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PARTICIPANT S SIGNATURE MAIL TO Stanislaus County Child Support P. O. Box 4189 Modesto CA 95352-4189 FAX 209 558-3135 DROP OFF 251 E. Hackett Rd Modesto CA DATE Print. This authorization shall expire on. I understand that if I wish to revoke this authorization at any time before the expiration date I must submit a written notification of revocation to the California Department of Child Support Services or any Local Child Support Agency. CHILD SUPPORT PARTICIPANT INFORMATION Telephone Number...
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