ࡱ>  { @ 82jbjbj  #:::8dh;<<<<= >|E?@Y%~~~~~~$RVE@==@@<<VCCC@<<YC@YCCRQCS<9 zM:@"wRS$l0R* A*<CS*QS?0?"C?????%DB%ADOPTION CONSENT REQUEST (CHILD IN HOME, NO COMPETING PARTIES) Department of Human ServicesChild s Name (Last, First, Middle)Date of BirthDHS Case Number FORMTEXT       FORMTEXT       FORMTEXT      Adoptive Placement CountyName of Recommended Adoptive Parent(s) FORMTEXT       FORMTEXT       FORMCHECKBOX Foster Family  FORMCHECKBOX Relative FORMCHECKBOX Other FORMTEXT      Date of Placement in the home:  FORMTEXT       FORMCHECKBOX EXPEDITED CONSENT REQUEST (All of the following must apply): FORMCHECKBOX The recommended family is the only family requesting to adopt the child. There are no competing families for adoption. FORMCHECKBOX The childs is residing in the adoptive home and all of his/her physical and emotional needs are being satisfactorily met.  FORMCHECKBOX This is the only child available for adoption OR all available siblings (i.e. PCWs or MCI wards) are being adopted together.  FORMCHECKBOX Criminal record checks and CPS clearances for all adults in the home are current (see policy) no arrests or convictions.  FORMCHECKBOX Fingerprinting of adoptive applicants completed. No arrests or convictions. FORMCHECKBOX The family has no previous complaints, licensing and/or CPS, involving the care of a child. FORMCHECKBOX Three references recommending the family for adoption of these children have been received. FORMCHECKBOX There are no Circumstances Requiring Additional Documentation as defined in the Adoption Policy CFA 540. FORMCHECKBOX Marriage and divorce verifications and medical evaluations of the adopting parent(s) are in the case record. FORMCHECKBOX REGULAR CONSENT REQUEST (One or more of the following apply):Child is not being placed with other siblings who are available for adoption.Family has previous licensing, protective services, or criminal complaints.There are other circumstances existing that require additional documentation.ALL OF THE FOLLOWING ARE REQUIRED FOR EACH CONSENT REQUEST: FORMCHECKBOX Consent to Adoption (PCA309) is attached which includes:County where petition will be filed, Childs name as it appears on the birth certificate and any documented AKA.Full legal name(s) of the adoptive parent(s) as confirmed by birth, marriage or divorce papers. FORMCHECKBOX The following required documentation is included and is current within 1 year.Child Assessment and addendum(s) (required to update or indicate changes in placement)Adoptive Family Assessment and addendum(s) with supervisory approval noted. FORMCHECKBOX Copy of the childs birth certificate or other verification of birth. FORMCHECKBOX Legal documentation (Copies of at least 1 of the following legal forms must be included) A copy of the Order Terminating Parental Rights, Commitment to DHS (JC63).The applicable legal documents committing a child to DHS following a voluntary release (PCA305, 306, 312, 318, 322)Combination of forms (JC 63, PCA 305, 306, 312, 318, 322), if applicable. Order committing a child to MCI, following a disrupted adoption.Placement Agency and Address FORMTEXT      Signature of Adoption WorkerDateTelephone Number FORMTEXT       FORMTEXT      FORMTEXT        FORMTEXT      Signature of Adoption Supervisor Approving this PlacementDate FORMTEXT      Department of Human Services (DHS) will not discriminate against any individual or group because of rac0|~ & B D X Z \ f h j l > @ B V X Z d f h j ~ |j h>O#Ujh>O#UjhmU hm5hmjhlUjhlUjhlUjh1UmHnHujUhlUh3jh3Uh5d hl5CJ h 5CJh^&hl.~ @ d)PSd)}rr<rJ $Ifgdm:kd]$$If94h>+)4 9af4$If:kd$$If94h>+)4 9af4*$Ifi1j@ B j .bkdq$$If94Fh#>+l    4 9af4 -$IfgdJ&Cbkd$$If94Fh#>+l    4 9af4 > @ h  I@ -$IfgdFOkd$$If940h >+N 4 9af4 -$IfgdJ&COkd$$If94 0h >+N 4 9af4 $Ifgdm ( * , : < P R T ^ ` b d óȤȜtla]X hF5hFh#6{5CJOJQJh#6{h#6{>*j h#6{h#6{>*U h#6{>*jh#6{>*Uh#6{ h5hFh>*jh1>*UmHnHujlhdih>*U h>*jh>*Ujh1Ujh1Uj h1UhjhU" . : b -$IfgdJ&C -$IfgdFd8$IfgdJ&Cb d PG> -$Ifgd#6{ $Ifgd#6{kd$$If94֞h x>+h hx4 9af4 8 9 : d)laSEf ad8$IfgdJ&C!d8$IfgdJ&C -$IfgdJ&C<kd> $$If94h>+)4 9af4$IfOkdm $$If940h >+` v 4 9af4     + / 7 8 : ; < = K L M T U V W X f g h i wxyz{󬚬j h1U hF>*CJj h1U hFCJj h1Uj h1U hF5h1hF0J<>*h1hF0J<hhhF5j h1UhFjhFU5: ; < N {{p&| $IfgdJ&C-dL$IfgdJ&Cukd# $$If94\h(#>+hF4 9af4 T U |z&|o&| $IfgdJ&C0 dL$IfgdJ&C-dL$IfgdJ&CbkdP $$If94Fh8>+hh'    4 9af4U V W i |z&|o&| $IfgdJ&C0 dL$IfgdJ&C-dL$IfgdJ&Cbkda $$If94Fh8>+hh'    4 9af4 wx|z&|o&| $IfgdJ&C0 dL$IfgdJ&C-dL$IfgdJ&Cbkdr$$If94Fh8>+hh'    4 9af4xyz|&| $IfgdJ&C-dL$IfgdJ&Cbkd$$If94Fh8>+hh'    4 9af4HIJKYZ[5789:HIJ ]^㫧hh5 h15j_h1UhjhUjbh1Uh#6{jQh1Uj@h1Uj/h1U hF5hFjhFUjh1U8H|&| $IfgdJ&C-dL$IfgdJ&Cbkd$$If94Fh8>+hh'    4 9af4HIJ\|&| $IfgdJ&C-dL$IfgdJ&Cbkd$$If94Fh8>+hh'    4 9af47|&| $IfgdJ&C-dL$IfgdJ&Cbkd$$If94Fh8>+hh'    4 9af4789K|&| $IfgdJ&C-dL$IfgdJ&Cbkd$$If94Fh8>+hh'    4 9af4d)Yd)<kd$$If94Xh>+)4 9af4$Ifbkd$$If94Fh8>+hh'    4 9af4 ]^P:'| & F $If^gd>+-dL$IfgdJ&COkd$$If94 0h>+hn(4 9af4 0$Ifgd -$Ifgd>O#<kd$$If94h>+)4 9af4]^_|'|;|'|Okd$$If940h>+hn(4 9af4 & F $If^gd>+-dL$IfgdJ&COkd|$$If940h>+hn(4 9af4d)|gd)|<kdm$$If94Xh>+)4 9af4 $IfgdJ&COkd$$If940h>+hn(4 9af4<=Od)wlc'| $Ifgd>O# -$Ifgd>O#<kdK$$If94 h>+)4 9af4!d8$Ifgd<kd$$If94h>+)4 9af4<=>LMN]^_`aopqhijklz{|23  PRfhjtvh#6{jh1UmHnHuj&hFUj!h1UjV h1Ujh1Ujh1UjhFU hF5hF@]|'|7|'|Okd$$If940h>+hn(4 9af4 & F h$If^h`gdUo-dL$Ifgd>O#Okd0$$If94 0h>+hn(4 9af4]^_`rd)|`UL'| $Ifgd>O# -$Ifgd>O#<kd$$If94 h>+)4 9af4$!$If^!a$gdUoOkdx$$If940h>+hn(4 9af4h|'|7|'|Okd$$If940h>+hn(4 9af4 & F h$If^h`gd>O#-dL$Ifgd>O#Okd$$If94 0h>+hn(4 9af4hijk}d)aVM'| $Ifgd>O# -$Ifgd>O#<kd$$If94 h>+)4 9af4 /'$If`'gdGnOkdF$$If940h>+hn(4 9af412d)|eZN'E'| $Ifgd>O# d8$Ifgd>O# -$Ifgd>O#<kds!$$If94 h>+)4 9af4 $If^gdGnOkd $$If94 0h>+hn(4 9af4234|'|7|'|Okd#$$If940h>+hn(4 9af4 & F h$If^h`gd>O#-dL$Ifgd>O#Okd^"$$If94 0h>+hn(4 9af4 |7|'|OkdG$$$If940h>+hn(4 9af4 & F h$If^h`gd>O#-dL$Ifgd>O#Okd#$$If940h>+hn(4 9af4  d)a[d)$If<kd%$$If94h>+)4 9af4 /'$If`'gdGnOkd$$$If940h>+hn(4 9af4NPxzd)y<<kdJ'$$If94h>+)4 9af4-$If<kdg&$$If94h>+)4 9af4$If<kd%$$If94Xh>+)4 9af4  -$Ifbkd'$$If94Fhz!>+F~     4 9af4$If  "$&,.02FHJTVXZnpr|~(*2hKiLiiiiiiiii0j1j2jڹڮڣړh1h3ehhyjhlh^&hFaJhUhB:hF^JaJj^,hFUj*hFUj)hFUj)hFUhFjh1UmHnHujhFUjT(hFU0, F@@-$IfOkd+$$If940h!>+X ~ 4 9af4$Ifbkd>+$$If94PFhz!>+F~     4 9af4,.02Li{iiiid)lcYYYY  Y$If $$Ifa$<kd-$$If94Xh>+)4 9af4$IfOkd-$$If94P0h!>+X ~ 4 9af4e, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.AUTHORITY: MCL 710.21 et. seq. and P.A. 280 of 1939. RESPONSE: Required. PENALTY: Adoption delay. DHS-3217 (Rev. 5-09) Previous edition obsolete. MS Word DISTRIBUTION: Original Central Office; Copy Retain for your file iii/j0j1j2j(xPxxxxxxy:y^y;:987654i  rgdGn rh^hgdGnOkd-$$If94`0h >+4 9af4.&P:p5d/ =!"#$%[$$If!vh5)#v):V 945)44 9af4[$$If!vh5)#v):V 945)44 9af4$$If!vh5l55#vl#v#v:V 945l55/  44 9af4tD9Text1D date1#Enter the Date (Example: 4/12/1997)D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)$$If!vh5l55#vl#v#v:V 94,5l55/ 44 9af4$$If!vh5N 5#vN #v:V 94 5N 5/  44 9af4tDText7tD=Text6$$If!vh5N 5#vN #v:V 94,5N 5/ 44 9af4vDeCheck17vDeCheck16vDeCheck15tDText8!$$If!vh5h5 555h55x#vh#v #v#v#vh#v#vx:V 94,5h5 555h55x/ /  / / 44 9af4jD$$If!vh5` 5v #v` #vv :V 94,5` 5v / / / / /  / 44 9af4m$$If!vh5)#v):V 945)/  44 9af4vDeCheck13$$If!vh5h55F5#vh#v#vF#v:V 94,5h55F5/ 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ / 44 9af4vDeCheck14$$If!vh5h5h5'#vh#v':V 945h5'/ /  / 44 9af4m$$If!vh5)#v):V 94X5)/ 44 9af4m$$If!vh5)#v):V 945)/  44 9af4vDeCheck13$$If!vh5h5n(#vh#vn(:V 94 ,5h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/ / / /  44 9af4m$$If!vh5)#v):V 94X5)/ 44 9af4m$$If!vh5)#v):V 945)/  44 9af4m$$If!vh5)#v):V 94 5)/  44 9af4vDeCheck13$$If!vh5h5n(#vh#vn(:V 94 ,5h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4m$$If!vh5)#v):V 94 5)/  44 9af4vDeCheck13$$If!vh5h5n(#vh#vn(:V 94 ,5h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4m$$If!vh5)#v):V 94 5)/  44 9af4vDeCheck13$$If!vh5h5n(#vh#vn(:V 94 ,5h5n(/  / / 44 9af4s$$If!vh5)#v):V 94 ,5)/  44 9af4vDeCheck13$$If!vh5h5n(#vh#vn(:V 94 ,5h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4$$If!vh5h5n(#vh#vn(:V 945h5n(/  / / 44 9af4m$$If!vh5)#v):V 945)/ 44 9af4m$$If!vh5)#v):V 94X5)/ 44 9af4m$$If!vh5)#v):V 945)/  44 9af4tDXText5m$$If!vh5)#v):V 945)/ 44 9af4$$If!vh55F5~ #v#vF#v~ :V 9455F5~ /  44 9af4D date1#Enter the Date (Example: 4/12/1997)DWorkerAreaCodeEnter the Area Code.D WorkerPhone2Enter the 7 digit phone number (Example: 373-1234)DWorkerExtension5Enter the extension number, if any, (Example: X12345)$$If!vh55F5~ #v#vF#v~ :V 94P55F5~ / 44 9af4$$If!vh5X 5~ #vX #v~ :V 945X 5~ /  44 9af4D date1#Enter the Date (Example: 4/12/1997)$$If!vh5X 5~ #vX #v~ :V 94P5X 5~ / 44 9af4_$$If!vh5)#v):V 94X5)44 9af4$$If!vh55#v#v:V 94`55/ /  / 44 9af4DGranteeFirstName=Enter the Grantee's First Name (and Middle Initial, if known)GranteeLastNameTDAddress1 UppercasedEnter the Addressee's=8@8 Normal_HmH sH tH B@B Heading 3 $<5CJDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List POP BLANKLINEdx5CJOJQJkHTOT Captions 6ptd(CJ OJQJkHDOD Captions 6pt bold5`O"` Captions 6pt boxd<5CJ OJQJkHDO2D Captions 6pt Nbox<DOBD Captions 7pt dtCJDOARD Captions 7pt Bold5BOqbB Captions 7pt box5^Or^ Captions 7pt NBoxdt<CJOJQJkHPOP 9 Captions 8pt d`CJOJQJkH^O^ Captions 8pt Bold d`5CJOJQJkHFOF Captions 8pt box <DOD :Captions 8pt NboxPPOP Captions 9pt dLCJOJQJkHJOJ Captions 9pt BolddLCJFOF Captions 9pt Box dDOD Captions 9pt Nbox5POP Captions 10pt d`( OJQJkH^O^ Captions 10pt Bold!d`(5OJQJkHXO"X Captions 10pt box"d`P OJQJkHHO2H Captions 10pt Nbox#P5J @BJ Footer$dt !CJOJQJkHRORR Form Title 10pt%$d8a$ OJQJkH^Ob^ Form Title 10pt Bld&$d8a$5OJQJkHVOrV Form Title 11pt'$d$a$CJOJQJkHLOaL Form Title 11pt Bld(d$CJVOV Form Title 12pt)$da$CJOJQJkHbOb Form Title 12pt Bld*$da$5CJOJQJkH4@4 Header + !HOH Small Blank Line ,CJXOX User Input 10pt-d8(5OJQJkHTOT User Input 11pt.d$5CJOJQJkH\O\ User input 12pt/d((5CJOJQJkHTOT <Letter Text 10pt0$d$a$ OJQJkHFOF Letter Text 11pt1dCJXO"X Letter Text 12pt2$da$CJOJQJkHLO2L Captions 10pt 2 line 3<FOBF Date 08pt45CJOJQJkH6OAR6 Date 09pt5CJ6OAb6 Date 10pt6CJ2Oar2 Date 11pt7CJFV@F jZFollowedHyperlink >*B* phXOX hCaptions 8pt CharCJOJQJ_HmH sH tH FOF hCaptions 8pt Nbox CharHH  Balloon Text;CJOJQJ^JaJZoZ 01Letter Text 10pt CharOJQJ_HmH sH tH 2n?\]^_ 4HI[j|89:;<NTUVWiwxyzHIJ\789K ]^_<=O] ^ _ ` r    h i j k } 1 2 3 4  B C D  @ A { L{/03*0*0 0 0 0 0 0 0 0 -0 -0 -0 0 0 0 0 -0 -0 0 -0 0 -0 0 -0 0 -0 0 0 -0 0 0 0 -0 !0 0 -0 0 -0 -0 0 0 -0 -0 000 0 -0 -0 000 0 -0 -0 000 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 0 0 0 0 -0 00 0 -0 0 0 -0 0 0 -0 0 0 0 0 0 0 !0 0 -0 0 0 -0 0 0 -0 0 0 0 0 -0 0 0 -0 0 0 -0 0 0 0 0 -0 0 0 0 0 -0 00 0 -0 0 0 -0 0 0 -0 0 0 -0 0 0 0 0 0 0 0 0 -0 0 0 0 0 0 -0 -0 -0 0 0 0 0 -0 -0 0 0 0 0 0000 0 0 @0@00 1'?\]^_ 4HI[j|89:;<NTUVWiwxyzHIJ\789K ]^_<=O] ^ _ ` r    h i j k } 1 2 3 4  B C D  @ A { L{3*0*0 0 0 0 0 0 0 0 -0 -0 -0 0 0 0 0 -0 -0 0 @-0 @0 @-0 @0 @-0 @0 @-0 0 -0 0 0 0 -0 !0 0 -0 0 -0 -0 0 0 -0 -0 000 0 -0 -0 000 0 -0 -0 000 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 -0 -0 0 0 0 0 0 0 @-0 @0 -0 0 0 -0 00-0 000 000!00-000-0 00-0 000 0-000-0 00-0 000 0-00000-0000-0 00-0 00-0 00-0 000 00000-000000-0-0-0000x0-0-00000000000 ,24@FIYjz<LWgzJZ9I=M` p k {      $ * , 8 > 2FFFFFG G G$FFG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FFFFFF8@0(  B S  ?Text1date1 CaseNumberText7Text6Check17Check16Check15Text8Check13Check14Text5WorkerAreaCode WorkerPhoneWorkerExtension!5J[|<   - 3 3GZ{M  + ? 3@ U@@ >B@ |A33=*urn:schemas-microsoft-com:office:smarttags PlaceName9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceType 03033 34GIZ[8899KLfgYZ5HI  LMo p z {  A     + , ? 0303 Wcd|k rBg\w)g\w8x|$"3J%foN/Tܲ>DQ-f2Z!j?tQ-y^RICY}N1h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`o(.^`o(.8&^`B*CJOJQJaJo(phhH8^`OJQJ^Jo(hHo8pp^p`OJQJo(hH8@ @ ^@ `OJQJo(hH8^`OJQJ^Jo(hHo8^`OJQJo(hH8^`OJQJo(hH8^`OJQJ^Jo(hHo8PP^P`OJQJo(hH^`o(.z^`zo(.H>H^H`>o(.H>H^H`>o(.8&^`B*CJOJQJaJo(phhH8^`OJQJ^Jo(hHo8pp^p`OJQJo(hH8@ @ ^@ `OJQJo(hH8^`OJQJ^Jo(hHo8^`OJQJo(hH8^`OJQJo(hH8^`OJQJ^Jo(hHo8PP^P`OJQJo(hHH>H^H`>o(.z^`zo(.8&^`B*CJOJQJaJo(phhH8^`OJQJ^Jo(hHo8pp^p`OJQJo(hH8@ @ ^@ `OJQJo(hH8^`OJQJ^Jo(hHo8^`OJQJo(hH8^`OJQJo(hH8^`OJQJ^Jo(hHo8PP^P`OJQJo(hH yfoN/3J%) rB$>Dj?t8xCY}fWc          >        >        >         @"!>O#3J&C~I>gREU3eyjmGnOo#6{\5dxm,>+Z jZC_di1B8V ^&UoFh, 4l\]^_ 4HI[j|89:;<NUVWixyzHIJ\789K ]^_<=O] ^ _ ` r    h i j k } 2 3 4  B C D  @ A { L39V{0n0nVz0n0nVy0n0nVx0n0nVw0n0nVv0n0nVu0n0nVt0n0nVr0n0nVq0n0nVp0n0nVo0n0nVn0n0nVm0n0nVl0n0nVk0n0nV j0n0nV!i0n0nV"h0n0nV#g0n0nV$f0n0nV%e0n0nV&d0n0nV'c0n0nV(b0n0nV)a0n0nV*`0n0nV+_0n0nV,^0n0nV-]0n0nV.\0n0nV/[0n0nV0Z0n0nV1Y0n0nV2X0n0nV3W0n0nV4V0n0nV5U0n0nV6T0n0nV7S0n0nV8R0n0nV9Q0n0nV:P0n0nV;O0n0nV<N0n0nV=M0n0nV>L0n0nV?K0n0nV@J0n0nVAI0n0nVBH0n0nVCG0n0nVDF0n0nVEE0n0nVFD0n0nVGB0n0nVH0n0n  Spell Check Spell CheckbLfQ+bLfQ+bLfQ+bLfQ+bLfQ+ 0(  Spell CheckForms Spell Check2Module1.FormsSpellCheck2g|(TemplateProject.Module1.FormsSpellCheck2%TemplateProject.SuperPhoneNumber.MAIN%TemplateProject.GranteeFirstName.MAIN$TemplateProject.WorkerExtension.MAIN$TemplateProject.GranteeLastName.MAIN$TemplateProject.GranteeClientID.MAIN$TemplateProject.GranteeAddress1.MAIN$TemplateProject.AddChildInfoRow.MAIN#TemplateProject.WorkerAreaCode.MAIN#TemplateProject.SupervisorName.MAIN#TemplateProject.SuperExtention.MAIN#TemplateProject.AddSvcReferral.MAIN"TemplateProject.SvcRefHeading.MAIN"TemplateProject.SuperAreaCode.MAIN"TemplateProject.GranteeCareof.MAIN"TemplateProject.CoSuppaddress.MAIN"TemplateProject.CoPhoneNumber.MAIN"TemplateProject.ClearCaseInfo.MAIN!TemplateProject.NewParagraph.MAIN!TemplateProject.GranteeState.MAIN!TemplateProject.countynumber.MAIN TemplateProject.WorkerPhone.MAIN TemplateProject.GranteeCity.MAIN TemplateProject.CoExtension.MAIN TemplateProject.ClientState.MAINTemplateProject.WorkerName.MAINTemplateProject.GranteeZip.MAINTemplateProject.CountyName.MAINTemplateProject.CoAreaCode.MAINTemplateProject.ClientCity.MAINTemplateProject.CaseNumber.MAINTemplateProject.WorkerFax.MAINTemplateProject.RemoveRow.MAINTemplateProject.lastname2.MAINTemplateProject.FirstName.MAINTemplateProject.CoAddress.MAINTemplateProject.ClientZip.MAINTemplateProject.RowBreak.MAINTemplateProject.LastName.MAINTemplateProject.District.MAINTemplateProject.CaseInfo.MAINTemplateProject.Address1.MAINTemplateProject.Section.MAINTemplateProject.OtherID.MAINTemplateProject.NoReset.MAINTemplateProject.CoState.MAINTemplateProject.Correct.MAINTemplateProject.AddRows.MAINTemplateProject.Worker.MAINTemplateProject.Hidden.MAINTemplateProject.County.MAINTemplateProject.CoCity.MAINTemplateProject.CareOf.MAINTemplateProject.FaxAC.MAINTemplateProject.Date1.MAINTemplateProject.CoZip.MAINTemplateProject.Unit.MAIN9TEMPLATEPROJECT.UNIT.MAINTEMPLATEPROJECT.COZIP.MAINTEMPLATEPROJECT.DATE1.MAINTEMPLATEPROJECT.FAXAC.MAINTEMPLATEPROJECT.CAREOF.MAINTEMPLATEPROJECT.COCITY.MAINTEMPLATEPROJECT.COUNTY.MAINTEMPLATEPROJECT.HIDDEN.MAINTEMPLATEPROJECT.WORKER.MAINTEMPLATEPROJECT.ADDROWS.MAINTEMPLATEPROJECT.CORRECT.MAINTEMPLATEPROJECT.COSTATE.MAINTEMPLATEPROJECT.NORESET.MAINTEMPLATEPROJECT.OTHERID.MAINTEMPLATEPROJECT.SECTION.MAINTEMPLATEPROJECT.ADDRESS1.MAIN TEMPLATEPROJECT.CASEINFO.MAIN!TEMPLATEPROJECT.DISTRICT.MAIN"TEMPLATEPROJECT.LASTNAME.MAIN#TEMPLATEPROJECT.ROWBREAK.MAIN$TEMPLATEPROJECT.CLIENTZIP.MAIN%TEMPLATEPROJECT.COADDRESS.MAIN&TEMPLATEPROJECT.FIRSTNAME.MAIN'TEMPLATEPROJECT.LASTNAME2.MAIN(TEMPLATEPROJECT.REMOVEROW.MAIN)TEMPLATEPROJECT.WORKERFAX.MAIN*TEMPLATEPROJECT.CASENUMBER.MAIN+TEMPLATEPROJECT.CLIENTCITY.MAIN,TEMPLATEPROJECT.COAREACODE.MAIN-TEMPLATEPROJECT.COUNTYNAME.MAIN.TEMPLATEPROJECT.GRANTEEZIP.MAIN/TEMPLATEPROJECT.WORKERNAME.MAIN0 TEMPLATEPROJECT.CLIENTSTATE.MAIN1 TEMPLATEPROJECT.COEXTENSION.MAIN2 TEMPLATEPROJECT.GRANTEECITY.MAIN3 TEMPLATEPROJECT.WORKERPHONE.MAIN4!TEMPLATEPROJECT.COUNTYNUMBER.MAIN5!TEMPLATEPROJECT.GRANTEESTATE.MAIN6!TEMPLATEPROJECT.NEWPARAGRAPH.MAIN7"TEMPLATEPROJECT.CLEARCASEINFO.MAIN8"TEMPLATEPROJECT.COPHONENUMBER.MAIN9"TEMPLATEPROJECT.COSUPPADDRESS.MAIN:"TEMPLATEPROJECT.GRANTEECAREOF.MAIN;"TEMPLATEPROJECT.SUPERAREACODE.MAIN<"TEMPLATEPROJECT.SVCREFHEADING.MAIN=#TEMPLATEPROJECT.ADDSVCREFERRAL.MAIN>#TEMPLATEPROJECT.SUPEREXTENTION.MAIN?#TEMPLATEPROJECT.SUPERVISORNAME.MAIN@#TEMPLATEPROJECT.WORKERAREACODE.MAINA$TEMPLATEPROJECT.ADDCHILDINFOROW.MAINB$TEMPLATEPROJECT.GRANTEEADDRESS1.MAINC$TEMPLATEPROJECT.GRANTEECLIENTID.MAIND$TEMPLATEPROJECT.GRANTEELASTNAME.MAINE$TEMPLATEPROJECT.WORKEREXTENSION.MAINF%TEMPLATEPROJECT.GRANTEEFIRSTNAME.MAING%TEMPLATEPROJECT.SUPERPHONENUMBER.MAINH(TEMPLATEPROJECT.MODULE1.FORMSSPELLCHECK2@ Wh$$WW(#@ 2pp p@pp@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New5& zaTahoma;Wingdings"h:IWFWF.YWZ WZ r ci#24d 3QH(?3HDHS-3217, Adoption Consent Request (Child in Home, No Competing Parties)comp martinezl<         kL@LNormal#CJ OJQJ_HmHnHsH tH uDAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List VV Address1d8(OJQJ_HkHmH sH tH Oh+'0( <H d p | LDHS-3217, Adoption Consent Request (Child in Home, No Competing Parties)comp 3217.dot martinezl46Microsoft Word 10.0@V)20@s@Ф%@sWZ ՜.+,0@ hp  !State of Michigan IDHS-3217, Adoption Consent Request (Child in Home, No Competing Parties) Title  !"#$%&'()*+,-./012345679:;<=>?@ABCDEFGHIJKLMNOQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FTData 8R1TablePzWordDocumentSummaryInformation(DocumentSummaryInformation8MacrosJH0<3 5VBA0<3 5dirk Unit  2CoZip ADate1  P  !"#$%&'()*+,-./013456789:;<=>?@BCDEFGHIJKLMNOQRSTUVWXYZ[\]^`abcdefghijklmopqrstuvwxyz{|~0* pHdTemplateProjectQH@  = | ^"9 J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\system32\e2.tlb#OLE Automation0MSForms>SFFrms3ED452EE1-E08F-101A-8-02608C4D0BB4EFM20.DLL#Microsoft : ^ Ob Library/;D~1u00}#0#k0 B11B0288-DD3E-49B5-A37E-2A97CC021D66DOCUME~1\bushd2\LOCALS\VBE\T.exd;@!.E .`M OfficOf@ic 12DF8D04C-5BFAgB-BDER5IAA42ggram Files\CommonhShared\ 105Op 8.0p@%:5»ThisDocumentG T@i"Dcuen@ 2 (HB1%XB,!5""+SuperPhoneNumberG `p@-(rP o`eNbr2(r 52!e`UTni&U i$2o ! :k !GranteeFirstPName!Ga`teiNab6!m!}!!!WorkerExtens@G>W@Irk4Ex$AJsin 26"Li"La*8"L() )a)"ClisIDkc) Ci*tIDd) Address1A@dSes1_ e_ ?E_ PChildInfoRowS UCOl0 I4f0)R0wT S n`o_ `O\ C0ArepaCodp>3AQBaC d`{b[2r1_W )H YviXsorsHSvYv=s rpY5HQ [ _W GqGGtG V _  Q(SvcReferral $SvR0f0rpa= (WX _e0r@Kl[Rwՠ'  PcHeadingG0 H jap2ip2g.2/* ? 1 'o1 a% u3- ?h VoVf3=Zae1f4* /roPE# Co7paY C1Zp"daspY+ /% `aA- ( /!  ClearCaseb51C0s`ub ) /b 9 1NewPHaraphNwа ag@&a-h@&e? `? /St`3 {,SaÄ/2 GranPteSpa)XH(1$P,5!+  countynumberG"Pouy umbrM^2/#G: WorkerPhoneGrkPhn 2FEFGranteeCityF CiyFFFCFCoExtensionEC#C@CExns@#omF C#  c#AQ#lien tStatDjCl@ e@ tD# E# c#OL# ƍNam#NfmK 2U !M!ZipGBˀZHp!G !Q !KCb{!?%{!'1aIAreaCod2 A e`2ad2|Co%-WPy>Ux2C&'U%UaseN$aweN஧&W/S eFaxGeF@3vxT2?!Q0RemoveRTow#RAmvRw$#/q_0lasTtn 2#ls`n2$# a ]0Firstt0FrAtAae$Go?[P7ddress3Q9dd":s~q foY6S19Rb9`W9cg/0(B@JkG'B4Jk 92?%M?(eL0( L$(Z5=cDistricZtsD'/rpc`05=aCMPInfoCreIf5S=YojA/1A..1?5= m%Sect]Ni ns2__k_OthePrIDGBOhrDTS #__i_N`oRese% N0[stTS _u5w_M4QJCoS _u_PrrArD4SW_y`s_,K[C*ss`,S _ҁq\`+3ښG2W`2CoaBUa92 HiddeHpPp͓   {P#A#CountyH(18F$P,y$:!0+CoCityG Ci:2:#o areOfoareOf_oo#o7iFaxACG axAlC6 2 4A4Date14D4tl14 4 44dModul5mdfl2ObSBMüI\c5 :xMEH 8 " 0Unit  B@oXPiAttribute VB_Name = "Unit" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:=Endv \c5:xMEH 8 " 0cozip  B@oXPoAttribute VB_Name = "CoZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cDozEndx \c5:xMEH 8 " 0date1  B@oXPlAttribute VB_Name = "Date1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="dEndx \c5:FaxAC _CareOf nCoCity}County xMEH 8 " 0FaxAC  B@oXPjAttribute VB_Name = "FaxAC" Public Sub MAIN() WordBasic.WW7_EditGoTo Destina@tion:=Endx \c5:xMEH 8 " 0careof  B@oXPqAttribute VB_Name = "CareOf" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coEndz \c5:xMEH 8 " 0cocity  B@oXPpAttribute VB_Name = "CoCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cocEndz \c5y:xMEH 8 " 0county  B@oXPnAttribute VB_Name = "County" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=""cEndz 5{:xMEHiddenqWorkerAddRowsqCorrect @p(Makes the selection hidden text (toggle)TemplateProject.Hidden.MAINh "10DF HJLN@PR0 ptT0 ptVXZ0bArial\^` B@BophxAttribute VB_Name = "Hidden" Public Sub MAIN(X) D.nDescription|Makes the selec,h text (toggle)Pro cDataWInvoke_FuncWTemplaTte"jV..JWordBasic.FormatFont Points:="10", Underline:=0, Color@:=9, SkeThrough SuperjFb<:=1mallCap1)ASpacinBg=0 pt>PosiKernMinTabd ArialBoldIIta End \c5:xMEH 8 " 0worker  B@oXPlAttribute VB_Name = "Worker" Public Sub MAIN() tdBasic.WW7_EditGoTo Destination:="wEndz {5q:xME @p+Adds row to table FOLLOWING cursor locationTemplateProject.AddRows.MAINh "0@ B@XP B@NnoH@Attribute VB_Name = "AddRows" Public Sub MAIN() D.pDescription~s row to table FOLLOWING cursor loca\NProcDataZInvoke_FuncZTemplateA"ject..KWordBasic.LineDown 1 TInserBt Numt:D="Ends t{s5s:xME`  @2  " V*h    ]@Q This serves as a replacement to the spell checker within a protected documentCheck spelling now? %4'2 2 B@0 B@6 B@8@l B@>Hko0Attribute VB_Name = "Correct" Public Sub MAIN() Dim ans Rem This se@rves a replacement to the spell checker within @a proted docu3 ZWordBasic.MsgBox("C?King now ?", 3If4-1en  QATools4UnoDi %St`artOf"S7d>0Pg NoReset:=1, Type:=2 End If \c5u:xMEH CoStateModule1NoReset/OtherID'&8 "(8costate  B@oPHqAttribute VB_Name = "CoState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cosEnd|       !"#$%'()*+,-./012346789:;<=>?@ABCEFGHJLNOPQRSTUVWXYZ[]^_`abcdefghijlmnopqrstuvwxy{|}~\5üxME( wdNo Then  9ZPassword:="c@ladd87E nd If'P(erf ing/Gramma8r clK.Op2tBs.vWi thFalse EachIn JsZx.Range.iof>$;;5AlwaysSuggest :=Tru; Next: 'Re the=&EW, N oRese&, o:=wdAllowOnlyAbAAe\co5w:xMEH 8 " <H hx8 This saves as a form without resetting the form fields.@l B@>oAttribute VB_Name = "NoReset" Public Sub MAIN() Rem This saves a form without rztin g the4fields. WordBasic.ToolsProtectDocument ~:=1, Ty pe:=2End \c5i:xMEH 8 "(8otherid  B@oPHsAttribute VB_Name = "OtherID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=$"oidEnd| \c5k:xSection5__SRP_0)__SRP_1D&__SRP_2ITMEH 8 "(8Section  B@oPHjAttribute VB_Name = "Section" Public Sub MAIN() WordBasic.WW7_EditGoTo Desti$nar:=End| rU K*srU~~~~~~~~k !uYBڗϦ  : )Y q!Iq9a 1Qq1Qq1Qq1Iay  !   ThisDocumentSuperPhoneNumberUnitGranteeFirstNameWorkerExtensionGranteeLastNameGranteeClientIDGranteeAddress1AddChildInfoRowWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral SvcRefHeading SuperAreaCode GranteeCareof CoSuppaddress CoPhoneNumber ClearCaseInfo NewParagraph GranteeState countynumber WorkerPhone GranteeCity CoExtension ClientState WorkerName GranteeZip CountyName CoAreaCode ClientCity CaseNumber WorkerFax RemoveRow lastname2 FirstName CoAddress ClientZipRowBreakLastNameDistrictCaseInfoAddress1SectionOtherIDNoResetCoStateCorrectAddRowsWorkerCoZipHiddenCountyCoCityCareOfFaxACDate1TemplateProjectF@C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLLVBA I q 0 F5C:\Program Files\Microsoft Office\Office10\MSWORD.OLBWord i  @0FC:\WINDOWS\system32\stdole2.tlbstdole y  P.E .`M C:\WINDOWS\system32\FM20.DLLMSForms Y Y  `>ݵI~*d 0C:\DOCUME~1\bushd2\LOCALS~1\Temp\VBE\MSForms.exd a Y  pL-[DR?C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLLOffice Q y MAIN Module1(trU~| krU $`n\c5m:x__SRP_3KgAddress1MCaseInfo!District#\MEH 8 "(8Address1  B@oPHnAttribute VB_Name = "Address1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:"= End~ \c5a:xMES5o:xME @`bEnter Personal InformationTemplateProject.CaseInfo.MAINx@ PPPPPPE PPP@ e` mPc " (08@HPX `"& (&0(X&(&&& $H Np*,* .P*,44.P   <FHXFJF8HLLHh 2 & FHHFJ Fp H L LP H " B DX B F B0 Dx H H DP " 6 : B8>6:N8NB 4 X` p ]]]]]]]]0]H]`]xOPEN FCTPSA TOOLBAR B@ FCTPSA Tools B@DEFINE DIALOG BOXF,CaseInfo B@  YourFCCNo B@8 YourFCCN B@P  YourFCWLNo B@i YourFCWN B@  YourPSCNo B@ YourPSCN B@fYourHAL B@fYourHAF B@fYourDC B@k  0Enter the following information about this case. B@d# FC Case No.: B@d; FC Case Name: B@dR FC Load No.: B@dk FC Worker Name: B@d PS Case No.: B@d PS Case Name: B@d Household Ass'd Last: B@d Household Ass'd First: B@d Date Completed: B@d,X B@ B@]F !!.6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXUserInfoFCCaseNoC:\Windows\CaseInfo.ini %  ( UserInfo FCCaseNameC:\Windows\CaseInfo.ini %  (UserInfoFCLoadNoC:\Windows\CaseInfo.ini %  (UserInfo FCWorkerNameC:\Windows\CaseInfo.ini %  (UserInfoPSCaseNoC:\Windows\CaseInfo.ini %  (UserInfo PSCaseNameC:\Windows\CaseInfo.ini %  (UserInfo HouseholdLastC:\Windows\CaseInfo.ini %  (UserInfoHouseholdFirstC:\Windows\CaseInfo.ini %  (UserInfo DCompletedC:\Windows\CaseInfo.ini %  (,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT  !%'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoFCCaseNo ! C:\Windows\CaseInfo.ini B@ UserInfo FCCaseName !C:\Windows\CaseInfo.ini B@ UserInfoFCLoadNo !C:\Windows\CaseInfo.ini B@ UserInfo FCWorkerName !C:\Windows\CaseInfo.ini B@ UserInfoPSCaseNo !C:\Windows\CaseInfo.ini B@ UserInfo PSCaseName !C:\Windows\CaseInfo.ini B@ UserInfo HouseholdLast !C:\Windows\CaseInfo.ini B@ UserInfoHouseholdFirst !C:\Windows\CaseInfo.ini B@ UserInfo DCompleted !C:\Windows\CaseInfo.ini B@ Get user info from INI fileUserInfoFCCaseNoC:\Windows\CaseInfo.ini % ' UserInfo FCCaseNameC:\Windows\CaseInfo.ini % ' UserInfoFCLoadNoC:\Windows\CaseInfo.ini % ' UserInfo FCWorkerNameC:\Windows\CaseInfo.ini % ' UserInfoPSCaseNoC:\Windows\CaseInfo.ini % ' UserInfo PSCaseNameC:\Windows\CaseInfo.ini % ' UserInfo HouseholdLastC:\Windows\CaseInfo.ini % ' UserInfoHouseholdFirstC:\Windows\CaseInfo.ini % ' UserInfo DCompletedC:\Windows\CaseInfo.ini % '  Update Form with user infoFCCASENO %"GFCCASENO  B@$j FCCASENAME %"G FCCASENAME  B@$jFCWORKERLOADNO %"GFCWORKERLOADNO  B@$j FCWORKERNAME %"G FCWORKERNAME  B@$jPSCASENO %"GPSCASENO  B@$j PSCASENAME %"G PSCASENAME  B@$jHOUSEHOLDASSESSEDLST %"GHOUSEHOLDASSESSEDLST  B@$jHOUSEHOLDASSESSEDFST %"GHOUSEHOLDASSESSEDFST  B@$j DATECOMPLETED %"G DATECOMPLETED  B@$j. Update other Form Fields on Form & Exit Macrod B@&'kxophmAttribute VB_Name = "CaseInfo" Public Sub MAI`N() D.rDescriptionEnter Personal rma:zProcDataIInvoke_FuncITemplateA"ject..yLDim iRet  UserFCCNo$ I WL WNPS HALFDCSelU 'OPEN FCTPSA TOOLBAR WordBasic.ViewToolbars ColorButtons:=1, Large0, Tipc"':=";/s", Show+'DEFINE DIALOG BOXBeginDialog 582, 30 Ʌ 1Text@Box 15 3 265, 18, "Youdka 56,  8/ wW 7@ 10ˀ& N13]\ 5A  2AY1y510QO 24 F i24 $DC@ 4 1079` 4B3;c|the following info} about this c. 19K$,1 FC | No.:w5p!YLoad #Y^k{x 1` PS} ,5,3 1 93(Household AsHs'd`st2B;FirD`eted3IOKc26% 821 EndÏdlgA Oba: SHet I= GCurValues.! GET USER INF@O FROM I FILE AND PUT I@NTO .@G[GetPrivfileSng$]("\NoaC:\Windows\!.ini" p H?u $T???C5?u?oNCp`9Q9_er"\OON OOjS##2bdaDLastooegHAF???KϒGOOHDC??>DCoKCDISPLAYAbCRESPOCPCED * HHIf(x>P?If0-1 Then 'OK BUTTONWRITE NEWXLIN6LYTQH`zHeB,G~OJo<O e4:CN;&HM_R] GW % GEo k SGO"qrA GL >FFFDCr fromr?cqfD)dC:("UserInfo", "FC CaseNXC:\Windows\P.ini"p) N$ = WordBasic.[GetPrivateProfileString$]1amev"jWLNo5lLoad(ՆWjkerNkPSC5k)ց4#'5HALsHouseholdLastdHAF<HFirfDC3DCompleted5 ' Upd Form with @Er &iIfExistBook mark(AASENO") ThDen SetR`esult ,2 yo$_ G AME CC A WORKERLOAD N'f N?!@j#/]4# ?$_ "H HOUSEHOLDASSE@DLST^B_#AnF"F?!DATECOMPLET?@ABCDEFGIJLTMNOPRcSUfVWXYZ[\]^_`abduegphijklmnoqzrstvwxy|}~H 8 "(8 coaddress  B@oPHsAttribute VB_Name = "CoAddress" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination@:="coaEnd \c5[:xMEH FirstNamelastname2$&RemoveRowWorkerFax/8 "(8 firstname  B@oPHtAttribute VB_Name = "First`" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="fnEnd \c5]:xMEH 8 "(8 LastName2  B@rsoPHtAttribute VB_Name = "lastnX2" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="LEnd \ck5_:xMEH 8 "   (8Xh B@0_ B@L B@@l B@>o Attribute VB_Name = "RemoveRow" Public Sub MAIN() WordBasic.ToolsUnprotectDocument BableS\el<2Dt oYP W NoReset:=1, Type:=2 End \c5Q:xMEH 8 "(8 WorkerFax  B@@oPHmAttribute VB_Name = "WorkerFax" Public Sub MA@IN() dBasic.WW7_EditGoTo Destination:= End \c5S:CaseNumberClientCity(*CoAreaCodeCountyName)-xMEH 8 "(8 casenumber  B@oPHuAttribute VB_Name = "CaseNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cnEnd \c5U:      !"$%&'()*+,-./013456789:;<=>?@BCDEFGHIJKLMNOQRSTUVWXYZ[\]^`abcdefghijklmopqrstuvwxyz{|~xMEH 8 "(8 clientcity  B@oPHuAttribute VB_Name = "ClientCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="ccEnd \c5W:xMEH 8 "(8 coareacode  B@oPHxAttribute VB_Name = "CoAreaCode" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coa"cEnd \c5I:xMEH 8 "(8 countyname  B@oPHuAttribute VB_Name = "Countyh" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=4"cnEnd \c5K:xMEGranteeZip#WorkerName,.2ClientStateACoExtension+7PH 8 "(8 GranteeZip  B@oPHpAttribute VB_Name = "GranteeZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End \c5M:xMEH 8 "(8 workername  B@oPHtAttribute VB_Name = "Workerh" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wnEnd \c5O:xMEH 8 "(8 clientstate  B@7oPHvAttribute VB_Name = "ClientState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="csEnd \c5A:xMEH 8 "(8 coextension  B@oPHtAttribute VB_Name = "CoExtension" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinatr@:="coeEnd \c5C:GranteeCity_WorkerPhone02ncountynumber}GranteeState15xMEH 8 "(8 GranteeCity  B@oPHqAttribute VB_Name = "GranteeCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End \c5E:xMEH 8 "(8 workerphone  B@oPHuAttribute VB_Name = "WorkerPhone" Public Sub MAIN() dBasic.WW7_EditGoTo DestinationP:="wpEnd \c5G:xMEH 8 "(8 Countynumber  B@oPHtAttribute VB_Name = "countynumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="C End \c55xMEH 8 "(8 GranteeState  B@oPHrAttribute VB_Name = "GranteeState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:= End \c55xMENewParagraph^ThisDocument46_VBA_PROJECT,/7ClearCaseInfo3;VH 8 " (@`px B@ B@0 $ B@:@l B@> B@^oŰAttribute VB_Name = "NewParagraph" Public Sub MAIN() WordBasic.ScreenUpdating 0 >ToolsUnprotectDo@cument Insert Chr(13[?P = NoReset:=1, Type:=2 QCharRight 1 End 55#xME (SLSS<N0{00020906-0000-0000-C000-000000000046}8(%HxAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomizD2\c55xas  *\G{000204EF-0000-0000-C000-000000000046}#4.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.2#0#C:\Program Files\Microsoft Office\Office10\MSWORD.OLB#Microsoft Word 10.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\system32\stdole2.tlb#OLE Automation*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{011B0288-DD3E-49B5-A37E-2A97CC021D64}#2.0#0#C:\DOCUME~1\bushd2\LOCALS~1\Temp\VBE\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M &*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.2#0#C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLL#Microsoft Office 8.0 Object Library:  ^"9%$")('&-,+*10/.54329876! 5:ThisDocument0;47c43393ThisDocument5% SuperPhoneNumber0<47c43393 SuperPhoneNumber5%Unit0=47c43393"Unit :0 GranteeFirstName0>47c43393$ GranteeFirstName5H%WorkerExtension0?47c43393&WorkerExtension5`%GranteeLastName0@47c43393(GranteeLastName5x%GranteeClientID0A47c43393*GranteeClientID5%GranteeAddress10B47c43393,GranteeAddress15%AddChildInfoRow1t4b2b81cf.AddChildInfoRow5#WorkerAreaCode0D47c43393BWorkerAreaCode5SupervisorName0E47c43393DSupervisorName5SuperExtention0F47c43393FSuperExtention5AddSvcReferral0G47c43393HAddSvcReferral5 SvcRefHeading0H47c43393JSvcRefHeading58 SuperAreaCode0I47c43393dSuperAreaCode5PGranteeCareof0J47c43393fGranteeCareof5hCoSuppaddress0K47c43393hCoSuppaddress5CoPhoneNumber0L47c43393jCoPhoneNumber5ClearCaseInfo0M47c43393lClearCaseInfo5 NewParagraph0N47c43393NewParagraph5GranteeState0O47c43393GranteeState5countynumber0P47c43393countynumberG:WorkerPhone0Q47c43393WorkerPhoneE:GranteeCity0R47c43393GranteeCityC:(CoExtension0S47c43393CoExtensionA:@ClientState0T47c43393ClientStateO:XWorkerName0U47c43393WorkerNameM:pGranteeZip0V47c43393GranteeZipK:CountyName0W47c43393CountyNameI:CoAreaCode0X47c43393CoAreaCodeW:ClientCity0Y47c43393ClientCityU:CaseNumber0Z47c43393CaseNumberS:WorkerFax0[47c43393WorkerFaxQ:RemoveRow0]47c43393RemoveRow_:qlastname20^47c43393lastname2]:0FirstName0_47c43393FirstName[:HCoAddress0`47c43393CoAddressY:`ClientZip0a47c43393ClientZipg:xRowBreak0b47c43393RowBreake:MLastName0c47c43393LastNamec:District0d47c43393Districta: CaseInfo0e47c43393CaseInfoo:Y Address10f47c43393(Address1m: Section0g47c43393*Sectionk: OtherID0h47c43393,OtherIDi:  NoReset0i47c43393@NoResetw:8uCoState0j47c43393.CoStateu:PCorrect0k47c433930Corrects:hyAddRows0l47c43393:AddRowsq: Worker0m47c43393< Worker: CoZip0n47c43393> CoZip: Hidden0o47c43393@ Hidden{: County0p47c43393b Countyy: CoCity0q47c43393d CoCity: CareOf0r47c43393f CareOf: FaxAC0s47c43393h FaxAC:( Date10t47c43393j Date1:@Module11v4b2b81e4nModule1ü`bpxh(@ P``X@08`HPMHPT2O,E3E6^*LqkuGE2@==Aw4v6~KS{,1~WJB]ǹj@;Xz3o@-F0XZ*H)㴐Xo+c@J@u 0$Lڽ=H!]?~WtISe B7<宧E~AӁ!Lz Kd%$6Z'C>jwI;Q["-ۛN rs/) ʷH.kOw uٗ5IV4UDL^I@((kb!@G+c @ͬw{[HDɯ) gpdDGnG9<44C /}lwvJ*_mؗHHpTeKyyA`:}ffIw9GA?lDw8($W/F}ϊvcG-۲zLUHnlHm~leQKl Wl[xB/&"1zmIwy%lF$@JwJ\-hb *It}i.KR8хo 96BC?]fx&: RsGf0}) \~K3)4;s"ݽBwWB`v.&D-o޷} Ep H03ɼZ .tN FptE&8Zo?҆ MVY D@-a#bƷNA᪞B D Ld]oFBFZz~@B9GqEOy9FeO(BrTy{eCjg|"ť];Mai>&nTeo=Ku-P;#$NsxxEkʨFl[^<@(CWordkVBAWin16~Win32MacVBA6#TemplateProjectEstdole`MSFormsCOfficeu ThisDocument< _EvaluateSuperPhoneNumber\MAIN, WordBasic WW7_EditGoTod DestinationлUnitGranteeFirstNameEWorkerExtensionGranteeLastName.GranteeClientIDGranteeAddress1AddChildInfoRow^ToolsUnprotectDocument(NextCellWW7_EditAutoTextCContextXnInsertAsInsertrCharLeftToolsProtectDocument-0NoResetgWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral} SvcRefHeadingi&TableSelectRowTableInsertRowQNumRows CenterParaLineUpK InsertPara,LineDownxTableInsertCells ShiftCells( CharRightPTableMergeCellst BorderRight_ SuperAreaCodeq GranteeCareof CoSuppaddress^  CoPhoneNumberx ClearCaseInfohFileFind SearchName֡ SearchPath.SubDir+Title~AuthorKeywordsTSubjectRPOptions MatchCase PatternMatch DateSavedFromu= DateSavedTojdSavedByDateCreatedFrom DateCreatedToViewISortByoListBy+ SelectedFile\Kill NewParagraphqScreenUpdating! ChrK~ GranteeStateM countynumberyx WorkerPhone GranteeCity@ CoExtensionK ClientState WorkerNameJ GranteeZip  CountyName CoAreaCode ClientCitym CaseNumberA WorkerFaxv RemoveRow0^TableDeleteRowA lastname2sL FirstName CoAddress ClientZipRowBreakFTableRowHeight"X RulerStyleaLineSpacingRulep LineSpacing LeftIndenti AlignmentI AllowRowSplit{LastNameDistrict}-CaseInfoiRet,p UserFCCNoBUserFCCN7 UserFCWLNoyUserFCWN UserPSCNoOUserPSCNqUserHALօUserHAFЅUserDC SelectNameW; ViewToolbars| ColorButtons} LargeButtonsSWToolTips5+Toolbar2Show BeginDialogFTextBoxQOKButton| EndDialogmP dlgUserInfo2" CurValuesȤ UserDialog YourFCCNo+GetPrivateProfileString$xYourFCCN. YourFCWLNoYourFCWN0 YourPSCNo9YourPSCNP<YourHALYYourHAFYYourDCDialogfSetPrivateProfileString=ExistingBookmark SetFormResult FileClose_Address1OSectionGOtherIDCoState1Correct'ansxtMsgBoxRStartOfDocument ToolsSpellingAddRowsWorker8CoZip0Hidden] FormatFont&Points UnderlineColor2F StrikeThrough" Superscript SubscriptV SmallCaps~cAllCapss_SpacingSPositionKerningB KerningMin1FontUBoldItalic!CountyG8CoCityr7CareOfƻFaxACjDate11DocumentjModule1bFormsSpellCheck2gzxo FormFieldActiveDocument\ProtectionTypewdNoProtection Unprotect?PasswordCheckGrammarWithSpelling FormFields-|Range  NoProofing] CheckSpellingW AlwaysSuggestProtectfwdAllowOnlyFormFields!   # %')+-/)*++-,/.1/;0=1?2A-C E !G "I #K $A3%c42e&g1i3k4m5e56g67i78k89o9l:LOPQRSTUVWXY Z!["\#^$_%`&a'b(j)k;MEH 8 "&  p c:\windows\r caseinfo.initvxz|~d B@n)1Bc:\windows\caseinfo.ini B@oH@EAttribute VB_Name = "ClearCaseInfo" Public Sub MAIN() WordBasic.File@Find Slch:=" ",! Path c:\wJows\4Jceie.ini0ubDir:=0, Title6Autho" Keywysject Option=`MatchKex#ternDateSavedFrom# LToByC?@ABCDEFHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklnopqrstuvwxyz{}~\c55xMEH 8 " (8 superareacode  B@oPH}Attribute VB_Name = "SuperAreaCode" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="sacEnd \c 55SvcRefHeading AddSvcReferral<>Gs SuperExtentionmSupervisorName=C|xMEH ?8@ "  (@2P  2  2 P ` p2   2  0 @2P   2   2  X h2x   4  ( 84H     0 HXh4x 4( B@0 B@LP B@N B@< asvcrefh168: B@4x B@R B@2svcrefh268: B@4 B@T B@R B@2svcrefh368: B@4 B@R B@V B@2svcrefh468: B@4 B@R B@V B@2svcrefh568: B@4 B@R B@V B@2svcrefh668: B@4 B@R B@V B@2svcrefh768: B@4 B@R B@V B@2svcrefh868: B@4 B@R B@2svcrefh968: B@4 B@R B@V B@2 svcrefh1068: B@4 B@R B@V B@2 svcrefh1168: B@4 B@R B@VAdd Instruction Row B@X\ B@Z B@< B@^ B@` B@2  B@^ B@` B@b B@< SvcRefH1268: B@4 B@2 svcrefH1368: B@4@l B@>oAttribute VB_Name = "SvcRefHeading" Public Sub MAIN() WordBasic.ToolsUnprotectDocu@ment Ba@bleSeloAttribute VB_Name = "AddSvcReferral" Public Sub MAIN(X) ".~Descriptions a row and fields for A. Ser`vice ePProcData\Invoke_Func\Template"ject. . WordBasic.ToolsU nprot2Document NextCell WW7_EditAutoT" :="F1", Cont :=1, InsertAs:=0 <22a23?YmK4?5?f6?_27?8 u_X.?9 1^0 ~t CharLeft p45 i @NoRese, Type:=2 E \c55xMEH 8 " (8superextension  B@oPH|Attribute VB_Name = "SuperExtention" Public Sub MAIN() WordBasic.WW7_EditGoTo DestinBar:="sesEnd \c55xMEH 8 " (8supervisorname  B@oPH{Attribute VB_Name = "Supervisor" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="snCEnd \c55xMEWorkerAreaCodeAddChildInfoRow @BGranteeAddress1 GranteeClientID AEH 8 " (8workerareacode  B@oPH|Attribute VB_Name = "WorkerAreaCode" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wacEnd ~55xME(6 << < `8.x%PH^"9$*\Rffff*1t4b2b81cf "  4( `4p 4 4 84H 4 4 @P B@00/P B@2 ChildInfo168: B@4S B@2L$ks ChildInfo268: B@4| B@2^X ChildInfo368: B@4G B@2I ChildInfo468: B@4 B@2 ChildInfo568: B@4 B@2 ChildInfo668: B@4 B@2 ChildInfo768: B@4 B@<@l B@>oAttribute VB_Name = "AddChildInfoRow" Public Sub MAIN () WordBasic.ToolsUnprotectDocument BNextCell &WW7_EditAutoT" :="1"@, Cont:=0, InsertAs :=1U>f2c33c34c3567CharLeft( 30RP N@oReset, Type:=2 EndA \c55xMEH 8 ""0@GranteeAddress1  B@oH@uAttribute VB_Name = "GranteeAddress1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End \c55xMEH 8 ""0@GranteeClientID  B@HSFOR~oH@uAttribute VB_Name = "GranteeClientID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End \c55GranteeLastName WorkerExtension DFGranteeFirstName"GSuperPhoneNumber"xMEH 8 ""0@granteelastname  B@oH@~Attribute VB_Name = "GranteeLast" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="glnEnd \c55xMEH 8 ""0@workerextension  B@oH@xAttribute VB_Name = "WorkerExtension" Public Sub MAIN() dBasic.WW7_EditGoTo DestinaBtr:="weEnd \c55x      !"#$%&'()*+,-./0123456789:;<=>?@BCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_aMEH 8 ""0@granteefirstname  B@J1oH@Attribute VB_Name = "GranteeFirstL" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="g5fnEnd \c55xMEH 8 ""0@superphonenumber  B@oH@Attribute VB_Name = "SuperPhoneNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="spnEnd ID="{235CFC89-6A2E-460C-9267-5608AFCF3C44}" Document=ThisDocument/&H00000000 Module=SuperPhoneNumber Module=GranteeFirstName Module=WorkerExtension Module=GranteeLastName Module=GranteeClientID Module=GranteeAddress1 Module=AddChildInfoRow Module=WorkerAreaCode Module=SupervisorName Module=SuperExtention MoPROJECTI~ PROJECTwmACompObj`jdule=AddSvcReferral Module=SvcRefHeading Module=SuperAreaCode Module=GranteeCareof Module=CoSuppaddress Module=CoPhoneNumber Module=ClearCaseInfo Module=NewParagraph Module=GranteeState Module=countynumber Module=WorkerPhone Module=GranteeCity Module=CoExtension Module=ClientState Module=WorkerName Module=GranteeZip Module=CountyName Module=CoAreaCode Module=ClientCity Module=CaseNumber Module=WorkerFax Module=RemoveRow Module=lastname2 Module=FirstName Module=CoAddress Module=ClientZip Module=RowBreak Module=LastName Module=District Module=CaseInfo Module=Address1 Module=Section Module=OtherID Module=NoReset Module=CoState Module=Correct Module=AddRows Module=Worker Module=Hidden Module=County Module=CoCity Module=CareOf Module=FaxAC Module=Date1 Module=CoZip Module=Unit Module=Module1 Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="D4D633BB3FC543C543C543C543" DPB="DAD83DB942BA42BA42" GC="E0E207C808C80837" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C SuperPhoneNumber=0, 0, 0, 0, C GranteeFirstName=0, 0, 0, 0, C WorkerExtension=0, 0, 0, 0, C GranteeLastName=0, 0, 0, 0, C GranteeClientID=0, 0, 0, 0, C GranteeAddress1=0, 0, 0, 0, C AddChildInfoRow=0, 0, 0, 0, C WorkerAreaCode=0, 0, 0, 0, C SupervisorName=0, 0, 0, 0, C SuperExtention=0, 0, 0, 0, C AddSvcReferral=0, 0, 0, 0, C SvcRefHeading=0, 0, 0, 0, C SuperAreaCode=0, 0, 0, 0, C GranteeCareof=0, 0, 0, 0, C CoSuppaddress=0, 0, 0, 0, C CoPhoneNumber=0, 0, 0, 0, C ClearCaseInfo=0, 0, 0, 0, C NewParagraph=0, 0, 0, 0, C GranteeState=0, 0, 0, 0, C countynumber=0, 0, 0, 0, C WorkerPhone=0, 0, 0, 0, C GranteeCity=0, 0, 0, 0, C CoExtension=0, 0, 0, 0, C ClientState=0, 0, 0, 0, C WorkerName=0, 0, 0, 0, C GranteeZip=0, 0, 0, 0, C CountyName=0, 0, 0, 0, C CoAreaCode=0, 0, 0, 0, C ClientCity=0, 0, 0, 0, C CaseNumber=0, 0, 0, 0, C WorkerFax=0, 0, 0, 0, C RemoveRow=0, 0, 0, 0, C lastname2=0, 0, 0, 0, C FirstName=0, 0, 0, 0, C CoAddress=0, 0, 0, 0, C ClientZip=0, 0, 0, 0, C RowBreak=0, 0, 0, 0, C LastName=0, 0, 0, 0, C District=0, 0, 0, 0, C CaseInfo=0, 0, 0, 0, C Address1=0, 0, 0, 0, C Section=0, 0, 0, 0, C OtherID=0, 0, 0, 0, C NoReset=0, 0, 0, 0, C CoState=0, 0, 0, 0, C Correct=0, 0, 0, 0, C AddRows=0, 0, 0, 0, C Worker=0, 0, 0, 0, C Hidden=0, 0, 0, 0, C County=0, 0, 0, 0, C CoCity=0, 0, 0, 0, C CareOf=0, 0, 0, 0, C FaxAC=0, 0, 0, 0, C Date1=0, 0, 0, 0, C CoZip=0, 0, 0, 0, C Unit=0, 0, 0, 0, C Module1=0, 0, 0, 0, C ThisDocumentThisDocumentSuperPhoneNumberSuperPhoneNumberGranteeFirstNameGranteeFirstNameWorkerExtensionWorkerExtensionGranteeLastNameGranteeLastNameGranteeClientIDGranteeClientIDGranteeAddress1GranteeAddress1AddChildInfoRowAddChildInfoRowWorkerAreaCodeWorkerAreaCodeSupervisorNameSupervisorNameSuperExtentionSuperExtentionAddSvcReferralAddSvcReferralSvcRefHeadingSvcRefHeadingSuperAreaCodeSuperAreaCodeGranteeCareofGranteeCareofCoSuppaddressCoSuppaddressCoPhoneNumberCoPhoneNumberClearCaseInfoClearCaseInfoNewParagraphNewParagraphGranteeStateGranteeStatecountynumbercountynumberWorkerPhoneWorkerPhoneGranteeCityGranteeCityCoExtensionCoExtensionClientStateClientStateWorkerNameWorkerNameGranteeZipGranteeZipCountyNameCountyNameCoAreaCodeCoAreaCodeClientCityClientCityCaseNumberCaseNumberWorkerFaxWorkerFaxRemoveRowRemoveRowlastname2lastname2FirstNameFirstNameCoAddressCoAddressClientZipClientZipRowBreakRowBreakLastNameLastNameDistrictDistrictCaseInfoCaseInfoAddress1Address1SectionSectionOtherIDOtherIDNoResetNoResetCoStateCoStateCorrectCorrectAddRowsAddRowsWorkerWorkerHiddenHiddenCountyCountyCoCityCoCityCareOfCareOfFaxACFaxACDate1Date1CoZipCoZipUnitUnitModule1Module1 @ vbjbj fP"fP"ʦdʦhER,÷|?'))))))$(RzM-Mz''59 zM 0zzʦʦzMMʦʦ$ʦʦ FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT 2jxxx&x(x*x>x@xBxLxNxPxRxfxhxjxtxvxxxzxxxxxxxxxxxxxxxxxxxxyyyyy(y󯪝xj14hBsUj=3hBsUjhBs5UmHnHujw2hBs5U hBs5jhBs5Uj1hBsUj0hBsUjhBsUmHnHujU/hBsUj.hBsUhBsjhBsU-(y*y8y:yz@zBzDzXzZzhzjzjy:hBsUj9hBsUj 9hBsUju8hBsUj7hBsUj6hBsUjk6hBsUjhBsUmHnHuj5hBsUhBsjhBsUj4hBsU1^yyyyy zBzjzzzzz"{J{r{{{{:bԆRQPONjLKJIHGFbDChA@?>=<jzlzzzzzzzzzzzzzzzzzzzzzzzzzz{{{{{ {"{${8{:{<{F{H{J{L{`{b{d{n{p{r{Ѿѳɥњɥяɥфɥyɥj?hBsUjE>hBsUj=hBsUj=hBsUjhBsUmHnHuje<hBsUj;hBsUjhBsUhBsjhBs5UmHnHuj:hBs5U hBs5jhBs5U/r{t{{{{{{{{{{{{{{{{{{{{{{|(*,68:<PR`bdxz|·jqGhBsUj{FhBsUjEhBsUjDhBsUj1DhBsUUjiChBsUj)BhBsUjhBsUmHnHuj@hBsUhBsjhBsU6       FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       †Ć҆Ԇֆ"$&:<>BDFH\^`fhjlЇ҇jcMhBsUjLhBsUjKhBsUj,KhBsUjhJhBsUjhBsUmHnHujIhBsUj3IhBsUjHhBsUjhBsUj)HhBsUhBs3$Fj&Jrˆ`_^]\[edXWVUcS$&(<>@FHJL`bprtˆĈ؈ڈ܈jQhBsUjPhBsUj.PhBsUjOhBsUj-OhBsUjhBsUmHnHujNhBsUjNhBsUjhBsUhBs(/ =!"#$% mail address (street address, PO Box, etc., where the mail will be delivered).2DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)D ClientCity UppercaseEnter the Addressee's City.D ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation.D ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond`CJOJQJ_HmH sH tH VOV CoState1?d8(OJQJ_HkHmH sH tH bOb CoSuppaddress1@d8(OJQJ_HkHmH sH tH \O\ CountyName1Ad8(OJQJ_HkHmH sH tH ^"^ CountyNumberBd8(OJQJ_HkHmH sH tH VO2V CoZip1Cdt CJOJQJ_HkHmH sH tH NOBN Date11 Dd`CJOJQJ_HmH sH tH XRX District1Ed8(OJQJ_HkHmH sH tH LObL FaxAC Fd`CJOJQJ_HmH sH tH VOrV FirstName1 Gd`CJOJQJ_HmH sH tH XOX FirstName21 Hd`CJOJQJ_HmH sH tH `O` GranteeAddress1 Id`CJOJQJ_HmH sH tH \O\ GranteeCareof Jd`CJOJQJ_HmH sH tH XOX GranteeCity Kd`CJOJQJ_HmH sH tH `O` GranteeClientID Ld`CJOJQJ_HmH sH tH hh GranteeFirstName1Md8(OJQJ_HkHmH sH tH fOf GranteeLastName1Nd8(OJQJ_HkHmH sH tH ZOZ GranteeState Od`CJOJQJ_HmH sH tH ZOZ GranteeZip Pd` CJOJQJ_HkHmH sH tH XOX LastName1Qd8(OJQJ_HkHmH sH tH ZO"Z LastName21Rd8(OJQJ_HkHmH sH tH VO2V OtherID1Sd8(OJQJ_HkHmH sH tH VBV Section1Td8(OJQJ_HkHmH sH tH ^OR^ SuperAreaCode1 Ud`CJOJQJ_HmH sH tH dObd SuperExtension1Vd8(OJQJ_HkHmH sH tH dOrd SuperPhoneNumber1 Wd`CJOJQJ_HmH sH tH dOd SupervisorName1Xd8(OJQJ_HkHmH sH tH PP Unit1Yd8(OJQJ_HkHmH sH tH TT Worker1Zd8(OJQJ_HkHmH sH tH `O` WorkerAreaCode1 [d`CJOJQJ_HmH sH tH fOf WorkerExtension1\d8(OJQJ_HkHmH sH tH XOX WorkerFax ]d` CJOJQJ_HkHmH sH tH \O\ WorkerName1^d8(OJQJ_HkHmH sH tH ZOZ WorkerPhone1 _d`CJOJQJ_HmH sH tH ^O^ WorkerTitle1 `d` CJOJQJ_HkHmH sH tH ^^ countynumber ad` CJOJQJ_HkHmH sH tH TO"T District2 bd`CJOJQJ_HmH sH tH RO2R Section2 cd`CJOJQJ_HmH sH tH LOBL Unit2 dd`CJOJQJ_HmH sH tH TORT Worker2 ed` CJOJQJ_HkHmH sH tH ^b^ Countynumber fd` CJOJQJ_HkHmH sH tH `r` Countynumber1 gd` CJOJQJ_HkHmH sH tH \O\ Countynumber2 hd`CJOJQJ_HmH sH tH POP ***** id` CJOJQJ_HkHmH sH tH dOd GranteeFirstName2 jd`CJOJQJ_HmH sH tH @0 /*****Address1CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountynumberCoZip Date1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZip LastName LastName2 OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle***** CaseNumber1 ClientZip1 CoAddress1CoCity1 CoExtension1CoState1CoSuppaddress1 CountyName1CoZip1GranteeLastName1 GranteeZip LastName1 LastName21OtherID1SuperExtension1SupervisorName1Worker2WorkerExtension1 WorkerFax WorkerName1 WorkerTitle1 Captions 8pt(<Pdu!5FZn 1BVj~%9Mau 2j(yjzr{ &1>?ABEG@ b : U xH7]]h2 ,i^y !"#$%'()*+,-./0236@F  &(4:<HNP\bdpsu!-35ADFRXZflnz} )/1=@BNTVbhjv|~#%179EKMY_amsuFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF/GranteeFirstNameAddress1CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountynumberCoZipdate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle)=Qev"6G[o 2CWk&:Nbv  !"#$%&'()*+,-.';Oct 4EYm~0AUi}$8L`tBs@ Wh$$WW(#(pxpzpUnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New5& zaTahoma;Wingdings"h0@?Bs  FMicrosoft Word Document MSWordDocWord.Document.89q