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Get and Sign Redetermination Custody Form
Detained at:
5. The places in the United States where I have lived during the last 5 years are as follows:
Complete Address - Including Apt. NO.
FROM MO/YR
TO
MO/YR
6. Upon release, I will be residing with
at the following address:
B.
FAMILY:
1. I am [ ] single
[ ] married
2. The name of my spouse is
3. We were married on
4. My spouse was born on
5. My spouse resides at
6. My spouse’s immigration status is
7. I have
Name
Relations
[ ] divorced
(M/D/Y) at
at
U.S.
(City)
Legal...
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