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Get and Sign Printable Liheap Application Form
Instructions, contact your local county assistance office. 1 Please complete this section for the head of household. County *Use the codes from page 2 to help provide the details. Name (Include Last, First Middle Initial) CASH Application Registration Number Date of Birth Sex Social Security Number District Record Number Home Address (Include Street, Apt. Number, City, State & ZIP Code+4) Worker I.D. Mailing Address if different (Include Street, Apt. Number, City, State & ZIP...Show details
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