Get the free 23DC065 - Attachment 1- LDSS-4580 - REQUEST FOR VOLUNTARY RESTRICTED PAYMENTS. LDSS-...

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LDSS4580 (Rev. 8/23)Request for Restricted Temporary Assistance (TA) Payments ___ COUNTY DEPARTMENT OF SOCIAL SERVICES CASE NAME:___ADDRESS:___CASE NUMBER:___ SEE BACK OF PAGE FOR AN EXPLANATION OF

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