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East Central Illinois Community Action Agency INCOME STATEMENT Wages, Social Security, etc. Person, Company or Agency Address City, State, Zip To whom it may concern: Re: (Applicant Name) I hereby
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112-1pub - comaction is a form that must be filed by certain individuals or entities with the relevant authority.
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The 112-1pub - comaction form must be completed accurately and submitted to the appropriate authority.
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Specific information as required by the authority must be reported on the 112-1pub - comaction form.
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