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Persons with disabilities who require a reasonable accomodation may contact HHA s Section 504 Coordinator as follows Michael M. 2 I hereby certify that the information I have provided in this pre-application is true and accurate. O Neil 812 Abbey St. Helena MT 59601 Alternate formats of the application are available upon request. Family Member Name Type of Income Wages SS/ SSI/SSDI Child Support Unemployment TANF VA Self-emp etc Amount received if wages also include of hours worked per week...
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