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DocuSign Envelope ID: C4B6D777038E4786969BDE9F7C7BFB25SIGNATURE DOCUMENT FOR HEALTH AND HUMAN SERVICES COMMISSION CONTRACT NO. 52917014400009 UNDER THE HOME AND COMMUNITYBASED SERVICES ADULT MENTAL

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Contract no 529-17-0144-00009 is a specific agreement outlining terms and conditions between parties.

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Information such as names of parties, terms of agreement, obligations, payment details, and signatures must be reported on contract no 529-17-0144-00009.

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