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 Fillable Online DESIGNEE DECLARATION Saha Org Fax 2019-2023

Fillable Online DESIGNEE DECLARATION Saha Org Fax 2019-2023

Use a designee form 2019 template to make your document workflow more streamlined.

That the statements therein are true and correct. DESIGNEE DECLARATION Please note that the below designee will only be approved by SAHA if they are either a granted Power of Attorney b approved as a Reasonable Accommodation by SAHA for a person with disabilities or c authorized as a caseworker from a SAHA partner agency. APPLICANT/PARTICIPANT INFORMATION Name Last 4 SSN Home Phone Cell Phone Work Phone Email Address Current Address City State Zip Code DESIGNEE INFORMATION I authorize to...
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