf[HuaOCݺ>nu	SbAy.bL?SΎj])5ptbX%yNǼmAY8Ój_;sCe{gu&7A<
VfFaq5.9ZEc/z>6JLjs9eX1j15"(, eb|NgTPTl­얁FeD(UƋ)ȭg	M^\5S2 fNb@җ_tLI+s`yiQ)YdZRBP*9RFxm\Od<yNψL0/)"$g0Ekzbh[@>S*_"0/I4:-İ\1=1x|5'̠DwZ4?cr`^22+<6wT6IR\L;IR[@S>g5g
(o`=mUD32%ILİ Dl
ܝU)f	d<cݞK9A1]EYi]j<	\f^4
-zIi.[D
ҤPnbvʙXI9&CZ	
*RA<F645LJ2V6Tab8QsiqZ8q"m Oz|U o;0<>)KmL">0*|u)\*xaJ1/E\ߕ1/ǈ]2Y:=EʛA;T9xZ%׆mA;i2ъqְ_k6yeMgyx<G	7}3bT2oSP	a'WTb:ݕeд4C>MGvsb5eɡٹx LUsb$y&Mʞ9C!VX005f s'NDYHf9]'Vr|)QX~JvL-pUE1Nl9<:CuRW}rugy*<7QĨ1_GЗzИlBe<ucK[?$3U?u{Y'ӠF0ckA9	;:ERM`W=0gW}I9٘fᯙFeV>_O~Mv3[A	f4\>FΌČyb̔dH\r)8Oϧ4{&g&y}&lmAcGH$E}*/-jxEzL(Kcn:.0NɭH80;<g#7[Htfx%Zf'jvw}0ܖgA׺S$8ZBz8^`T=Iȑa1矟'STP*x?Ȏ.O*ĘΉ􊗽RQda#GYk?bl<}Wi3)V{02-r|X{eE/~oy@=8߬ikϯrgL@{*Ec,XR(wD^fsLPT)&"Px'H=P+fWtL8by-RO+vFr#R]c/iƮ7Ŧ1Ue-T2.oRycTlau_4+y{
5 u6o[Xj|<g̵[m3SjʦΈm[XC)򵠪cFL=,\(rf<3(쩠}#dO)0jbw@we81`'/8?H(;>^KʒȨI8BT.gQ7dgOC%͐?64F/cP9m0Kn{\1+YSc-P0DL-R#([C3|N~3V"Gs&&Pȉ_mU7|JLsnu2<vn)P#21NaOA=(vĈI\ƥz-v08AD*Gߔ/vrUE1;۳W4}1\|^ DE]fzy$bZNYGʖ]J&ڔf11 Nk-Cѳm޶W=fBeXR|6ű}E9j짴]J[*RO%Y(b|>Vntc7JrjvdP<)%5"H%ubr91AI
-ieF۽J@fa*NxcTPyWߓA`8-v"uY64
sH:#:8/q#Ŗ|#Uzz`%J|_*=+gUY`ϩj~jl,˦ A;(hRt}3TJj5G&Y[#}^s2 xlaQ4{4Ybv%zsft+D7NN7X D|fiae>/Aa9veZ͗|lbAL2ĎE{ =Js5tHgCX)We-j1(g_1FY/ݺU-N"=}Ĕdcײ=?P(̝d(8댦 :yzYN`M9nZdqlD:d4F^ sb'|8A8/R2&`)9n3t5uKAGYb(ľ*O׎!\L:Z㈁r>{T|sH{D%&lKAW|PiKR%v7t\a=/'j)OQkGރQidZaȼ%ҨOw#/RӪ{HH]mU.\^U:X=T]5"WNxYM/gew؜8V 8m%ֳ~kxUAɱ&`8_RPX2܍O@\3w|BnOm;4{{[K0ҝ}cO7Sdu-i}yLEtB7oGoES,^gFX>ê#§lN1a[Ōp˅/r=a_L3e>+h)|0||qӝ-6lTгM.1I4_s'/b_HM'`7N5J&Yg_N@i)	<1Vm[=SP.8N?îTzjWwRx!iWFk 8ĚUbRsV<&e
;KsmoA)(^zj9i[/#:42;n0Tty{IaCUPQ͖!?kZ!z,ޟgXw{E'=TE#ҎAЖtx)(nVw[CiwQrtn\!7WVLj!Cw)}6gfcKg0^p FϥSy5;2@Ԛޠ*ޑ<,?!YN=ğ^=V	xKJ~?P,U7W(O<]Ҷe*Qn71
#0S-ȵؿ=6ajco_!O6^\ng7'j6cemg	FQo>jmtkO7tQ0j;vnk{)̨h?wY2,g}.Vûirz;L̽.6=+tzY.s|Zǟd|s313?\ w-    IENDB`   D                                                                     T e x t 9       
 M M / d d / y y y y                    $$If     !v h5 5555#v #v#v#v#v:V l      5 55554       D                                                                      I A g e n c y C o p y                    S h o w 7 T o o l b a r . M A I N          D                                                                     C a s e N a m e                E n t e r   C l a i m a n t ' s   f u l l   n a m e            $$If     !v h5 5d#v #vd:V l       5 5d/      /	     /4       D                                                                      I C o u n t y M a i l i n g C o p y                              D                                                                     T e x t 4                E n t e r   c l a i m a n t ' s   c a s e   n u m b e r            $$If     !v h5 5d#v #vd:V l       5 5d/      /	     /4       D                                                                      I C o u n t y C i t y S t a t e Z I P C                              D                                                                     T e x t 6               $ E n t e r   c l a i m a n t ' s   f u l l   s t r e e t   a d d r e s s            $$If     !v h5 5d#v #vd:V l       5 5d/     /      /      4       D                                                                    I C o u n t y A r e a C o p y               * E n t e r   c o u n t y   o f f i c e   p h o n e   n u m b e r   a r e a   c o d e              D                                                                    I C o u n t y P r e f i x C o p y               ' E n t e r   c o u n t y   o f f i c e   p h o n e   n u m b e r   p r e f i x              D                                                                    I C o u n t y P h o n e C o p y               3 E n t e r   c o u n t y   o f f i c e   p h o n e   n u m b e r   ( l a s t   f o u r   d i g i t s )              D                                                                     T e x t 3 0               ) E n t e r   c l a i m a n t ' s   c i t y ,   s t a t e   a n d   z i p   c o d e            $$If     !v h5 5d#v #vd:V l       5 5d/      //     4       D                                                                     T e x t 1 1               E E n t e r   t h e   n a m e   o f   t h e   i n s t i t u t i o n   f r o m   w h i c h   i n f o r m a t i o n   i s   r e q u e s t e d             D                                                                     C a s e w o r k e r N a m e C o p y               < T h e   c a s e w o r k e r   r e q u e s t i n g   t h e   i n f o r m a t i o n   w i l l   s i g n   t h e   f o r m            $$If     !v h5 N5#v N#v:V l       5 N5/      /     /4      D                                                                     T e x t 1 2               H E n t e r   t h e   a d d r e s s   o f   t h e   i n s t i t u t i o n   f r o m   w h i c h   i n f o r m a t i o n   i s   r e q u e s t e d             D                                                                    L o a d N u m b e r C o p y               > E n t e r   t h e   l o a d   n u m b e r   o f   t h e   c a s e w o r k e r   r e q u e s t i n g   i n f o r m a t i o n            $$If     !v h5 H$5#v H$#v:V l H     5 H$5/      /     /4     $$If     !v h5 *#v *:V l 	
          5 */      / 
     4    p
     Y $$If     !v h5 *#v *:V l      5 */ 
     4     $$If     !v h5 *#v *:V l 	
          5 */      / 
     4    p
        D                                                                     T e x t 1 4               C E n t e r   t h e   f u l l   n a m e   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d             D                                                                    T e x t 1 3               P E n t e r   t h e   S o c i a l   S e c u r i t y   n u m b e r   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d           
  D                                                                                   P E n t e r   t h e   S o c i a l   S e c u r i t y   n u m b e r   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d           
  D                                                                                   P E n t e r   t h e   S o c i a l   S e c u r i t y   n u m b e r   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d            $$If     !v h5 555#v #v#v#v:V l       5 555/ 
     4       D                                                                                    C E n t e r   t h e   f u l l   n a m e   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d              D                                                                     Text13       PEnter the Social Security number of the person for whom information is requested        D                                                                             PEnter the Social Security number of the person for whom information is requested        D                                                                             PEnter the Social Security number of the person for whom information is requested      $$If     !v h5 555#v #v#v#v:V l       5 555/      4       D                                                                                    C E n t e r   t h e   f u l l   n a m e   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d           
  D                                                                                   P E n t e r   t h e   S o c i a l   S e c u r i t y   n u m b e r   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d              D                                                                             PEnter the Social Security number of the person for whom information is requested     
  D                                                                                   P E n t e r   t h e   S o c i a l   S e c u r i t y   n u m b e r   o f   t h e   p e r s o n   f o r   w h o m   i n f o r m a t i o n   i s   r e q u e s t e d            $$If     !v h5 555#v #v#v#v:V l       5 555/      4     $$If     !v h5 *#v *:V l 	
          5 */      / 
     4    p
     Y $$If     !v h5 *#v *:V l H     5 */      4       D                                                                     T e x t 1 9                E n t e r   a n y   k n o w n   a c c o u n t   n u m b e r           x   D                                                                              Enter any known account number     x   D                                                                              Enter any known account number     x   D                                                                              Enter any known account number     ~   D                                                                      Text19       Enter any known account number      $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4       D                                                                     T e x t 2 4       
 T I T L E   C A S E        E n t e r   t h e   t y p e   o f   a c c o u n t           }   D                                                                          
Title Case   Enter the type of account     }   D                                                                          
Title Case   Enter the type of account        D                                                                      Text24   
Title Case   Enter the type of account        D                                                                      Text24   
Title Case   Enter the type of account      $$If     !v h5 55555#v #v#v:V l       5 55/ 
     /      //     4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4       D                                                                      Text29   M/d/yyyy   0Enter specific dates that a balance is requested      $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4     $$If     !v h5 55555#v #v#v:V l       5 55/      /	     /4    Y $$If     !v h5 *#v *:V l      5 */      4    2  D                                                                     T e x t 3 2               ^ E n t e r   t h e   n a m e   o f   t h e   c l i e n t   w h o   i s   r e q u e s t i n g   d i r e c t   d e p o s i t   ( c l i e n t   w i l l   s i g n   i n   n e x t   f i e l d )              D                                                                      Text33   M/d/yyyy   *Enter date client signs for direct deposit      $$If     !v h5 j55#v j#v#v:V l       5 j55/      /	     /4    Y $$If     !v h5 *#v *:V l p     5 */      4     $$If     !v h5 j55#v j#v#v:V l       5 j55/      /     /4    Y $$If     !v h5 *#v *:V l      5 */      4    Y $$If     !v h5 *#v *:V l      5 */ 
     4    Y $$If     !v h5 *#v *:V l H     5 */      4     $$If     !v h5 5~	5#v #v~	#v:V l      5 5~	5/      4    a $$If     !v h5 5,#v #v,:V l 8     5 5,4                                                                                                                                                                                                                                                                                                                                              	   
                                                                      !   "   #   $   %   &   '   (   )   *   +   ,   -   .   /   0   1   2   3   4   5   6   7   8   :   ;   <   =   >   ?   @   A   B   C   D   E   F   G   H   I   J   K   L   M   N   O   P   Q   R   S   T   U   V   W   X   Y   Z   [   ^   c   r   a   b   d   q   e   f   g   h   i   j   k   l   m   n   o   p   s   |      t   u   v   w   x   y   z   {   }      ~      R o o t   E n t r y                                                 	           F            ls`   @h      D a t a                                                         
                                     9   D      W o r d D o c u m e n t                                                                                     *p      M a c r o s                                                                                 נlsDls            V B A                                                             
                       נlsЉls            T h i s D o c u m e n t                                                                                               _ _ S R P _ 4                                                                                                  _ _ S R P _ 5                                                        	                                          B                               	   
                                                             !   "   #   $   %   &   '   (   )   *   +   ,   -   .   /   0   1   2   3   4   5   6   7   8   9   ;   <   =   >   ?   @   A   B   C   D   E   F   G   I   K   L   M   N   O   P   Q   R   S   T   U   V   W   X   Y   Z   [   \   ]   ^   _   `   a   b   c   d   e   f   g   h   i   j   k   l   m   n   o   p   q   r   s   t   u   v   w   x   y   z   {   |   }             D       r             S7Z  #              <   AbNWU	           F                   UEOԛՐ               x   UEOԛՐAbNWU    ME                   (    SL   S   S    6"       N 0 { 0 0 0 2 0 9 0 6 - 0 0 0 0 - 0 0 0 0 - C 0 0 0 - 0 0 0 0 0 0 0 0 0 0 4 6 }        (                  %   H   @    h               %                 %   X                          p   @           @        0   JAY $ * \ R f f f f * 0 3 4 3 f d c b 7 9      4                                                                     x      Attribut e VB_Nam e = "Thi sDocument"

Bas0{00020P906- 0C $0046}|GlobalSpacFalsedCreatablPredecla Id TruBExposeTempl ateDerivBustomizD2                                                  rU                    	       	                          	      1      Y              4         a                [`          rU                    	          @          n                                                                    C o p y 7 W o r k e r I n f o                                                                            J      _ _ S R P _ 6                                                                                        :   L      _ _ S R P _ 7                                                                                              H   g       C o p y 7 C o u n t y I n f o                                                                               J                    ]  9         S|                                                                                        x                                       ME                   (     6
        L    L                `               8k              0    x                %   8  P       r o d u c t  i @x	         @h  h         @  X         @  H         @8                                  P                  @   JAY $ * \ R f f f f * 0 4 4 3 f d c b 7 9  * \ R 1 * # 1 7 b  * \ R 1 * # c 1  * \ R 1 * # c 1                                                               	     "          (      &        & (     
  H      & X     $ & x     
        &       &      
        "       &       & 0    
  P     & `                 wrkrINFO.DOT   B@"     CaseworkerName &  B@$   B@(        IM-7.dot   B@" h     CaseworkerNameCopy &  B@$ 1  B@*    wrkrinfo.dot   B@"  
 LoadNumber &  B@$   B@(      B@,   IM-7.dot   B@"   LoadNumberCopy &  B@$   B@*    CaseName &  B@$ o X   P     D:\FSforms\      B@  rp     Attribut e VB_Nam e = "Cop y7Worker Info"
 
Public  Sub MAIN()
 dBa sic.ChDe faultDir  "D:\FSf orms\", 0	PFileOpen :="w rkrINFO.DOT fQWW7 _EditGoT o Destin ation 3CasewD
51rIM-7.dot3n.9Pastesi;LoadNumber7qClose 2|G c=lDkEndA
                                                      rU              ~|         	       	                              !            !	      a	      	      	      	      
      I
      
      
      )                  	      I      y                  L      (:h %(H  %x $ @  x  x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x "(h %x $ @  x  x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x 	  
 x   a      D $                                 x     k                                                          rU                    	              $          `                 n                                            p         S                                                                                        x                                       ME                    P     6
        L    L    L    <     <     <                `               8k   * *          0   . x                %   8  P       r o d u c t  i @x	         @h  h         @  X         @  H         @8                                  P                  @   JAY $ * \ R f f f f * 0 5 4 3 f d c b 7 9  * \ R 1 * # 1 7 b  * \ R 1 * # c 1  * \ R 1 * # c 1  * \ R 1 * # c 1                                                             +  	     "          ( 8     &       & (     
  H      & X      & x     
        ( `     &        &      
        &      $ &     
  @     & P    & & p    
       &     & &     
       &       &      
  @     & P    " & p    
       &       &     
       &     $ &     
  @     & P     & p    
       "      &     " &     
       &      (            CTYINFO.DOT    B@"     IAgency  &  B@$  `  B@(          IM-7.dot   B@" h     IAgencyCopy  &  B@$ B@  B@*  B@*  CTYINFO.DOT    B@"     ICountyMailing &  B@$   B@(   0   IM-7.dot   B@"   ICountyMailingCopy &  B@$       B@*          CTYINFO.DOT    B@"     ICountyCityStateZIP  &  B@$     B@(          IM-7.dot   B@" S     ICountyCityStateZIPC &  B@$     B@*          CTYINFO.DOT    B@"     ICountyArea  &  B@$     B@(  m e n   IM-7.dot   B@" m a t   ICountyAreaCopy  &  B@$         B@*          CTYINFO.DOT    B@" r   ICountyPrefix  &  B@$   B@(          IM-7.dot   B@"         ICountyPrefixCopy  &  B@$       B@*          CTYINFO.DOT    B@"     ICountyPhone &  B@$     B@(            B@, t  IM-7.dot   B@" x   ICountyPhoneCopy &  B@$         B@*          CaseName &  B@$       o       D:\FSforms\      B@    p    D:\FSForms\      B@  c x    t Attribut e VB_Nam e = "Cop y7County Info"
 
Public  Sub MAIN ()
Word Basic.Ch DefaultD ir "D:\F Sforms\", 0	PFile Open := "CTYINFO0.DOT ePWW 7_EditGo To Desti@nation 2IAgency
.*jIM-7.dot,g+5Paslte	6FVMailingM΃'Cy"ICi tyStateZIP:C~?;;Area?9#9?si`+Prefix??w,8?%8Phone_@Close 2I(?3aECaseEnd!
                  rU              ~|         	       	     	                         !            !	            	      	    _ _ S R P _ 8                                                                                        ~         _ _ S R P _ 9                                                                                                 g       P r i n t F o r m T w i c e                                                                                    _ _ S R P _ a                                                                                                                                                                                                                                                                                                                                                                                                                                                                           A      
      I
      
      
      q                        a            )      i            	      a      I                                    (:h %(H  %x $ @  x  x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x (:h %(H  %x $ @  x  x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x "(h %x $ @  x  x &:h %x $ @  x    x &:h %x $ @  x 	  
 x x $ @  x   x &:h %x $ @  x 	  
 x          D $                                 x     k                  rU                    	              $          `                 n                                          *  &         S5=                                                                                        x                                       ME                    (     6
        L    <                `               k              0   0 x                %   8  P       r o d u c t  i @x	         @h  h         @  X         @  H         @  8         @  (         @           @           @           @(         @@           @X           @p           @       x  @           @           @  x         @  h         @   X         @  H         @0  8         @H  (         @`           @x           @         h                        P                  @   JAY $ * \ R f f f f * 0 6 4 3 f d c b 7 9  * \ R 1 * # 1 7 b  * \ R 1 * # c 1                                                               	     "         p ~       x                4  4  6    8    :    h    l  2  <  1  >    @    B   D    F  B@2 o       ϰ Attribut e VB_Nam e = "Pri ntFormTw ice"

 Public S ub MAIN( )
WordB asic.Filef AppendPr":=0,  Range:= "4", PrTo0 $ "From	Toyp . 8NumCopies 2<ag1 Order^uUColla"t A1, 	j
End
 rU              ~|         	       	           
                   1      I            !            Y      a                        !      9      Y                              )              ~(h  %:H  %:( %: %: %(  %: %: %(h  %(H  %(( %: %x $ @  x    	 
          x         $                                 x     k                      rU                    	     
         $      
    `                 n                                          *  &         S                                                                                        x                     _ _ S R P _ b                                                                                                  g       P r i n t F o r m O n l y                                                                                           _ _ S R P _ c                                                                                                  _ _ S R P _ d                                                                                                 g                         ME                    (     6
        L    <                `               k              0   H x                %   8  P       r o d u c t  i @x	         @h  h         @  X         @  H         @  8         @  (         @           @           @           @(           @@           @X           @p           @       x  @           @           @  x         @  h         @   X         @                                                                                                                                                                                                                                               H         @0  8         @H  (         @`           @x           @         h                        P                  @   JAY $ * \ R f f f f * 0 7 4 3 f d c b 7 9  * \ R 1 * # 1 7 b  * \ R 1 * # c 1                                                               	     "         p ~       x                4  4  6    8    :    h    l  1  <  1  >    @    B   D    F  B@2 o       ˰ Attribut e VB_Nam e = "Pri ntFormOn ly"

P ublic Su b MAIN() 
WordBa sic.Filed AppendPr":=0,  Range:=" 4", PrTo0 $ "From	Toyp . 8 NumCopieJs 1<agOrder^uU@Collat A1, 	j
End
     rU              ~|         	       	                              I            !            Y      a                        !      9      Y                              )              ~(h  %:H  %:( %: %: %(  %: %: %(h  %(H  %(( %: %x $ @  x     	 
         x         $                                 x     k                              rU                    	              $          `                 n                                          B           S~                                                                  S h o w 7 T o o l b a r                                                                                  u      _ _ S R P _ 2                                                                                                    _ _ S R P _ 3                                                                                                g       _ V B A _ P R O J E C T                                                                               
                              x                                       ME                    (     6
        L    <                `            x   8k              J p                %   0  H       a t     B   @x	       @`  h      r o@x  X         @  H         @8       :                         H                 @   JAY $ * \ R f f f f * 0 _ 4 1 f 6 4 a c e  * \ R 1 * # 1 7 b  * \ R 1 * # c 1                                                                        	                                               !  "  #  $  %  &  '  (  )  *  +  ,  -  .  /  0  1  2  3  4  5  6  7  8  9  :  ;  <  =  >  ?  @  B  C  D  E  F  G  H  I  J  K  L  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  [  \  ]  ^  _  `  a  b  c  d  e  f  g  h  i  j  k  l  m  n  o  p  q  r  s  t  u  v  w  x  y  z  {  |  }  ~       	     "         " .       0   @           7Toolbar N   P  B@L       o H   @     m Attribut e VB_Nam e = "Sho w7Toolba r"

Pu blic Sub  MAIN() 
WordBasic.ViewXDs :=", :=1
End
           rU              ~|         	       	                             !                  I      q      h   4     .:h  %(H %x $ @  x     x        D 4 $                                x     k              rU                    	              $          `                 n                               ay   	  	               * \ G { 0 0 0 2 0 4 E F - 0 0 0 0 - 0 0 0 0 - C 0 0 0 - 0 0 0 0 0 0 0 0 0 0 4 6 } # 4 . 0 # 9 # C : \ P R O G R A ~ 1 \ C O M M O N ~ 1 \ M I C R O S ~ 1 \ V B A \ V B A 6 \ V B E 6 . D L L # V i s u a l   B a s i c   F o r   A p p l i c a t i o n s             * \ G { 0 0 0 2 0 9 0 5 - 0 0 0 0 - 0 0 0 0 - C 0 0 0 - 0 0 0 0 0 0 0 0 0 0 4 6 } # 8 . 3 # 0 # C : \ P r o g r a m   F i l e s \ M i c r o s o f t   O f f i c e \ O F F I C E 1 1 \ M S W O R D . O L B # M i c r o s o f t   W o r d   1 1 . 0   O b j e c t   L i b r a r y              * \ G { 0 0 0 2 0 4 3 0 - 0 0 0 0 - 0 0 0 0 - C 0 0 0 - 0 0 0 0 0 0 0 0 0 0 4 6 } # 2 . 0 # 0 # C : \ W I N D O W S \ S y s t e m 3 2 \ s t d o l e 2 . t l b # O L E   A u t o m a t i o n             (* \ G { 2 D F 8 D 0 4 C - 5 B F A - 1 0 1 B - B D E 5 - 0 0 A A 0 0 4 4 D E 5 2 } # 2 . 3 # 0 # C : \ P r o g r a m   F i l e s \ C o m m o n   F i l e s \ M i c r o s o f t   S h a r e d \ O F F I C E 1 1 \ M S O . D L L # M i c r o s o f t   O f f i c e   1 1 . 0   O b j e c t   L i b r a r y                          
         JAY                          S  T h i s D o c u m e n t  0 3 4 3 f d c b 7 9  T h i s D o c u m e n t 7Z             C o p y 7 W o r k e r I n f o  0 4 4 3 f d c b 7 9  C o p y 7 W o r k e r I n f o |         ?   C o p y 7 C o u n t y I n f o  0 5 4 3 f d c b 7 9 . C o p y 7 C o u n t y I n f o       0   v    P r i n t F o r m T w i c e  0 6 4 3 f d c b 7 9 0 P r i n t F o r m T w i c e 5=      H   ,   P r i n t F o r m O n l y  0 7 4 3 f d c b 7 9 H P r i n t F o r m O n l y       `   ,   S h o w 7 T o o l b a r  0 _ 4 1 f 6 4 a c e J S h o w 7 T o o l b a r ~      x         `  x  0  H  9pH%P   =ah F}dSv1   `V=uA6p0[      qζ
 KEON땰   OB<'V   *:bKLL   h       )*  <*  Wordk VBA Win16~ Win32 Mac VBA6# Project1
 stdole` TemplateProjectE ThisDocument< 	   _Evaluate Officeu Module1b Copy7WorkerInfo h   MAIN, 	   WordBasic  ChDefaultDir  FileOpen   WW7_EditGoTod    Destinationл  EditCopy. 	 EditPaste 	 FileClose_ Copy7CountyInfo PrintFormTwicep 	 FilePrintI  AppendPrFile3    Range  PrToFileName)  From~  	 NumCopies    Pages  OrderA  PrintToFileo  Collate    FileNamej PrintFormOnly  Show7Toolbar.  ViewToolbars|  Toolbar2    Show Documentj          I  K      1  /        l                                                                                                                                                      0*	 pH  d   Template ProjectQ H  @

=
|	JAY J<
 9stdole>s t  d o l eP  h %^ * \G{00020430- C 
0046}# 2.0#0#C: \WINDOWS \System32\e2.tlb #OLE Automation 0 EOfficEO f i cEE2DF 8D04C-5B FA-101B-BDE5EAAC42Egra m Files\@CommonM icrosoft  Shared\ OFFICE11 \MSO.DLL#M 11.0 Ob Library K ׈ S ThisDocumentG Ti s Dc u m7n]*2  
d i r                                                                                                A        _ _ S R P _ 0                                                                                               M  z      _ _ S R P _ 1                                                                                                  P R O J E C T w m                                                                                             HB1Bx  B,!7Z"B+BCop y7Worker InfoG   C#p y 7 "W@r k%r I n ao &2 O)?O)|!S)CountyQ)+u@'t,P)'M)O)vO)K),Print@FormTw@G AP r i&FRm T w@iA O2,)(5=OnHlyG8  Ol(~EA2\?+ Show7TooPlbar#cS co %7%o 'l b a`)#c#co-c~i`%                 K*y                                                                                                               rU             ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~[         	                    -0J%]7 	  	          e 	                      a 	      y              a        Q      a 	      y              a        y      a 	     
 y              a              a 	      y             a              a 	      y      p        a                                     	                                            	                                 Project1     TemplateProject     ThisDocument     Module1     Copy7WorkerInfo     Copy7CountyInfo     PrintFormTwice     PrintFormOnly     Show7Toolbar             F  /   C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA6\VBE6.DLL     VBA
  
         	   A            0               	           F  5   C:\Program Files\Microsoft Office\OFFICE11\MSWORD.OLB     Word  k	           F  
  
            9            @               0           F     C:\WINDOWS\System32\stdole2.tlb     stdole
  
a                         P               L-[  DR  ?   C:\Program Files\Common Files\Microsoft Shared\OFFICE11\MSO.DLL     Office
  
A            i            `                  MAIN                  7 T o o l b a r   	           F  	           F                    T o o l b a r      S h o w      V i e w T o o l b a r s                    AbNWU  	           F  UEOԛՐ  
           F     Document    @              D : \ W o r d \      C h D e f a u l t D i r      w r k r I N F O . D O T      N a m e      F i l e O p e n 	     C a s e w o r k e r N a m e      D e s t i n a t i o n      W W 7 _ E d i t G o T o      E d i t C o p y      I M - 7 . d o t   $   C a s e w o r k e r N a m e C o p y      E d i t P a s t e 	     w r k r i n f o . d o t      L o a d N u m b e r      F i l e C l o s e 	     L o a d N u m b e r C o p y      C a s e N a m e      C T Y I N F O . D O T      I A g e n c y      I A g e n c y C o p y 	     I C o u n t y M a i l i n g   $   I C o u n t y M a i l i n g C o p y   &   I C o u n t y C i t y S t a t e Z I P   (   I C o u n t y C i t y S t a t e Z I P C      I C o u n t y A r e a 	     I C o u n t y A r e a C o p y 	     I C o u n t y P r e f i x 
  "   I C o u n t y P r e f i x C o p y      I C o u n t y P h o n e 
      I C o u n t y P h o n e C o p y      4            2      1      A p p e n d P r F i l e   
   R a n g e      P r T o F i l e N a m e      F r o m      T o      T y p e      N u m C o p i e s   
   P a g e s   
   O r d e r      P r i n t T o F i l e      C o l l a t e      F i l e N a m e      F i l e P r i n t      D : \ F S f o r m s \      D : \ F S F o r m s \           rU              ~}      
   	           	                                                            	      	     	 	      	      	        		                  p                                                        ThisDocument T h i s D o c u m e n t   Copy7WorkerInfo C o p y 7 W o r k e r I n f o   Copy7CountyInfo C o p y 7 C o u n t y I n f o   PrintFormTwice P r i n t F o r m T w i c e   PrintFormOnly P r i n t F o r m O n l y   Show7Toolbar S h o w 7 T o o l b a r                                                              ID="{9710B0E7-8604-4F5C-A26C-1CAB2C9D1746}"
Document=ThisDocumeP R O J E C T                                                                                                      1 T a b l e                                                                                                    4e       S u m m a r y I n f o r m a t i o n                           (                                                    D o c u m e n t S u m m a r y I n f o r m a t i o n           8                                       @      nt/&H00000000
Module=Copy7WorkerInfo
Module=Copy7CountyInfo
Module=PrintFormTwice
Module=PrintFormOnly
Module=Show7Toolbar
Name="TemplateProject"
HelpContextID="0"
VersionCompatible32="393222000"
CMG="D5D703780D491149114B134B13"
DPB="AAA87CAB50AC50AC50"
GC="7F7DA986AB8E818F818F7E"

[Host Extender Info]
&H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000

[Workspace]
ThisDocument=0, 0, 0, 0, C
Copy7WorkerInfo=44, 44, 417, 491, C
Copy7CountyInfo=22, 22, 395, 469, C
PrintFormTwice=88, 88, 461, 535, C
PrintFormOnly=66, 66, 439, 513, C
Show7Toolbar=110, 110, 483, 557, C
                                                       Oh +'0                                                    $  	   4     @  
   `     l     x                                      IM-7           Financial Information Request         FAMIS                   rev 10-98 Word 2003       IM-7.DOT          dennqur       26        Microsoft Office Word   @    8C   @    ȏ&;@    @@    ~ls              
                                                                ՜. +,0           h      p                                                                       (   Missouri Department of Social Services                 h                                          IM-7            Title         
  	           F   Microsoft Office Word Document 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               H  @ H           N o r m a l      5$ 7$ 8$ 9D H$  _HmH	sH	tH	                  D A  D          D e f a u l t   P a r a g r a p h   F o n t     V i@ V          T a b l e   N o r m a l     :V   4   4 
l a      ( k  (           N o   L i s t             n    p           z         n                   ,   D   b   c   d   e   f   g   l                               &  '  8  L  M  U  i  j  p                        )  *  3  G  H  n  o            (  <  r  |                        1  E  {                              +  ,  -  .  >  ?  @  A  U  V  W  X  l  m  n  o                                            	  
              2  3  4  5  6  7  8  9  C  S  T  U  V  W  X  Y  Z  [  n  o  p  q  r  s  t  u  v                                  	   	  !	  "	  -	  A	  K	  P	  d	  e	  	  	  	  	  
  
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  l
     !  "      &  7  <  =  [  l  m  p       D      j      j      s    '  v:      v:      GV      GV      GV      GV               C     GV          GV             k      GV            GV               k      GV            GV      GV               k      GV            #       #                k    v  GV    v        GV               k    p#  GV    p#      p#  GV      GV               3    *  j             *  j             *  j               GV            GV            GV      GV      ^         6\      GV            GV            GV      GV         k      GV            GV            GV      GV         k    *  j             *                 #       #       R      v:      v:      v:      v:      v:         k      #       #       R      /       9       9             /       9       9             /       9       9             /       9       9             /       9       9                6\      #       #       R                                       k      GV      GV                                       k      #       R      ^                                       k      #       R      R                                       k      #       #       R                                       k      #       #       R                                       k      #       #       R                                       k    *  j    *  j    *  j         .      GV      s      GV      GV      s         k    *  j               GV      GV      GV         k    *  GV         .    *  R    *           PS    *           3      GV      GV      GV               GV    T  R             0*  v:        ,   D   b   c   d   e   f   g   l                               &  '  8  L  M  U  i  j  p                        )  *  3  G  H  n  o            (  <  r  |                        1  E  {                              +  ,  -  .  >  ?  @  A  U  V  W  X  l  m  n  o                                            	  
              2  3  4  5  6  7  8  9  C  S  T  U  V  W  X  Y  Z  [  n  o  p  q  r  s  t  u  v                                  	   	  !	  "	  -	  A	  K	  P	  d	  e	  	  	  	  	  
  
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  l
     !  "      &  7  <  =  [  l  m  p      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                     0                      0                      0                     0                      0                     0                      0                      0                     0                      0                     0                      0                      0                     0                      0                      0                     0                      0                      0                     0                      0                      0                     0                      0                      0                     0                      0                     0                      0                      0                     0                      0                      0                     0                      0                      0                      0                      0                      0                      0                      0                      0                     0                      0                     0                      0                      0                      0                      0                      0                     0                      0                      0                      0                      0                      0                      0                     0                      0                     0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                     0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                     0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                     0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                      0                       	  p
            &  @@  TA  .D  H  J                             '   +   3   6      P	  	  
              (  @  j@   A  RA  A  ,B  nB  B  B  B   D  lE  F  
J  J                                   &   (   )   *   ,   -   .   /   0   1   2   4   5   7      J     l   w                                             $  8  D  J  U  a  g  p  |                                
    !  '  3  ?  E       &  <  H  L  N  Z  ]  _  k  p                            )  /  E  Q  U  W  c  f  h  t  y                            #  )  A  M  S  X  d  j  o  {                  *  0  -	  9	  ?	  P	  \	  b	  n  FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF  8                         @                             (    	                    
          P    
      
  3       1  ?    "                       P    
      
  3       1  ?    "                       P    
      
  3       1  ?    "                       P    
      
  3       1  ?    "                       P    
      
  3       1  ?    "                       P    
      
  3       1  ?    "                       \   B
      
  S    jJ           ?    "           	            P   B
   	   
  3          ?    "                       P   B
   
   
  3          ?    "                        P   B
      
  3          ?    "                       B    
        S              	   ?                    l
  m
  n
  o
  p
  w
    n  
  #    *    t       *    *    t     	  #    #    t       Z           t                  t                   t       !      e"     t       J           t                 t           4     5  t         T e x t 9  I A g e n c y C o p y  C a s e N a m e  I C o u n t y M a i l i n g C o p y  T e x t 4  I C o u n t y C i t y S t a t e Z I P C  T e x t 6  I C o u n t y A r e a C o p y  I C o u n t y P r e f i x C o p y  I C o u n t y P h o n e C o p y  T e x t 3 0  T e x t 1 1  C a s e w o r k e r N a m e C o p y  T e x t 1 2  L o a d N u m b e r C o p y  T e x t 1 4  T e x t 1 3  T e x t 1 9  T e x t 2 4  T e x t 2 9  T e x t 3 2  T e x t 3 3 l              8  U  p              3    <    A    -	  Q	  p                              	   
                                               %  K  h              (  F  '  M    T  1  @	  c	  p      p           p   :      l                         %  8  K  U  h  p                          (  3  F    '  <  M  N  ^  _  q                     0  E  V  W  g  h  z                    *  A  T  X  k  o              1  -	  @	  P	  c	  T  U  Y  Z  m  p                                                                                            p                      xx. !L 0Q % gK j         b   c   d                    &  '  M  i  j              *  G  H  n  o          (  r  |                1  {                          +  ,  >  U  l                          	  
          2  3  4  5  6  7  8  S  T  U  V  W  X  Y  n  o  p  q  r  s  t                              !	  "	  A	  K	  d	  e	  	  	  	  	  
  
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  l
  !  "      &  7  <  =  [  l  m  p                                                                                                                                                                                                                                                         S i g n      w  ,   u
                    0s	*Hd0`10*H 0R
+7D0B0
+7& ۶(6U0 0*H 	NHœg00W MkBَ/Z0	*H 01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CA0031009184123Z231009185034Z01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CA0"0	*H  0
 VQ+p8"
b>iEDis&?[%Ɯ%?;y)Lve:E{םmZAJ/v(lǉFU B%w"~=RXqq:_rڃ;rBTC8ܹbaIM_)QpR NfU@hB{>9"NV`!!apw~샔ƼTFR՚X(2Ě~Nw,0#)Ibj<}
:?Cf">G@%ZYܸE%Hqu^XsI$4SF^ tvZ	wڮGc~Z3Jb=i-+987odqE*(,'Fu޳/m}I<R}QL.8;s>Ғފ$Vqo:+סS4uL]yY]ms'7f{1!) 00	+7 C A0UF0U00UtAQrblkH.8tOM]0IUB0@0><:8http://www.dss.mo.gov/CertificateAuthority/DSSRootCA.crl0	+7 0	*H  |b_ˮZԤi#NNP&T؏0Xs鹋2Z Nm0WMI3A <N9ks+ۃ6~uV8Ka@p4Gz}45H94JDN[_5.c:C/tpcpL^ޜV,UsrNn ;"q̜C4ϑ,̸
 鋜xTD=M[_߼<g+A%r΂HMңvHp=~0-)bR7qt
ߢ	4M#}~;H=SϬ[)]Zjڅ,Hg5@bI1%%.'<$lp&z&iڦ?j=muZC`(B~
ٲvD$0VSbeaB*B(C8e"$#)]hYTAno|$F=*y|7%:f=jq7NL00
>$      0	*H 01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CA0050404160655Z150404161655Z010	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1 0UFamily Support Division00	*H  0 ïUFs|zML&Zh;f.!/ɃDE$MױbNpcA0KǝsLl!ӐcO0tSyfz(9%B)prq
 D0@0U0U%0
+0U$et{fYB(İK20$U#0tAQrblkH.8tOM]줁01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CAW MkBَ/Z0`UW0S0码䠁ᆁldap:///CN=Missouri%20Department%20of%20Social%20Services%20Root%20CA,CN=dssca1,CN=CDP,CN=Public%20Key%20Services,CN=Services,CN=Configuration,DC=modss,DC=net?certificateRevocationList?base?objectclass=cRLDistributionPoint0gecahttp://dssca1.modss.net/CertEnroll/Missouri%20Department%20of%20Social%20Services%20Root%20CA.crl0l+^0Z0+0ldap:///CN=Missouri%20Department%20of%20Social%20Services%20Root%20CA,CN=AIA,CN=Public%20Key%20Services,CN=Services,CN=Configuration,DC=modss,DC=net?cACertificate?base?objectclass=certificationAuthority0~+0rhttp://dssca1.modss.net/CertEnroll/dssca1.modss.net_Missouri%20Department%20of%20Social%20Services%20Root%20CA.crt0	*H  t-GS)8&#
P{㙴KO!~D}iE>Rق>v9i*̫hwl5VO!嘦E:50it#e  1lh[y%/lpr<6VVŵ`?śXlB:6Щ|9WT܇Zn"jp6xAhik)G;)h@{AW+Ld_7詢سΠ#P)k1ɾ+XOmڑ%H	xYggHM^}:lopƟzoJz2\}^=[uĂij~PY=qşr̒'/9h8zX`gcMx)(az8!T=5vz^,9y>'4H!&pquFw "et̸C'10001.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CA
>$      0*H p0
+710 0	*H	1
+70
+710
+70	*H	1Շ}D<0	*H Ǉ՞ n(Qarf4tD9Ňny^SXmdnzWѬ9J:xgqb(()y[nUoZ~3	LbR_[>    CERT         gGf) I5|.,         `!]`0`^         $et{fYB(İK2            l                     { D 9 6 4 A 1 4 7 - 5 D A 4 - 4 3 E 6 - 9 A 7 7 - 7 E 8 9 B 9 D 9 F 9 2 6 }     M i c r o s o f t   B a s e   C r y p t o g r a p h i c   P r o v i d e r   v 1 . 0              eHuX`.~d         HB*|dZ7i6         E%-79ѫ         00
>$      0	*H 01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CA0050404160655Z150404161655Z010	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1 0UFamily Support Division00	*H  0 ïUFs|zML&Zh;f.!/ɃDE$MױbNpcA0KǝsLl!ӐcO0tSyfz(9%B)prq
 D0@0U0U%0
+0U$et{fYB(İK20$U#0tAQrblkH.8tOM]줁01.0,	*H	CertificateAuthority@dss.mo.gov10	UUS10UMissouri10UJefferson City10U
State of Missouri1&0$UDepartment of Social Services1705U.Missouri Department of Social Services Root CAW MkBَ/Z0`UW0S0码䠁ᆁldap:///CN=Missouri%20Department%20of%20Social%20Services%20Root%20CA,CN=dssca1,CN=CDP,CN=Public%20Key%20Services,CN=Services,CN=Configuration,DC=modss,DC=net?certificateRevocationList?base?objectclass=cRLDistributionPoint0gecahttp://dssca1.modss.net/CertEnroll/Missouri%20Department%20of%20Social%20Services%20Root%20CA.crl0l+^0Z0+0ldap:///CN=Missouri%20Department%20of%20Social%20Services%20Root%20CA,CN=AIA,CN=Public%20Key%20Services,CN=Services,CN=Configuration,DC=modss,DC=net?cACertificate?base?objectclass=certificationAuthority0~+0rhttp://dssca1.modss.net/CertEnroll/dssca1.modss.net_Missouri%20Department%20of%20Social%20Services%20Root%20CA.crt0	*H  t-GS)8&#
P{㙴KO!~D}iE>Rق>v9i*̫hwl5VO!嘦E:50it#e  1lh[y%/lpr<6VVŵ`?śXlB:6Щ|9WT܇Zn"jp6xAhik)G;)h@{AW+Ld_7詢سΠ#P)k1ɾ+XOmڑ%H	xYggHM^}:lopƟzoJz2\}^=[uĂij~PY=qşr̒'/9h8zX`gcMx)(az8!T=5vz^,9y>'4H!&pquFw "et̸C'                   V   
 *p         *p  V  	 *p         *p  V   *p         *p  V   *p         *p  V   *p         *p                    7 T o o l b a r              7 T o o l b a r   1    M  f 1     M  f 1     M  f 1     M  f 1           0        A d d C o u n t y I n f o  C o p y 7   C o u n t y   I n f o       C o p y 7 C o u n t y I n f o . M A I N       A d d W o r k e r I n f o  C o p y 7   W o r k e r   I n f o       C o p y 7 W o r k e r I n f o . M A I N       	P r i n t F o r m  P r i n t   F o r m   O n l y       P r i n t F o r m O n l y . M A I N       P r i n t 2 C o p i e s  P r i n t   F o r m   T w i c e       P r i n t F o r m T w i c e . M A I N                            $ T e m p l a t e P r o j e c t . C o p y 7 W o r k e r I n f o . M A I N  $ T e m p l a t e P r o j e c t . C o p y 7 C o u n t y I n f o . M A I N  # T e m p l a t e P r o j e c t . P r i n t F o r m T w i c e . M A I N  " T e m p l a t e P r o j e c t . P r i n t F o r m O n l y . M A I N  ! T e m p l a t e P r o j e c t . S h o w 7 T o o l b a r . M A I N     ! T E M P L A T E P R O J E C T . S H O W 7 T O O L B A R . M A I N    " T E M P L A T E P R O J E C T . P R I N T F O R M O N L Y . M A I N    # T E M P L A T E P R O J E C T . P R I N T F O R M T W I C E . M A I N    $ T E M P L A T E P R O J E C T . C O P Y 7 C O U N T Y I N F O . M A I N    $ T E M P L A T E P R O J E C T . C O P Y 7 W O R K E R I N F O . M A I N   @        x,W               X             !  !  !  !  n  @      @      @   @  @      @      @      @  @            U n k n o w n                                   G  z                  T i m e s   N e w   R o m a n   5                       S y m b o l   3&  z                  A r i a l   "  :  h    +lB1 4     
            
         ?j8!                                                                                                                                                                                                                                                                                                                         x x 24    d      h  h      
B                                                               3                             HX    ( ?    gK     *                         I M - 7  F i n a n c i a l   I n f o r m a t i o n   R e q u e s t   	 r e v   1 0 - 9 8  F A M I S  d e n n q u r                                                                                                                                                                                                                                  C o m p O b j                                                                                         q                                                                                                                                                                                                                                                                                                                                                                      MSWordDoc    Word.Document.8 9q                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           