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About
Example Forms
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This site is for demonstration of forms.
Do NOT submit personal applications.
This release is valid for one year from date that it is signed.
I/we authorize theTribal TANF Program to provide/obtain information to/from other agencies, employers, schools or institutions with the intention of verifying and coordinating services.
Adult 1
(Required)
Adult 2
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Head of Household Signature
(Required)
I declare under penalty of perjury under the laws of the United States and the State of Washington that the facts contained in this report are true and correct and complete for the entire report month.
Spouse Signature
I declare under penalty of perjury under the laws of the United States and the State of Washington that the facts contained in this report are true and correct and complete for the entire report month.
Social Security #
(Required)
Date
(Required)
MM slash DD slash YYYY
Social Security #
Date
MM slash DD slash YYYY
In order to protect your private information the completed PDF form will be encrypted with a password. Please type a memorable password below.
Password
(Required)
The completed PDF form will be emailed to you please provide an email address below.
Email
(Required)
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