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 Form 04af010e 2012-2023

Form 04af010e 2012-2023

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Needy Families (TANF). Source of income Gross monthly income Take-home income        $             $                    $             $                    $             $             B. Applicant mother 1. Employment Name        Present employer's name        2. Days and working hours        Income Gross monthly income $             Take-home monthly income $             3. Other income or benefits List other income or benefits such as Social Security benefits, adoption...
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