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Myflorida.com/accessflorida or call 1-866-762-2237. can get this anytime even when enrollment is closed. Income/assets all that apply Recent federal personal income tax return with W2 s OR form 4506T verification of non-filing. I understand that any misrepresentation by me in submission or omission may result in termination from Good Samaritan Clinic services. Zero or free or barter is NOT acceptable I began renting at the above location on approximate date Applicant Signature print...
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