ࡱ>  { bjbjBrBr *"  %SK<<""""""""8QM\"\"(((()I,|-87#[[[[[[$^ca\".))..\""((\222.F"("(82.822:37,7 (0 똾._7 8\0\i7Ra.a7a"7..2.....\\0 ...\....a.........< \!: ADOPTION PAYMENT VOUCHERFOR DHS ACCOUNTING USE ONLYDepartment of Human ServicesVoucher NumberInstructions:* See Reverse Side for Non-Discrimination Statement and P.A. 431 Information1. a.Payee / Vendor Names2. Department Code3. Audited4. Due Date FORMTEXT      4 3 164630 FORMTEXT       FORMTEXT      b.Contract Number: FORMTEXT      c.Contact Name5. Federal Employment ID No6. Address/Mail Code7. Date Prepared FORMTEXT       FORMTEXT       FORMTEXT     FORMTEXT      d.Contact Phone NumberI certify the goods/services shown below were provided and the amount of this voucher is proper. FORMTEXT      e.Delivery Address (If Applicable) FORMTEXT      f.Cityg. Stateh. Zip Code8. Vendor SignatureDate FORMTEXT       FORMTEXT    FORMTEXT       FORMTEXT      9.Vendor Invoice No.10. Child s Name, DOB, Case Number FORMTEXT       FORMTEXT      11. N.I.G.P. Commodity Code12. CS-13813. Complete Description of Item or Service14. Item Amount95201431S0200053a. Funding Source: FORMTEXT      b. Amount of Per Diem PaymentsFrom:  FORMTEXT       to:  FORMTEXT       FORMTEXT      day(s) x $20 per day$  FORMTEXT      c. Amount for Placement and/or Finalization & Permanency$  FORMTEXT      d. Amount of Per Diem Payment Previously Claimed ( FORMTEXT     days x $20 per day)$  FORMTEXT      15. Voucher Total(Subtract amount on line d from amount on line c)$  FORMTEXT      I certify that these expenditures were pre-approved and necessary to accomplish the DHS mission according to the executive directive criteria. The most cost effective option available and that the items claimed represent proper charges. FORMCHECKBOX  1. Legal Mandate FORMCHECKBOX  2. Health & Safety FORMCHECKBOX  3. Budgetary Savings FORMCHECKBOX  4. OPR Supplies/Services/Travel16. Authorized / Approval Signature of DHS EmployeeDate17. Authorized / Approval Signature of DHS EmployeeDate FORMTEXT       FORMTEXT      18. Print NameDate19. Print NameDate FORMTEXT       FORMTEXT       FORMTEXT      20. Agency Code21. Approp. Year22. Index Code23. Program Cost Account (PCA)24. Agency Object Code (AOBJ)25. Agency Code AC226. Distribution (Dollar Amount)43120 FORMTEXT   FORMTEXT  64630 FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT   FORMTEXT  $ FORMTEXT      27. FORMCHECKBOX LATE ADOPTION PENALTY LEVEL 3 (total $5,000.00) Box 24  6185 FORMCHECKBOX BASELINE (total $9,000.00) Box 24 - 6180(OPC is more than 365 days from PCW, commitment or 3600 date)(OPC is 211 to 240 days from PCW, commitment, or 3600 date) FORMCHECKBOX Placement - $3,000.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX Placement - $5,400.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX Finalization and Permanency -$2,000.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Finalization and Permanency - $3,600.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Placement Finalization & Permanency-$5,000.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX Placement Finalization & Permanency -$9,000.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX MARE (total $20,400.00) Box 24 - 6186 FORMCHECKBOX EARLY ADOPTION INCENTIVE LEVEL 1 (total $10,000.00) Box 24 - 6181 FORMCHECKBOX Placement - $12,240.00 (need photo listing) Box 23-Federal 74772, State 74766(OPC is 151 to 210 days from PCW, commitment, or 3600 date) FORMCHECKBOX Finalization and Permanency -$8,160.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Placement - $6,000.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX Placement Finalization & Permanency-$20,400.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX Finalization and Permanency $4,000.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Placement Finalization & Permanency-$10,000.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX RESIDENTIAL (total $13,300.00) Box 24 6187 FORMCHECKBOX Placement - $7,980.00 (need photo listing) Box 23-Federal 74772, State 74766 FORMCHECKBOX EARLY ADOPTION INCENTIVE LEVEL 2 (total $11,500.00) Box 24 - 6182 FORMCHECKBOX Finalization and Permanency -$5,320.00 Box 23-Federal 74773, State 74767(OPC is less than 150 days from PCW, commitment or 3600 date) FORMCHECKBOX Placement Finalization & Permanency-$13,300.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX Placement - $6,900.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX Finalization and Permanency -$4,600.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX In-State Transfer (total $1,800.00) Box 24 6188 FORMCHECKBOX Placement Finalization & Permanency-$11,500.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX PCA 320 from placing agency Box 23-Federal 74775, State 74769 FORMCHECKBOX LATE ADOPTION PENALTY LEVEL 1 (total $8,000.00) Box 24 - 6183 FORMCHECKBOX Inter-State Transfer Existing Services (total $1,800.00) Box 24 6189(OPC is 241 to 300 days from PCW, commitment, or 3600 date) FORMCHECKBOX PCA 320 from placing agency Box 23-Federal 74775, State 74769 FORMCHECKBOX Placement - $4,800.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX Finalization and Permanency -$3,200.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Inter-State Transfer New Services (total $3,500.00) Box 24 6190 FORMCHECKBOX Placement Finalization & Permanency-$8,000.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX PCA 320 from placing agency Box 23-Federal 74775, State 74769 FORMCHECKBOX LATE ADOPTION PENALTY LEVEL 2 (total $7,000.00) Box 24 - 6184 FORMCHECKBOX Per Diem Matched ($20/day, max 150 days, total $3,000.00) Box 24 6192(OPC is 301 to 365 days from PCW, commitment, or 3600 date) FORMCHECKBOX DHS-4809 Indent to Adopt Statement Box 23-Federal 74776, State 74770 FORMCHECKBOX Placement - $4,200.00 Box 23-Federal 74772, State 74766 FORMCHECKBOX DHS-3600 FORMCHECKBOX Finalization and Permanency -$2,800.00 Box 23-Federal 74773, State 74767 FORMCHECKBOX Placement Finalization & Permanency-$7,000.00 Box 23-Federal 74774, State 74768 FORMCHECKBOX Per Diem Unmatched ($20/day, max 150 days, total $3,000.00) Box 24 6193 FORMCHECKBOX DHS-.3600 Box 23-Federal 74776, State 74770Documents RequiredPLACEMENTFINALIZATION FORMCHECKBOX PCA 322 Commitment Order FORMCHECKBOX PCA 321 Order of Adoption FORMCHECKBOX PCW Order, JC63 Must include date stamp of receipt FORMCHECKBOX Adoption Subsidy Support Agreement FORMCHECKBOX DHS-3600 Signed referral form, if applicable FORMCHECKBOX Copy of placement check/automatic deposit notice FORMCHECKBOX PCA 318 Order terminating rights after release/consent FORMCHECKBOX PCA 320 Order Placing ChildPERMANENCY FORMCHECKBOX Adoption Subsidy Support AgreementInclude Permanency amount with Finalization VoucherINSTRUCTIONS  RScqs       " $ & ( * , . 0 2 4 H J L V X Z \ p r t ~ hw,hw,5CJaJjhg^FUmHnHujhUjhUjh5U htL5jhg^F5UmHnHujh5Ujh5U hCJ hCJ h5hh#l 156Sbc;Okdm$$If0i,~   +,4 a~ytw,%$If3$IfOkd$$If0i,~+,4 a~ytw,$($Ifa$gdAv $Ifcqrsb\\\\\ $If:kd]$$Ifi,+,+,4 a~ytX]$IfOkd$$If0i,~   +,4 a~ytw,$If%$If  /)$Ifkd$$Ifֈi#r',cE"  (+,4 a~p(ytw, $If    $ ( , 0 2 Z <$Ifgdw,$If $$Ifa$gdw,FfL<$If$If $$Ifa$$If D p   " $ . 0 ޼޵ޫtijhw,UjWhw,Ujhw,Ujhw,5UmHnHujshw,5U hw,5jhw,5U h#l hw,h#l hw,@jhw,UmHnHujQ hw,Uhw,jhw,Uhw,hw,5CJaJhw,5CJaJ) D n $Ifgd#l $Ifgd$* $$Ifa$gd$*Ff? $If 2 xofo]]] <$Ifgd$* $Ifgd$* $Ifgd$*kd$$Ifriv&,cw+,4 a~ytw,2 4 : d f cZQK? !$$Ifa$gd#l  $If $Ifgd$* $$Ifa$kd7$$Ifֈiv&,cHkw+,4 a~ytw,0 f & ( , . B D F P R T V X 6@BFH\^`jlnp޵ޯމ|jshw,5Ujhw,5Uh#l hw,@ h#l hw,h#l hw,@ hw,@jhw,5Ujhw,5UmHnHujhw,5U hw,5jhw,5U hw,CJh#l hw,CJhw,. ( * , T V X xrrrr$Ifxkd$$If4\i,cH`k+,4 a~f4ytw,$($Ifa$gd#l X Z ` }tn $If $Ifgd$* $$Ifa$xkdY$$If4\i,cH k +,4 a~f4ytw, $If$Ifckd2$$If4Fi,c +,    4 a~f4ytw, 8B}wwwnn $Ifgd$*!$If !$$Ifa$xkdX$$If4\i,cHk +,4 a~f4ytw,BDFne____TK <$Ifgd$* ($Ifgd-g$Ifkd,$$Ifֈi< 5 r',cpJ"+,4 a~ytw,VZ\prt~rt~øǪ՝ÒǪÅuunn h-ghw,htLhw,5CJOJQJ^Jhw,5CJOJQJ^Jjhw,Uj_hw,5Ujhw,UmHnHuj[hw,Uhw,jhw,U hw,CJ hw,5jhw,5UmHnHujhw,5Ujhw,5U(VcZTT!$If !$Ifgd-gkd$$Ifֈi< 5 r',cpJ"+,4 a~ytw,VXZ<$If$If$If`kd$$IfFi5 ,ci _+,    4 a~ytw,Rr !$$Ifa$gd-gbkdM$$IfFi5 ,c i _ +,    4 a~ytw,rt}}tkt` <$Ifgd-g <$Ifgdw, $$Ifgd-g $$$Ifa$gdtLukd$$If\i5 v&,I   A   +,4 a~ytw,,.:<PRT^`jl˾˓ˍ˾y˓p_Rh5>*OJQJ^J!jh5>*OJQJU^Jh-ghw,^J'jhw,5>*OJQJU^J hw,^J,jhw,5>*OJQJU^JmHnHu'jzhw,5>*OJQJU^Jhw,5>*OJQJ^J!jhw,5>*OJQJU^J hw,5 h-ghw,hw,jhw,Ujhw,U.cZZZQH <$Ifgd-g $$IfgdtL $$Ifgd-gkdQ$$Ifֈi5 8&v&,I {> +,4 a~ytw,vmmmmd <$Ifgd-g $$Ifgd-gkdZ $$Ifri5 v&,I    +,4 a~ytw, &(<>@Hڿ}p\'j$h5>*OJQJU^Jh5>*OJQJ^JjR#hw,U hw,5jhw,UmHnHuj!hw,Ujhw,Uhw,CJOJQJ h-ghw,hw,,jh5>*OJQJU^JmHnHu!jh5>*OJQJU^J'ja!h5>*OJQJU^J$vmmmd <$Ifgd-g $$Ifgd-gkdK"$$Ifri5 #v&,I S +,4 a~ytw,rwn <$Ifgd-g $$Ifgd $$Ifgd-gukd#$$If\i5 v&,I A +,4 a~ytw,HJprtvx2468:NPR\^` !/012CDRѸѳѸѳꌆypcpjhghw,CJUhghw,CJj(hw,CJU hw,CJjhw,CJUj'hw,U#hP3Ghw,5CJOJQJ^JaJ hw,5jhw,UmHnHuj %hw,Ujhw,Uhw,CJOJQJ h-ghw,hw,!jh5>*OJQJU^J%w <$Ifgd-g $$Ifgd-gukd%$$If\i5 v&,I A +,4 a~ytw,4`tk <$Ifgd-g $$$Ifa$gdP3G $$Ifgd-gukdN&$$If\i5 v&,I A +,4 a~ytw,`b ChC555 d$$IfgdAv<kdn($$Ifi,+,  +,4 a~ytX] $Ifgd5eukd'$$If\i5 v&,I   A   +,4 a~ytw,RSTUhiwxyz467AB  &(*468:ٵծաՖ~q~b~թաjhw,5UmHnHuj,hw,5Ujhw,5Ujhw,UmHnHuj9,hw,Ujhw,U hw,5 hw,5@j?*hg^Fhw,CJUj)hg^Fhw,CJUhw,hghw,CJjhghw,CJUjW)hg^Fhw,CJU&h/4h_YYY!$If !$Ifgd1kd*$$If ri0 S , Q b p A  +,4 a~ytw, d$$IfgdAv4568}o}}<d$$Ifgdgd$$Ifgdgskdt+$$If\iv&,s    +,4 a~ytw,8:Xb!$Ifukd-$$If\iv&,s    +,4 a~ytw,}}o}d$$Ifgdg<d$$Ifgdgskd-$$If\iv&,s+,4 a~ytw,LV^`tvxz|~ڿڹڮڣږڋڀj2hw,Ujy2hw,Uh/[hw,OJQJ^Jj2hw,Uj1hw,U hw,CJ hw,5jy/hw,Uj/hw,Uhw,jhw,UmHnHujhw,Uj.hw,U2(Jh L}}}}}}}}}}}} !$$Ifa$gd/[ukd/$$If\iv&,s    +,4 a~ytw, LNVZ^~PDDD88 <$$Ifa$gdtL !$$Ifa$gdtLkd0$$If+֞ii]{!,qs +,4 a~ytw,2Rr2R|~ <$Ifgd/[ !$Ifgd/[ !$$Ifa$gd/[Ff9 <$$Ifa$gdtL  (*,.024HJLNPRThjlnprtj5hw,Uj5hw,Uj=5hw,Uj4hw,Ujk4hw,Uj 4hw,Uj3hw,Ujhw,UmHnHujK3hw,Ujhw,Uhw,8  (*,.024HJLNPRTVjlnxz~ojChw,CJUaJhw,CJaJjhw,CJUaJhJ hw,CJaJh/[hw,OJQJ^J hw,CJj}7hw,Uhw,CJOJQJj7hw,Uj6hw,Ujhw,UmHnHuj]6hw,Ujhw,Uhw,* $Ifgd/[Ff? <$Ifgd/[bd6bkdnD$$If@Fi{1,c+,    4 a~ytw, $Ifgd $IfgdJ OkdC$$If0i{,+,4 a~ytw,F`bdf-.09lm{|}~ұҥҐ҄ugUҥ#jGhJ hw,CJUaJhDhw,5@CJaJjHFhw,CJUaJjhw,CJUaJhw,CJaJhJ hw,@CJaJhJ hw,5CJaJ#jEhJ hw,CJUaJjhJ hw,CJUaJhJ hw,CJaJhn]hw,5@CJaJhw,5@CJaJhw,@CJaJ!./0l~sh] $Ifgd$* $IfgdtLukdE$$If@\i{1,]c+,4 a~ytw, $Ifgd $IfgdJ b~~sh $Ifgd $Ifgd$* $IfgdJ ukdF$$If@\i{1,]c+,4 a~ytw,@abcdrst $ % & ' 5 6 ǹxxi[LjJhw,CJUaJh,hw,5@CJaJjIhw,CJUaJhw,5CJaJhJ hw,5CJaJ#j*IhJ hw,CJUaJjhJ hw,CJUaJhJ hw,CJaJhDhw,5@CJaJhw,5@CJaJhw,@CJaJhw,CJaJjhw,CJUaJjGhw,CJUaJbcu% ~sh] $Ifgd $Ifgd$* $Ifgd $IfgdJ ukdiH$$If@\i{1,]c+,4 a~ytw,% & 8 ~~~~ $IfgdJ ukdJ$$If@\i{1,]c+,4 a~ytw,6 7 8 i ! !!!"!0!1!2!3!a!!!ŶŭŒň}o`}RhDhw,5@CJaJjMhw,CJUaJh,hw,5@CJaJhw,5@CJaJhw,@CJaJjCMhw,CJUaJhhw,5CJaJhw,5CJaJj Lhw,CJUaJhw,CJaJhJ hw,5@CJaJhJ hw,@CJaJhJ hw,CJaJjhw,CJUaJ ~~~~ $IfgdJ ukdKK$$If@\i{1,]c+,4 a~ytw, !!3!!~s~h $Ifgd $IfgdD $IfgdJ ukdL$$If@\i{1,]c+,4 a~ytw,!!!!!"~~~s $Ifgd $IfgdJ ukd/N$$If@\i{1,]c+,4 a~ytw,!!!!!!!!!!!""" "."/"0"1"I"j"k"l"z"{"|"}"""""""""" #,#-#0#1#㰢㰅v㰅g㰅jQhw,CJUaJjPhw,CJUaJh,hw,5@CJaJj'Phw,CJUaJhDhw,5@CJaJhw,5@CJaJjNhw,CJUaJjhw,CJUaJhJ hw,@CJaJhw,@CJaJhw,CJaJhJ hw,CJaJ(""1"k"}""~~~s $Ifgd $IfgdJ ukdfO$$If@\i{1,]c+,4 a~ytw,"""-#.#/#~~~~ $IfgdJ ukdQ$$If@\i{1,]c+,4 a~ytw,/#0#B####~s~~ $Ifgdn] $IfgdJ ukdJR$$If@\i{1,]c+,4 a~ytw,1#?#@#A#B#s###################$9$:$;$<$J$K$L$M$Ⱥݠ~oݠaRjUhw,CJUaJhDhw,5@CJaJjThw,CJUaJhJ hw,@CJaJhhw,5CJaJhw,5CJaJhJ hw,CJaJjShw,CJUaJh,hw,5@CJaJhw,5@CJaJhw,@CJaJjhw,CJUaJj Shw,CJUaJhw,CJaJ #####:$~~sh $Ifgd $Ifgd$* $IfgdJ ukdS$$If@\i{1,]c+,4 a~ytw,:$;$M$$$$~s~h $Ifgd $IfgdD $Ifgd$*ukd.U$$If@\i{1,]c+,4 a~ytw,M$$$$$$$$$$$$$$-%.%/%=%>%?%@%q%%%%%%%%%%%%%%%%%%&?&ɺѯݯɓѯ녯vݯgj Zhw,CJUaJjXhw,CJUaJh,hw,5@CJaJjWhw,CJUaJhJ hw,@CJaJhJ hw,CJaJjeVhw,CJUaJhw,CJaJjhw,CJUaJhDhw,5@CJaJhw,5@CJaJhw,@CJaJ($$$.%@%%~~~s $IfgdtL $Ifgd$*ukdV$$If@\i{1,]c+,4 a~ytw,%%%%%%~~~~ $Ifgd$*ukdX$$If@\i{1,]c+,4 a~ytw,%%%@&R&&~~~~ $Ifgd$*ukdIY$$If@\i{1,]c+,4 a~ytw,?&@&A&O&P&Q&R&x&&&&&&&&&&&&&&&&&'='>'?'@'A'E'F'T'ݺݟݕ|mݺ`hJ hw,@CJaJj-\hw,CJUaJh,hw,5@CJaJhw,5@CJaJhw,@CJaJj[hw,CJUaJh$*hw,5CJaJhw,5CJaJhJ hw,CJaJjZhw,CJUaJhw,CJaJjhw,CJUaJhDhw,5@CJaJ &&&&&>'~s~~ $Ifgdn] $Ifgd$*ukdZ$$If@\i{1,]c+,4 a~ytw,>'?'@'A'B'C'D'~~~~~ $Ifgd$*ukd\$$If@\i{1,]c+,4 a~ytw,D'E'W''''vkkkk $Ifgd$*kdd]$$Ifpri{1,]+,4 a~ytw,T'U'V'W''''''''''''''/(0(1(?(@(A(B(`(((((((((((ǹܪܖ}nܖ_jahw,CJUaJj_hw,CJUaJhJ hw,@CJaJh$*hw,5CJaJhw,5CJaJhJ hw,CJaJj^hw,CJUaJhn]hw,5@CJaJhw,5@CJaJhw,@CJaJhw,CJaJjhw,CJUaJj3^hw,CJUaJ"'''0(B((~s~~ $Ifgdn] $Ifgd$*ukd_$$If@\i{1,]c+,4 a~ytw,(((((((~s~~~ $Ifgdn] $Ifgd$*ukdV`$$If@\i{1,]c+,4 a~ytw,(((((((()/)0)1)?)@)A)B)x)))))))))))))))))*<*=*>*ҹҟҖ{ҹm^Җjdhw,CJUaJh,hw,5@CJaJj dhw,CJUaJh$*hw,5CJaJhw,5CJaJjbhw,CJUaJhw,5@CJaJhw,@CJaJj\bhw,CJUaJhw,CJaJjhw,CJUaJhJ hw,CJaJhDhw,5@CJaJ$(((0)B))vk`kk $Ifgdn] $Ifgd$*kda$$If@ri{1,]+,4 a~ytw,)))))=*~s~~ $Ifgdn] $Ifgd$*ukdHc$$If@\i{1,]c+,4 a~ytw,=*>*?*@*A*B*C*~~~~~ $Ifgd$*ukdd$$If@\i{1,]c+,4 a~ytw,>*?*@*D*E*S*T*U*V**************1+2+3+A+B+C+D+k+++++++++~o~`jiihw,CJUaJj2hhw,CJUaJh$*hw,5CJaJhw,5CJaJjfhw,CJUaJhn]hw,5@CJaJhw,5@CJaJhw,@CJaJjfhw,CJUaJjhw,CJUaJhJ hw,CJaJhJ hw,@CJaJhw,CJaJ%C*D*V****vk`kk $Ifgdn] $Ifgd$*kde$$If@ri{1,]+,4 a~ytw,***2+D++~s~h $Ifgd $Ifgdn] $Ifgd$*ukdqg$$If@\i{1,]c+,4 a~ytw,++++++~s~h $Ifgd $Ifgd $Ifgd$*ukdh$$If@\i{1,]c+,4 a~ytw,++++++++++++,,,,1,R,S,W,X,f,g,h,i,,,,,,,,, -----ɺѯɯɠݯɑtѯk_h$*hw,5CJaJhw,5CJaJjlhw,CJUaJh,hw,5@CJaJj[lhw,CJUaJjkhw,CJUaJhJ hw,CJaJjihw,CJUaJhw,CJaJjhw,CJUaJhDhw,5@CJaJhw,5@CJaJhw,@CJaJ%++,S,T,U,V,~s~~~ $Ifgd $Ifgd$*ukdUj$$If@\i{1,]c+,4 a~ytw,V,W,i,,,-vk`kk $Ifgd $Ifgd$*kdk$$If@ri{1,]+,4 a~ytw,----0-^-~s~h $Ifgd $Ifgdn] $Ifgd$*ukdGm$$If@\i{1,]c+,4 a~ytw,-----.-/-<-]-_-r-s-}--------------------ʿyn^NjqhX]hw,CJUjphX]hw,CJUhX]hw,@CJj5phX]hw,CJUhX]hw,CJjhX]hw,CJUhX]hw,5CJhX]hw,5@CJhX]hw,6CJhJ hw,CJaJhw,5CJaJjnhw,CJUaJhw,CJaJjhw,CJUaJhw,@CJaJ^-_-r-s-}--{>{{<kdio$$Ifi,+,+,4 a~ytX] d$IfgdX]ukd~n$$If@\i{1,]c+,4 a~ytw,------ d$IfgdX]Okdo$$If0i{,+,4 a~ytw,---,.>.a.{{{{ d$IfgdX]ukd!q$$If\i{,"+,4 a~ytw,-,.-.;.<.=.a.b.c.q.r.s.t.............2/4/5/6/D/E/F/G/e/p/q/r//////ߴߤߔ߄zjjvhX]hw,CJUhX]hw,5CJjuhX]hw,CJUjthX]hw,CJUjshX]hw,CJUjshX]hw,CJUhJ hw,CJaJj rhX]hw,CJUhX]hw,CJjhX]hw,CJUhX]hw,@CJ)a.b.t....{{{{ d$IfgdX]ukdr$$If\i{,"+,4 a~ytw,...2/3/4/{{{{ d$IfgdX]ukd t$$If\i{,"+,4 a~ytw,4/5/G/e/p/{{{ d$IfgdX]ukd u$$If\i{,"+,4 a~ytw,p/q//// d$IfgdX]bkd v$$IfFi{,+,    4 a~ytw,/////////FRkqxyz 12MNefj26rvɾɾɾ hw,CJ hX]hw,hX]hw,@CJhX]hw,5@CJUhX]hw,5CJhX]hw,@CJhJ hw,CJaJhX]hw,CJF///// d$IfgdX]bkdv$$IfFi{,+,    4 a~ytw,////yz{><kdw$$Ifl i,+,+,4 la~yt| 9$$Ifa$9$d`$Ifa$gd5e 9$$Ifa$bkduw$$IfFi{,+,    4 a~ytw,IMPROPER OR INCOMPLETE PAYMENT VOUCHERS WILL BE RETURNED AND REQUIRED RESUBMISSION. It is especially important to assure that the account coding structures are accurate and that the payment voucher has proper authorized signature(s). NOTE: Remove all paper clips and staple the original vendor invoice, billing, etc., to the back of the DHS-1582 Payment Voucher. DO NOT attach payment envelopes, payment stubs, or additional copies of the DHS-1582 to the payment voucher. Payment Vouchers submitted without the original documentation require two PAL (Payment Authorization Listing) signatures. Print clearly or type payment voucher.1a. Enter FULL legal name of business or FULL LEGAL name of individual. 1b. Enter Adoption Contract number. 1c. Enter contact name. 1d. Enter contact phone number. 1e. Enter address where payment will be sent. DO NOT address payments to DHS address in accordance with DMB policy. 1f. Enter city name in full. 1g. Enter the two-character abbreviation only. 1h. Enter either 5 or 9 digit zip code. 2. Pre-filled. 3. Central office use only. 4. Central office use only. 5. Enter payee FEIN#. 6. Enter mail code if known or check ADPICS. 7. Enter date prepared. 8. Vendor MUST sign and date here. 9. Enter vendor invoice number. This box MUST be filled out. If no invoice number is applicable, use date of service, receipt number, account number, etc. 10. Enter childs name, date of birth, and case number. 11. N.I.G.P. Commodity Code, pre-filled. 12. CS-138 code, pre-filled. 13. Item description. a. Enter funding source. b. Enter per diem dates and number of days if applicable. c. Pre-filled. d. Enter date of per diem previously claimed (__ days x $20 per day). 14. Enter payment amounts. a. N/A b. Enter per diem amount. c. Enter adoption type payment amount. d. Enter amount of previously paid per diem. 15. Voucher total. (Subtract line d from line c, if applicable.) 16. 19. Central Office Use only. 20. Agency code will always be 431. 21. Enter appropriate year. 22. Index code, pre-filled. 23. Enter program cost account (PCA). 24. Enter agency object code. 25. Enter AC2 code if applicable. 26. Enter dollar amount. 27. Check appropriate boxes.      DHS-1582-A (Rev. 11-12) Previous edition obsolete. MSWord  PAGE 1 z1McfM\9$c$If^c`a$gdl89$ $If^ `a$2s6Xq:kd@x$$Ifli,+,+,4 la~yt|9$ $If^ `a$gd5e9$ $If^ `a$9$c$If^c`a$gdl85:W\pu   & ( ʺºʥ}uqfuqjxh Uh jh Uhw,%h0J@CJOJQJaJmHnHu h\hw,0J@CJOJQJaJ)jh\hw,0J@CJOJQJUaJhjlCJaJhw,CJaJh\hw,CJaJhdMjhdMUhX]hCJ hX]hw, hw,CJhX]hw,CJ(( P x     6 ^     gdVdA2&P:pVdA/ =!"#$% k$$If~!vh#v~#v:V +,,5~544 a~ytw,s$$If~!vh#v~#v:V +,5~5/  44 a~ytw,y$$If~!vh#v~#v:V +,,5~5/  44 a~ytw,S$$If~!vh#v+,:V +,5+,44 a~ytX]\$$If~!vh#vc#v#vE#v#v#v":V   (+,5c55E555"/ / /  / /  / / 44 a~p(ytw,tD&VNameZDjD $$If~!v h#vc#vH#vk#v#v h#v L#v #v ":V 4 !d+,++ 5c5H5k55 h5 L5 5 "/ / / / / / 44 a~f4pdytw,kdH$$If4  iOW#r',cH`khhhhh`L" !d+,00004 a~f4pdytw,jD$$If~!vh#vc#v#v #vk#v h#v L#v #v ":V 4 !x+,++ 5c55 5k5 h5 L5 5 "/ / / / / /  / / / / / / 44 a~f4pxytw,{kd $$If4 8i_OW#r',c  khhhhhhh L" !x+,88884 a~f4pxytw,$$If~!vh#vc#v#vw#v#v:V +,5c55w55/ /  / 44 a~ytw,zD&VAddressjDjDvD Text47$$If~!vh#vc#vH#vk#vw#v#v:V +,5c5H5k5w55/ / / / / 44 a~ytw,$$If~!vh#vc#vH#vk#v:V 4+,++,5c5H5k5/ / / 44 a~f4ytw,zD&VSupName$$If~!vh#vc#vH#vk#v:V 4+,++5c5H5k5/ / / /  / 44 a~f4ytw,$$If~!vh#vc#v#v:V 4+,+5c55/ / / 44 a~f4ytw,D& VSupAddress$$If~!vh#vc#vH#vk#v:V 4+,+5c5H5k5/ / / /  / 44 a~f4ytw,$$If~!vh#vc#vp#v#vJ#v#v":V +,5c5p55J55"/ / / / 44 a~ytw,tDVCityvDVStaterD VZipvD Text15$$If~!vh#vc#vp#v#vJ#v#v":V +,5c5p55J55"/ / / / / / /  44 a~ytw,$$If~!vh#vc#vi #v_:V +,5c5i 5_/ /  44 a~ytw,xDCountryvDBText48$$If~!vh#vc#vi #v_:V +,5c5i 5_/ /  /  44 a~ytw,$$If~!vh#vI#v#vA#v:V +,,5I55A5/  /  / / /  /  / 44 a~ytw,zD&VAddress'$$If~!vh#vI#v#v{#v#v>#v:V +,,,5I55{55>5/  /  / / / / / / /  44 a~ytw,vD Text50jD $$If~!vh#vI#v#v #v #v:V +,,5I55 5 5/  /  / / / / / /  44 a~ytw,vDText51tD Item3$$If~!vh#vI#v#v#vS#v:V +,,5I555S5/  /  / / / / / /  44 a~ytw,tD Item4$$If~!vh#vI#v#vA#v:V +,,5I55A5/  /  / / /  44 a~ytw,vDText49tD Item5$$If~!vh#vI#v#vA#v:V +,,5I55A5/  / / / /  44 a~ytw,$$If~!vh#vI#v#vA#v:V +,,5I55A5/  / / / /  44 a~ytw,tD Item7$$If~!vh#vI#v#vA#v:V +,,5I55A5/  /  / / /  /  44 a~ytw,s$$If~!vh#v+,:V +,5+,/  / 44 a~ytX]tDeCheck1tDeCheck2tDeCheck3tDeCheck4$$If~!vh#v#vQ#vb#vp#vA :V  +,,55Q5b5p5A / /  /  44 a~ytw,$$If~!vh#vs#v#v#v:V +,5s555/ / / /  / 44 a~ytw,vD Text35jD $$If~!vh#vs#v#v#v:V +,5s555/ / / /  / 44 a~ytw,$$If~!vh#vs#v#v#v:V +,5s555/ / / / 44 a~ytw,vD Text46jD jD $$If~!vh#vs#v#v#v:V +,5s555/ / / /  / 44 a~ytw,$$If~!vh#vq#v#v#v#vs#v#v :V ++,,5q5555s55 /  / / / 44 a~ytw,pDYr1rDYr1ArDPCA1`DText38`DText38`DText38`DText38rDOBJ1`DText38`DText38`DText38`DText38`DText38`DText38`DText38tDDist1$$If~!vh#vq#vc#v d#v h#v d#v#vE#vd#vf#vp#vd#vl#vi#v :V +,,5q5c5 d5 h5 d55E5d5f5p5d5l5i5 /  / / / / / / / / / / / / 44 a~ytw,kd7$$Ifi=i 1 ]%{$^. !,q cddddddddddhdEddfpdli +,````4 a~ytw,$$If~!vh#vq#vc#v d#v h#v d#v#vE#vd#vf#vp#vd#vl#vi#v :V @+,,5q5c5 d5 h5 d55E5d5f5p5d5l5i5 /  / / / / / /  / / / / / / / / / /  44 a~ytw,kd=$$If@i=i 1 ]%{$^. !,q cddddddddddhdEddfpdli +,````4 a~ytw,s$$If~!vh#v#v:V +,55/  44 a~ytw,vDeCheck15$$If~!vh#v#v#vc:V @+,,555c/  / / 44 a~ytw,tDeCheck5$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck12$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,tDeCheck8vDeCheck13$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,tDeCheck9vDeCheck14$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck10$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck11vDeCheck16$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck17$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck12vDeCheck18$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck13$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck14vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck16$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck11vDeCheck17$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck18$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck12$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck13vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck14vDeCheck19$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,$$If~!vh#v#v]#v#v#v:V p+,,55]555/ / / / 44 a~ytw,vDeCheck11vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck12$$If~!vh#v#v]#v#v#v:V @+,,55]555/ / / / 44 a~ytw,vDeCheck13vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck14vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,$$If~!vh#v#v]#v#v#v:V @+,,55]555/ / / / 44 a~ytw,vDeCheck11vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck12vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck13$$If~!vh#v#v]#v#v#v:V @+,,55]555/ / / / 44 a~ytw,vDeCheck14vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / 44 a~ytw,vDeCheck15$$If~!vh#v#v]#v#vc:V @+,,55]55c/ / / / / / /  44 a~ytw,]$$If~!vh#v+,:V +,,5+,44 a~ytX]k$$If~!vh#v#v:V +,,5544 a~ytw,vDeCheck12vDeCheck12$$If~!vh#v#v#v"#v:V +,,555"544 a~ytw,vDeCheck13vDeCheck13$$If~!vh#v#v#v"#v:V +,,555"544 a~ytw,vDeCheck14vDeCheck14$$If~!vh#v#v#v"#v:V +,,555"544 a~ytw,vDeCheck12$$If~!vh#v#v#v"#v:V +,,555"544 a~ytw,vDeCheck13y$$If~!vh#v#v#v:V +,,55544 a~ytw,vDeCheck14y$$If~!vh#v#v#v:V +,,55544 a~ytw,y$$If~!vh#v#v#v:V +,,55544 a~ytw,N$$If!vh#v+,:V l +,5+,4a~yt|J$$If!vh#v+,:V l+,5+,4a~yt|DAddress1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., where the mail will be delivered). ClientCityDCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: S^C 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 Normal_HmH sH tH DA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List TOT Captions 6ptd(CJ OJQJkHROR Captions 8pt d`5CJOJQJkHJOJ User inputd(( OJQJkHNO"N Form Title $Pa$5CJOJQJkHPO2P BLANKLINEdx5CJOJQJkHPOBP Captions 10ptd`( OJQJkH>OR> Captions 6ptdCJ BQbB Captions 6pt xbox(FOQrF Items$d$<a$CJOJQJkH@OQ@ Reverse Txt$a$B*CJDOD Captions 6pt bold5`O` Captions 6pt boxd<5CJ OJQJkHDD Captions 6pt Nbox<DOD Captions 7pt dtCJDOD Captions 7pt Bold5`O` Captions 7pt boxdt<5CJOJQJkH^O^ Captions 7pt NBoxdt<CJOJQJkHPOP Captions 8pt d`CJOJQJkH^O^ Captions 8pt Bold !d`5CJOJQJkHF"F Captions 8pt box "<D2D Captions 8pt Nbox#PPOBP Captions 9pt $dLCJOJQJkHJORJ Captions 9pt Bold%dLCJFOQbF Captions 9pt Box &dDOarD Captions 9pt Nbox'5LAL Captions 10pt 2 line (<^O^ Captions 10pt Bold)d`(5OJQJkHXOX Captions 10pt box*d`P OJQJkHHOH Captions 10pt Nbox+P5HOH Date 08pt ,d8(CJOJQJkH6O6 Date 09pt-CJ6O6 Date 10pt.CJ2O2 Date 11pt/CJJ @J Footer0dt !CJOJQJkHROR Form Title 10pt1$d8a$ OJQJkH^O"^ Form Title 10pt Bld2$d8a$5OJQJkHVO2V Form Title 11pt3$d$a$CJOJQJkHLO!BL Form Title 11pt Bld4d$CJVORV Form Title 12pt5$da$CJOJQJkHbObb Form Title 12pt Bld6$da$5CJOJQJkH4r4 Header 7 !TOT Letter Text 10pt8$d$a$ OJQJkHFOF Letter Text 11pt9dCJXOX Letter Text 12pt:$da$CJOJQJkHHO1H Small Blank Line ;CJXOX User Input 10pt<d8(5OJQJkHTOT User Input 11pt=d$5CJOJQJkH\O\ User input 12pt>d((5CJOJQJkH0U`0 Hyperlink>*B*.)@. Page NumberH@H B$0 Balloon TextACJOJQJ^JaJNo!N A$0Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] ,&  RRRU 0<BDPVmy (.:FLNZ]_kqtv!ams3?E7GZjMY_bnt       ! # / 1 3 ? A C O Q S _ a c o q s    # _ o  + %5{+y+;3C=MFV-=EU4DP`%x ?O AQ,&FFFFFTFFTFFTFTFTFTFTFFFFFFFFTFTFFFTG G$G$G$FFFTFFFTFTFFFFFFFFFFFFFFTG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FMOU!8@0(  B S  ?/Text1Text2VNameText47VSupNameText7 VSupAddressText11VCityVStateVZipText15CountryText48VAddressText50Text51Item3Item4Text49Item5Item7Check1Check2Check3Check4Text33Text35Text46Yr1Yr1APCA1OBJ1Dist1Check15Check5Check8Check9Check10Check11Check16Check17Check12Check18Check13Check14Check19   9;O`uvb47[MN   &|z,G-&   !"#$%&'()*+,-.0D/M^_r"tFHk`b   $ 6,<W-&%%%%%%%%%*&-&mm /  :MN^_rQQu7HM`bu , . / F G f g &!'!%%%%%%%%&&(&-&mm /  :MN^_rQQuv7HM`bu , . / F G f g &!'!%%%%%%%%%%%%%%&&(&-&Ba!k1~q^`o(. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.^`o(. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.B!k1~                   32|<#l J $w,dM04l8VdADg^FP3GtL8^MW/[\g-gjl1QX]oz2My??wg, T$**T5eXKn] [-Av%%7V s44V r44V q44V p44V o44Vn44Vm44Vl44Vk44Vj44Vi44Vh44Vg44Vf44Ve44Vd44Vc44Vb44Va44V`44V_44V^44V]44V \44V![44V"Z44V#Y44V$X44V%W44V&V44V'U44V(T44V)S44V*R44V+Q44V,P44V-O44V.N44V/M44V0L44V1K44V2J44V3I44V4H44V5G44V6F44V7E44V8D44V9C44V:B44V;A44V<@44V=?44V>>44V?=44t%TemplateProject.SuperPhoneNumber.MAIN%TemplateProject.InsertCisAddress.MAIN%TemplateProject.GranteeFirstName.MAIN$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.lastname2.MAINTemplateProject.FirstName.MAINTemplateProject.CoAddress.MAINTemplateProject.ClientZip.MAINTemplateProject.RowBreak.MAINTemplateProject.LastName.MAINTemplateProject.District.MAINTemplateProject.CaseInfo.MAINTemplateProject.Address1.MAINTemplateProject.Section.MAINTemplateProject.OtherID.MAINTemplateProject.CoState.MAINTemplateProject.Correct.MAINTemplateProject.AddRows.MAINTemplateProject.Worker.MAINTemplateProject.MyInfo.MAINTemplateProject.County.MAINTemplateProject.CoCity.MAINTemplateProject.CareOf.MAINTemplateProject.FaxAC.MAINTemplateProject.Date1.MAINTemplateProject.CoZip.MAINTemplateProject.Unit.MAIN7 TEMPLATEPROJECT.UNIT.MAIN TEMPLATEPROJECT.COZIP.MAIN TEMPLATEPROJECT.DATE1.MAIN TEMPLATEPROJECT.FAXAC.MAIN TEMPLATEPROJECT.CAREOF.MAINTEMPLATEPROJECT.COCITY.MAINTEMPLATEPROJECT.COUNTY.MAINTEMPLATEPROJECT.MYINFO.MAINTEMPLATEPROJECT.WORKER.MAINTEMPLATEPROJECT.ADDROWS.MAINTEMPLATEPROJECT.CORRECT.MAINTEMPLATEPROJECT.COSTATE.MAINTEMPLATEPROJECT.OTHERID.MAINTEMPLATEPROJECT.SECTION.MAINTEMPLATEPROJECT.ADDRESS1.MAINTEMPLATEPROJECT.CASEINFO.MAINTEMPLATEPROJECT.DISTRICT.MAINTEMPLATEPROJECT.LASTNAME.MAINTEMPLATEPROJECT.ROWBREAK.MAINTEMPLATEPROJECT.CLIENTZIP.MAINTEMPLATEPROJECT.COADDRESS.MAINTEMPLATEPROJECT.FIRSTNAME.MAINTEMPLATEPROJECT.LASTNAME2.MAIN TEMPLATEPROJECT.WORKERFAX.MAIN!TEMPLATEPROJECT.CASENUMBER.MAIN"TEMPLATEPROJECT.CLIENTCITY.MAIN#TEMPLATEPROJECT.COAREACODE.MAIN$TEMPLATEPROJECT.COUNTYNAME.MAIN%TEMPLATEPROJECT.GRANTEEZIP.MAIN&TEMPLATEPROJECT.WORKERNAME.MAIN' TEMPLATEPROJECT.CLIENTSTATE.MAIN( TEMPLATEPROJECT.COEXTENSION.MAIN) TEMPLATEPROJECT.GRANTEECITY.MAIN* TEMPLATEPROJECT.WORKERPHONE.MAIN+!TEMPLATEPROJECT.COUNTYNUMBER.MAIN,!TEMPLATEPROJECT.GRANTEESTATE.MAIN-!TEMPLATEPROJECT.NEWPARAGRAPH.MAIN."TEMPLATEPROJECT.CLEARCASEINFO.MAIN/"TEMPLATEPROJECT.COPHONENUMBER.MAIN0"TEMPLATEPROJECT.COSUPPADDRESS.MAIN1"TEMPLATEPROJECT.GRANTEECAREOF.MAIN2"TEMPLATEPROJECT.SUPERAREACODE.MAIN3"TEMPLATEPROJECT.SVCREFHEADING.MAIN4#TEMPLATEPROJECT.ADDSVCREFERRAL.MAIN5#TEMPLATEPROJECT.SUPEREXTENTION.MAIN6#TEMPLATEPROJECT.SUPERVISORNAME.MAIN7#TEMPLATEPROJECT.WORKERAREACODE.MAIN8$TEMPLATEPROJECT.ADDCHILDINFOROW.MAIN9$TEMPLATEPROJECT.GRANTEEADDRESS1.MAIN:$TEMPLATEPROJECT.GRANTEECLIENTID.MAIN;$TEMPLATEPROJECT.GRANTEELASTNAME.MAIN<$TEMPLATEPROJECT.WORKEREXTENSION.MAIN=%TEMPLATEPROJECT.GRANTEEFIRSTNAME.MAIN>%TEMPLATEPROJECT.INSERTCISADDRESS.MAIN?%TEMPLATEPROJECT.SUPERPHONENUMBER.MAIN@ZZ Z Z G,&@ ,@<@@UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewI" Arial (W1)Arial5. *aTahomaA$BCambria Math"hJ  3 D3 Dr cq24%%3QHX? T*!xx "DHS-1582, Adoption Payment Vouchercompbushd2  ^=Oh+'0  < H T `lt|$DHS-1582, Adoption Payment Vouchercomp 1582-A.dotbushd29Microsoft Office Word@b@J*@lJ@ܘ3 ՜.+,0 hp  State of MichiganD% #DHS-1582, Adoption Payment Voucher Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      F:A!"#$%&'()*+,-./0123456789;<=>?@BJCDEGiHI\bLMNOPQRSTUVWXYZ[]^_`acldefghj~kmtnopqrsu}vwxyz{|Root Entry F똾@Data 1Table0WordDocument *"SummaryInformation(DocumentSummaryInformation8MsoDataStoreH0 똾0 똾1FN0C0K53T==20 똾0 똾Item  PropertiesUMacrosF0 똾0 똾VBA0 똾0 똾  !"#$%&'()*+,-./0123456789:<=>?@ABCDEFGHIKLMNOPQRSTUVWXZ[\]^_`abcdefgijklmnopqrstuvxyz{|}~ 0* pHdTemplateProjectQH@  = | A7 J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\system32\STDOLE@2.TLB# Automation0MSForms>SFFrms3ED452EE1-E08F-@101A-8-02608C4D0BB4EFM20.DLL#Microsoft E: ^ Ob Library/;D1u00}#0F#0dir  Unit  ;CoZip JDate1  Yj 2D37FD65-E790-11D2@.D6502AE150CH.TEMP\VBE\E.EXD -.E .`M A|OffDic|Of@ic| *F8D04C-5BFAAYB-BDE5*AA{42*gram Files\Co0mmonYShared\OFFICE145O b& 8.0Lb@%"8KBThisDocumentG TiDcuen* 2  HB1B%B,!K"EB+BSuperPhoneNumberG, A"pZrP@(o$eN*br2r K!iInsertCisAddresscIsPtC)A`d e +scmcS}o5*pGranteeFirstNamecGateiaNab?cmc}**lAWorkerExPtensGGDW@Rrk+ElxRASs,Ab 2?"Ui"La*D"L() )a)"hCli|IDkc) Ci*}IDT mjh1h1[ _ e_ I(l_ PChildInfoRowS CSl>!U3A0>e)C dm`B[2r1_aMo@e3^` ^visorsH S]vS~o0 7HQ [ _rPaKQh b GQGGtG V _ d Q(SvcReferral $SvR0f0r0a= (WX _e0r!lYՀ'f  PcHeadingG0 H ja $i`gg.2/* ?px 1 'o1 % u- ?z $aC`of3=Zae ;^f4* /roGPE | Co7pa1C1p"das+ /% ~ `j A- ( /!  p ClearCasebWrAWrTae~ub ) aCo`% 9r NewParRaphN"wPqag@&a-~h@&? `t? /St@3 {,SaSȀ/nteeState2GrantTeS8a,lH1$(, vK!D+  countynumberGcouy umbkr/+/#H WorkerPhon0eGIrkCPhn 2FJFGraCityF Ciy_FFFLFCoExtensionC#C@CExтns@#omF/ C# c#NQ#liXentE#l@ e@ tD# E# c#@L# ƍNamՀNmK l2U !B!ZXipGBˀZHp!G !Q a{DCb{!?%{!'/1FAr`eaCod2 A- e`2ad2Co%-XPsy>COx2C_&/ZaXseN$aweN஧&/+\ eFaPxGeF@3xT2?!^0lastnu2#jls nu2$#?!P0`FirstCda FUsr1t1a@e$#?!R0`^ddressc Qcddds~Qfo?T.J1i1JB1`71cQV'RowB BkG mwBBk ]92?Mr(L0( L$(Q5=*DistrictsD'/rpc`05=, CEInfoECreI{f?5=Y_.A/1A..15= %Sectғg5i n2G__"_OtherIDGUBOhrD?TS __$_Co !C9S __&_Prr@Ar<#-SW_y̝8_1%`DPT"RPwTQ_%S _CZ:\$GWe2<My3;My:':>  s 0 w Co2PPreOf a*Of@9aG4"ЖACG3XAC2(HP1pH,6K!0+Date1G ateh142 4#AiCoZipiCoZipii#i i}UnitGihUn3t3 2+ 1 1+\cK KxMEH &8 " 0Unit, (B@*utoXPiAttribute VB_Name = "Unit" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:=Endv \cK KxMEH &8 " 0cozip, (B@*oXPoAttribute VB_Name = "CoZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cDozEndx \cKKxMEH &8 " 0date1, (B@*oXPlAttribute VB_Name = "Date1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="dEndx FaxAC hCareOfwCoCityCounty\cK6KxMEH &8 " 0FaxAC, (B@*oXPjAttribute VB_Name = "FaxAC" Public Sub MAIN() WordBasic.WW7_EditGoTo Destina@tion:=Endx \cK4KxMEH &8 " 0careof, (B@*oXPqAttribute VB_Name = "CareOf" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coEndz \cK2KxMEH &8 " 0cocity, (B@*oXPpAttribute VB_Name = "CoCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cocEndz \cK0KxMEH &8 " 0county, (B@*oXPnAttribute VB_Name = "County" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=""cEndz \cKKxME &@`Enter Personal InformationTemplateProject.MyInfo.MAIN@ Pb PdP2PfPhPjPlPnPpPrPtPvPxPzP|P~PPXPP< @ h`2 P " (08@HPX`hpx &((@*h&(&&(8&`$&$$&($P&x&(N$@$h&&*$"80`T$$8X x <46 8X686486p846 4P 2 2 4 20 4h : : 2 X p & 4 6 8( 6` 8 6 4 6@ 8x 4 6 4 2X24248:p: "02H4242(0`240200h..0.(0X66 ": >`B>F(2p:26 6X.2::82x64B Fh 4 2 &  (H *p .  2 8(`h x ]]]]]]]](]@]X]p]]]]]]]]0]H]`]xDEFINE DIALOG BOXF,MyInfo (B@*m ^YourName (B@,m8^ YourTitle (B@,mP^ YourOffice (B@,mi^ YourAddress (B@,xYourCity (B@,T( YourState (B@,FYourZip (B@,n(AreaCode (B@,P YourPhone (B@,<YourExt (B@,r(FAXAC (B@,XPYourFax (B@,(YourCO (B@,(YourDI (B@,(YourSEC (B@,T(YourUN (B@,(YourWKR (B@,m^BossName (B@,> m^ BossTitle (B@,k  /Enter the following information about yourself. (B@d#2 Name: (B@d;2 Title: (B@dR< Office: (B@dkU Address: (B@d City-ST-Zip: (B@d7 Phone: (B@d>% FAX: (B@dCO-DI-SEC-UN-WKR: (B@dK 6Enter the following information about your supervisor. (B@d2 Name: (B@d 2 Title: (B@d X (B@."X (B@ (B@0]F (!4!6.26GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXUserInfoName MYINFO.ini (%d 2(UserInfoTitle MYINFO.ini (%d 2(UserInfoAreaCode MYINFO.ini (%d 2(2UserInfoPhone MYINFO.ini (%d 2(UserInfoYourExt MYINFO.ini (%d 2(hUserInfoFaxAC MYINFO.ini (%d 2(jUserInfoFax MYINFO.ini (%d 2(lUserInfoOffice MYINFO.ini (%d 2(UserInfoAddress MYINFO.ini (%d 2(UserInfoCity MYINFO.ini (%d 2(UserInfoState MYINFO.ini (%d 2(UserInfoZip MYINFO.ini (%d 2(UserInfoCO MYINFO.ini (%d 2(UserInfoDI MYINFO.ini (%d 2(UserInfoSEC MYINFO.ini (%d 2(UserInfoUN MYINFO.ini (%d 2(UserInfoWKR MYINFO.ini (%d 2(UserInfo Boss Name MYINFO.ini (%d 2(UserInfo Boss Title MYINFO.ini (%d 2(,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT 2 (!J%6'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoName 2! MYINFO.ini (B@LUserInfoTitle 2! MYINFO.ini (B@LUserInfoAreaCode 2!2 MYINFO.ini (B@LUserInfoPhone 2! MYINFO.ini (B@LUserInfoYourExt 2!h MYINFO.ini (B@LUserInfoFaxAC 2!j MYINFO.ini (B@LUserInfoFax 2!l MYINFO.ini (B@LUserInfoOffice 2! MYINFO.ini (B@LUserInfoAddress 2! MYINFO.ini (B@LUserInfoCity 2! MYINFO.ini (B@LUserInfoState 2! MYINFO.ini (B@LUserInfoZip 2! MYINFO.ini (B@LUserInfoCO 2! MYINFO.ini (B@LUserInfoDI 2! MYINFO.ini (B@LUserInfoSEC 2! MYINFO.ini (B@LUserInfoUN 2! MYINFO.ini (B@LUserInfoWKR 2! MYINFO.ini (B@LUserInfo Boss Name 2! MYINFO.ini (B@LUserInfo Boss Title 2! MYINFO.ini (B@LGet user info from INI fileUserInfoName MYINFO.ini (%d' bUserInfoTitle MYINFO.ini (%d' dUserInfoAreaCode MYINFO.ini (%d' 2UserInfoPhone MYINFO.ini (%d' fUserInfoYourExt MYINFO.ini (%d' hUserInfoFaxAC MYINFO.ini (%d' jUserInfoFax MYINFO.ini (%d' lUserInfoOffice MYINFO.ini (%d' nUserInfoAddress MYINFO.ini (%d' pUserInfoCity MYINFO.ini (%d' rUserInfoState MYINFO.ini (%d' tUserInfoZip MYINFO.ini (%d' vUserInfoCO MYINFO.ini (%d' xUserInfoDI MYINFO.ini (%d' zUserInfoSEC MYINFO.ini (%d' |UserInfoUN MYINFO.ini (%d' ~UserInfoWKR MYINFO.ini (%d' UserInfo Boss Name MYINFO.ini (%d' UserInfo Boss Title MYINFO.ini (%d'  Update Form with user info WorkerName (%fG workerName b (B@hj WorkerTitle (%fG WorkerTitle d (B@hjWorkerAreaCode (%fGWorkerAreaCode 2 (B@hj WorkerPhone (%fG WorkerPhone f (B@hjWorkerExtension (%fGWorkerExtension h (B@hjFaxAC (%fGFaxAC j (B@hj WorkerFax (%fG WorkerFax  (B@hjCounty (%fGCOunty x (B@hjDistrict (%fGDIstrict z (B@hjSection (%fGSECtion | (B@hjUnit (%fGUNit ~ (B@hjWorker (%fGWorker  (B@hj CountyName (%fG CountyName n (B@hj CoAddress (%fG CoAddress p (B@hjCoCity (%fGCoCity r (B@hjCoState (%fGCoState t (B@hjCoZip (%fGCoZip v (B@hjSupervisorName (%fGSupervisorName  (B@hjSupervisorTitle (%fGSupervisorTitle  (B@hj. Update other Form Fields on Form & Exit Macro- Selected$=GetFormResult$ ("CurrentDate")! TheSerialDate = Today() + 14$ TheDate$ = Date$(TheSerialDate)& SetFormResult "DueDate", TheDate$) EditGoTo "CreateDate" : UnlinkFields EditGoTo "GranteefirstName"- ToolsProtectDocument .NoReset = 1, .Type = 23 ToolsProtectSection .Section = 2, .Protect = 0d (B@N'kpoh`5Attribute VB_Name = "MyInfo" Public Sub MAIN(X) D.nDescription|Enter Personal rma:zProcDataIInvoke _FuncITe@mplate"ject..wJDim iRet  User$TitleAreaCod!-PhonYo urExtFaxAC  Offic $Ad dressCidtyStbZ$ipCODISEB;UN WKRBoss| |]Sel'DEFINE DIALOG BOX WordBasic.BeginDialog 582, 300,H G TextBox 109@ A 5@ |18@ Ok 5^6 0 83 Cf[ 105o 2A3321A5Ay 34    9 7 1$55ź [1 P4b23` 6ifV3jFAXACy41e `XV1@,CO629 *DI7m sV? UN64!l1.}Vm23n`Ł64`Iz7,, c3zthe following info$ ab out yself. ",  !:w5f"?bC #10}@8O$1 {1A-ST- u5 abm3r13@ gY  ;"CO-DI-T-UN-K@H4722@4f supervisor!a 124`f6p6iOKButt,48 8pR21 fCance:l3kEndn rdlgvQ As Ob@: Set =hUCurValues. 'GET USER INFO FROMI FILE AND PUT I NTOzx.t7 [Ge tPrivfileSpng$]t(" "P:qMY.ini"r hl ? a"4??>? Mpn1r &.nAC `axU/-Y??>OMA\C$$a&gp O?p | DIpp/-UN0 | {p y QaBasic.[GetPrivateProfileString$]("UserInfo", "Boss Name0MYINFO.ini") dl gR.LTitle = Word0>e 'DISPLAY DIALOG BOX AND RESPOTO USER INPUT@ iRet Dialog. F(\cIf -1 Then 'OK BUTTO@N 'WRITE NE2W5FO8I @FILE zS Your , - -AreaCod|PhonEExtE@FaxA~CL+@Offic- l+[Address0$ Cityϐ ? : StP  z Zip0  CO CO ɺ DI DI |SEdr U2NUN WKR  )i߿Po qr1n' up i frommps $~? n"uqb UiU bij"i_ _QQ!hhhuhh_UCOOOOBmB Q!DI???"m?2 hOOOUNOOOl gOOO aa]&G]^!Rk Upd0 Form with7lSk݇Exist0Bookmark("keB<")`aResult "wor,B_._Ss oetisr$ kԲrmResult "WorkerAreaCode", P$ If dBasic.ExistingBook mark(|Phone") Then\SetFo V, User )hExtension$l/, Your#nFaxAC2, c`0#/County-CO CaCODrict^DIst DISectvxSEC C@Udni.UN U>NCE WKR#sNam׈ OfficeAddress|Co%  CoCiS" ! CoStat$c b CoZip?# +B ?"Supervisor<, Boss! 0Titl% b ' Upd. other Fiel ds on& t Macro Rem" Sel}ed$=G$ ("CurrentD9'@Serial = Today()-14$5()Du>e"GEditGoTo " Ct : Unlink'GranteefPirst3"ToolsProtADocum H.Noet`1, .Type@2#% .8= 2d 0 ` ElsedcFileClose  @-1Pnd If Sub H &8 " 0worker, (B@*oXPlAttribute VB_Name = "Worker" Public Sub MAIN() tdBasic.WW7_EditGoTo Destination:="wEndz {K:KxME &@p+Adds row to table FOLLOWING cursor locationTemplateProject.AddRows.MAINh "0@ (B@tt (B@op\158oH@Attribute VB_Name = "AddRows" Public Sub MAIN() D.pDescription~s row to table FOLLOWING cursor loca\NProcDataZInvoke_FuncZTemplateA"ject..KWordBasic.LineDown 1 TInserBt Numt:D="Ends t{sK8KxME` & @V ST  " V*h    ]@Q This serves as a replacement to the spell checker within a protected documentCACheck spelling now? (%X'V V (B@v (B@Z (B@\l (B@ko0Attribute VB_Name = "Correct" Public Sub MAIN() Dim ans Rem This se@rves a replacement to the spell checker within @a proted docu3 ZWordBasic.MsgBox("C?King now ?", 3If4-1en  QATools4UnoDi %St`artOf"S7d>0Pg NoReset:=1, Type:=2 End If \cK&KxMECoStateOtherIDSectionAddress1+ H &8 "(8costate, (B@*na\desoPHqAttribute VB_Name = "CoState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cosEnd| \cK$KxMEH &8 "(8otherid, (B@*na\desoPHsAttribute VB_Name = "OtherID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=$"oidEnd| \cK"KxME     !"#$%&()*+,-./012345789:;<=>?@ABCDEFHIJKLMNOPQRSTUWXYZ[\]^_`abcdfghijklmnopqrsuvwxyz{|}~H &8 "(8Section, (B@*na\desoPHjAttribute VB_Name = "Section" Public Sub MAIN() WordBasic.WW7_EditGoTo Desti$nar:=End| \cK KxMEH &8 "(8Address1, (B@*na\desoPHnAttribute VB_Name = "Address1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:"= End~ CaseInfoK!DistrictLastName'RowBreak!6SK.KxME &@`bEnter Personal InformationTemplateProject.CaseInfo.MAINx@ P P PPPPPPP@ `2 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@0]F (!4!6.26GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXUserInfoFCCaseNoC:\Windows\CaseInfo.ini (%d 2(8UserInfo FCCaseNameC:\Windows\CaseInfo.ini (%d 2(:UserInfoFCLoadNoC:\Windows\CaseInfo.ini (%d 2(<UserInfo FCWorkerNameC:\Windows\CaseInfo.ini (%d 2(>UserInfoPSCaseNoC:\Windows\CaseInfo.ini (%d 2(@UserInfo PSCaseNameC:\Windows\CaseInfo.ini (%d 2(BUserInfo HouseholdLastC:\Windows\CaseInfo.ini (%d 2(DUserInfoHouseholdFirstC:\Windows\CaseInfo.ini (%d 2(FUserInfo DCompletedC:\Windows\CaseInfo.ini (%d 2(H,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT 2 (!J%6'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoFCCaseNo 2!8C:\Windows\CaseInfo.ini (B@LUserInfo FCCaseName 2!:C:\Windows\CaseInfo.ini (B@LUserInfoFCLoadNo 2!<C:\Windows\CaseInfo.ini (B@LUserInfo FCWorkerName 2!>C:\Windows\CaseInfo.ini (B@LUserInfoPSCaseNo 2!@C:\Windows\CaseInfo.ini (B@LUserInfo PSCaseName 2!BC:\Windows\CaseInfo.ini (B@LUserInfo HouseholdLast 2!DC:\Windows\CaseInfo.ini (B@LUserInfoHouseholdFirst 2!FC:\Windows\CaseInfo.ini (B@LUserInfo DCompleted 2!HC:\Windows\CaseInfo.ini (B@LGet user info from INI fileUserInfoFCCaseNoC:\Windows\CaseInfo.ini (%d' UserInfo FCCaseNameC:\Windows\CaseInfo.ini (%d' UserInfoFCLoadNoC:\Windows\CaseInfo.ini (%d' UserInfo FCWorkerNameC:\Windows\CaseInfo.ini (%d' UserInfoPSCaseNoC:\Windows\CaseInfo.ini (%d' UserInfo PSCaseNameC:\Windows\CaseInfo.ini (%d' UserInfo HouseholdLastC:\Windows\CaseInfo.ini (%d' UserInfoHouseholdFirstC:\Windows\CaseInfo.ini (%d' UserInfo DCompletedC:\Windows\CaseInfo.ini (%d'  Update Form with user infoFCCASENO (%fGFCCASENO  (B@hj FCCASENAME (%fG FCCASENAME  (B@hjFCWORKERLOADNO (%fGFCWORKERLOADNO  (B@hj FCWORKERNAME (%fG FCWORKERNAME  (B@hjPSCASENO (%fGPSCASENO  (B@hj PSCASENAME (%fG PSCASENAME  (B@hjHOUSEHOLDASSESSEDLST (%fGHOUSEHOLDASSESSEDLST  (B@hjHOUSEHOLDASSESSEDFST (%fGHOUSEHOLDASSESSEDFST  (B@hj DATECOMPLETED (%fG DATECOMPLETED  (B@hj. Update other Form Fields on Form & Exit Macrod (B@N'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?@ABCDEGHIJKLMNOPQRSTUVWYZ[\]^_`abcdefgijklmnopqrstuvwxyz{|}7H &8 "(8 coextension, (B@*esoPHtAttribute VB_Name = "CoExtension" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinatr@:="coeEnd \cKLKxMEH &8 "(8 GranteeCity, (B@*esoPHqAttribute VB_Name = "GranteeCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End \cKJKxMEH &8 "(8 workerphone, (B@*esoPHuAttribute VB_Name = "WorkerPhone" Public Sub MAIN() dBasic.WW7_EditGoTo DestinationP:="wpEnd \cKHKxMEH &8 "(8 Countynumber, (B@*esoPHtAttribute VB_Name = "countynumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="C End \cKvKGranteeState7NewParagraph02F^ThisDocumentX_VBA_PROJECT/;D6xMEH &8 "(8 GranteeState, (B@*esoPHrAttribute VB_Name = "GranteeState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:= End \cKtKxMEH &8 " (@`px (B@tt (B@vna\des $ (B@tl (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 KK#xME (SLSS<N0{00020906-0000-0000-C000-000000000046}8(%HxAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomizD2a  *\G{000204EF-0000-0000-C000-000000000046}#4.1#9#C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA7\VBE7.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.5#0#C:\Program Files\Microsoft Office\Office14\MSWORD.OLB#Microsoft Word 14.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\system32\STDOLE2.TLB#OLE Automation*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\system32\FM20.DLL#Microsoft Forms 2.0 Object Library*\G{2D37FD65-E790-11D2-85D6-000502AE150C}#2.0#0#C:\TEMP\VBE\MSForms.EXD#Microsoft Forms 2.0 Object Library.E .`M &*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.5#0#C:\Program Files\Common Files\Microsoft Shared\OFFICE14\MSO.DLL#Microsoft Office 8.0 Object Library8 A77654/.-,3210'&%$+*)(#"! K8ThisDocument0=50c1a123!ThisDocumentK% SuperPhoneNumber0>50c1a123$ SuperPhoneNumberK% InsertCisAddress0?50c1a123. InsertCisAddressK05 GranteeFirstName0@50c1a123j GranteeFirstNameKH%WorkerExtension0A50c1a123lWorkerExtensionK`%GranteeLastName0B50c1a123nGranteeLastNamehKx%GranteeClientID0C50c1a123pGranteeClientIDjK%GranteeAddress10D50c1a123rGranteeAddress1lK%AddChildInfoRow0E50c1a123tAddChildInfoRownKWorkerAreaCode0F50c1a123WorkerAreaCode`KSupervisorName0G50c1a123SupervisorNamebKSuperExtention0H50c1a123SuperExtentiondKAddSvcReferral0I50c1a123AddSvcReferralfK SvcRefHeading0J50c1a123SvcRefHeadingxK8 SuperAreaCode0K50c1a123SuperAreaCodezKPGranteeCareof0L50c1a123GranteeCareof|KhCoSuppaddress0M50c1a123CoSuppaddress~KCoPhoneNumber0N50c1a123CoPhoneNumberpKClearCaseInfo0O50c1a123ClearCaseInforK NewParagraph0P50c1a123NewParagraphtKGranteeState0Q50c1a123GranteeStatevKcountynumber0R50c1a123XcountynumberHKWorkerPhone0S50c1a123WorkerPhoneJKGranteeCity0T50c1a123GranteeCityLK(CoExtension0U50c1a123CoExtensionNK@ClientState0V50c1a123`ClientState@KXWorkerName0W50c1a1230WorkerNameBKpGranteeZip0X50c1a123GranteeZipDKCountyName0Y50c1a1236CountyNameFKCoAreaCode0Z50c1a123CoAreaCodeXKClientCity0[50c1a123^ClientCityZKCaseNumber0]50c1a123VCaseNumber\KWorkerFax0^50c1a123WorkerFax^Klastname20_50c1a123lastname2PKFirstName0`50c1a123RFirstNameRK0CoAddress0a50c1a123CoAddressTKHClientZip0b50c1a123bClientZipVK`RowBreak0c50c1a123RowBreak(KxMLastName0d50c1a123TLastName*KDistrict0e50c1a1238District,KCaseInfo0f50c1a123CaseInfo.KY Address10g50c1a123\Address1 K Section0h50c1a123:Section"K OtherID0i50c1a123POtherID$K CoState0j50c1a123RCoState&K  Correct0k50c1a123TCorrect8K8yAddRows0l50c1a123^AddRows:KP Worker0m50c1a123> WorkerK' County0o50c1a123 County0K CoCity0p50c1a123 CoCity2K CareOf0q50c1a123Z CareOf4K FaxAC0r50c1a123j FaxAC6K Date10s50c1a123 Date1K CoZip0t50c1a123 CoZip KUnit0u50c1a123<Unit K(HP(@H (p Pxx`h088-Mm÷L57X0^j1CIIUʘ^M~fJ ]0bC4DEipօHH\jF{(UQ |@G ޷0ݭOʣci9Ň?BjG}c eBVu+ GK+_qcA(NxKg" 2+f{K-$دufbAyoEdү.I7oqPWm}A|1 4ManEKǬY53oHF.d,cCKBKwfHCq^ pAF"Ju?1O1/am8HpLwLםHEB/ϫLyj[J*mFʙCC/ncAn%ܓ( EWordkVBAWin16~Win32Win64xMacVBA6#VBA7#TemplateProjectEstdole`MSFormsCOfficeu ThisDocument< _EvaluateSuperPhoneNumber\MAIN, WordBasic WW7_EditGoTod DestinationлInsertCisAddress>} WorkerNameJAreaCode PhoneNumber CountyNameDistrict}-SectionGUnitWorker8 ApDistrictApUnitPApWorkerW FsDistrictaFsUnitFsWorker SvDistrict]SvUnit/SvWorker FirstNameLastName CaseNumberA countynumberyxCareOfƻAddress1O ClientCitym ClientState ClientZipGetPrivateProfileString$xExistingBookmark SetFormResultGranteeFirstNameEWorkerExtensionGranteeLastName.GranteeClientIDGranteeAddress1AddChildInfoRow^ToolsUnprotectDocument(NextCellWW7_EditAutoTextCContextXnInsertAsInsertrCharLeftToolsProtectDocument-0NoResetgWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral} SvcRefHeadingi&TableSelectRowTableInsertRowQNumRows CenterParaLineUpK InsertPara,LineDownxTableInsertCells ShiftCells( CharRightPTableMergeCellst BorderRight_ SuperAreaCodeq GranteeCareof CoSuppaddress^  CoPhoneNumberx ClearCaseInfohFileFind SearchName֡ SearchPath.SubDir+Title~AuthorKeywordsTSubjectRPOptions MatchCase PatternMatch DateSavedFromu= DateSavedTojdSavedByDateCreatedFrom DateCreatedToViewISortByoListBy+ SelectedFile\Kill NewParagraphqScreenUpdating! ChrK~ GranteeStateM WorkerPhone GranteeCity@ CoExtensionK GranteeZip  CoAreaCode WorkerFaxv lastname2sL CoAddressRowBreakFTableRowHeight"X RulerStyleaLineSpacingRulep LineSpacing LeftIndenti AlignmentI AllowRowSplit{CaseInfoiRet,p UserFCCNoBUserFCCN7 UserFCWLNoyUserFCWN UserPSCNoOUserPSCNqUserHALօUserHAFЅUserDC SelectNameW; ViewToolbars| ColorButtons} LargeButtonsSWToolTips5+Toolbar2Show BeginDialogFTextBoxQOKButton| EndDialogmP dlgUserInfo2" CurValuesȤ UserDialog YourFCCNo+YourFCCN. YourFCWLNoYourFCWN0 YourPSCNo9YourPSCNP<YourHALYYourHAFYYourDCDialogfSetPrivateProfileString= FileClose_OtherIDCoState1Correct'ansxtMsgBoxRStartOfDocument ToolsSpellingAddRowsMyInfo@UserName\ UserTitleV9 UserPhoneYourExthLFaxACjYourFaxrN UserOffice0 UserAddressFUserCity UserStateUserZipDUserCOUserDIUserSEC4UserUN0UserWKR,BossNamef BossTitleHFaxY CancelButtonYourName;R YourTitleA# YourPhone YourOffice YourAddressYourCity YourStateYourZipYourCOYourDIYourSECvYourUNVYourWKRnCountyG8CoCityr7Date11CoZip0Documentj{ !#% (!%/17 9'#;*$=7e?/%S"'U&1W2Y3[34])5_6a7c$8Q+9S,:U-;k<m=o>q?s@uA_.Ba0Ck4D E L M N OP]^_`1a2b5c6dwwz&|ClearCaseInfohVCoPhoneNumber46~CoSuppaddressGranteeCareof59\cKrKxMEH &8 "&   c:\windows\ caseinfo.inid (B@esktc:\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?@ABCDFGHIJKLMNOPQRSTUVWXYZ[\]^_`bcdefghijklmnoqrstuvwxyz{|}~ &@x-Adds a row and fields for A. Service Referral#TemplateProject.AddSvcReferral.MAIN@X "  2( `2p 2 2 82H 2 2 2  X2h 4 40@`p (B@vd sett (B@xna\desSvcRefF1|~ (B@z (B@xSvcRefF2|~ (B@z (B@xl LeavSvcRefF3|~ (B@z.DO (B@xSvcRefF4|~ (B@zc: (B@xtowrd.SvcRefF5|~ (B@zr (B@x\cistoSvcReff6|~ (B@z (B@xistowrSvcRefF7|~ (B@z (B@xSvcRefF8|~ (B@z (B@xSvcRefF9|~ (B@z (B@x SvcRefF10|~ (B@z (B@x SvcRefF11|~ (B@z- (B@l (B@oAttribute 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 \cKdKxMEH &8 " (8superextension, (B@*oPH|Attribute VB_Name = "SuperExtention" Public Sub MAIN() WordBasic.WW7_EditGoTo DestinBar:="sesEnd \cKbKSupervisorName'WorkerAreaCode<>6AddChildInfoRow EGranteeAddress1 =AaxMEH &8 " (8supervisorname, (B@*oPH{Attribute VB_Name = "Supervisor" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="snCEnd \cK`KxMEH &8 " (8workerareacode, (B@*oPH|Attribute VB_Name = "WorkerAreaCode" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wacEnd \cKnKxMEH &8 "  4( `4p 4 4 84H 4 4 @P (B@vd sett (B@xna\des ChildInfo1|~ (B@z (B@x ChildInfo2|~ (B@z (B@x ChildInfo3|~ (B@z (B@x ChildInfo4|~ (B@zc: (B@xtowrd. ChildInfo5|~ (B@zr (B@x\cisto ChildInfo6|~ (B@z (B@xistowr ChildInfo7|~ (B@z (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 \cKlKxMEH &8 ""0@GranteeAddress1, (B@*op\158oH@uAttribute VB_Name = "GranteeAddress1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End GranteeClientID pGranteeLastName @CWorkerExtension GranteeFirstName"BD\cKjKxMEH &8 ""0@GranteeClientID, (B@*op\158oH@uAttribute VB_Name = "GranteeClientID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End \cKhKxMEH &8 ""0@granteelastname, (B@*op\158oH@~Attribute VB_Name = "GranteeLast" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="glnEnd \cKKxMEH &8 ""0@workerextension, (B@*op\158oH@xAttribute VB_Name = "WorkerExtension" Public Sub MAIN() dBasic.WW7_EditGoTo DestinaBtr:="weEnd \cKKxMEH &8 ""0@granteefirstname, (B@*op\158oH@Attribute VB_Name = "GranteeFirstL" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="g5fnEnd \cKKxMEInsertCisAddress"ESuperPhoneNumber"PROJECT GD PROJECTwmpDK/KKxME0 &@_=Retrieves CIS Client address info from c:\glwin\cistowrd.ini nalx%TemplateProject.InsertCisAddress.MAIN DuP0P2P4P6P8P:P<P>P@PBPDPFPHPJPLPNPPPRPTPVPXPZP\P^P`Pb` " (08@HPX`hpx>BF`DBB8>@ FBHD FB Dh FBD@ DBDF`@B>0@p> :606h:>: :` > 2 : 2X 6 : 2 6@ :x 2 6 :( :h F F :8 6x 6 . 26P>: ]]]]]]0]H]`]x]]]]]]] ]8]P]h]]]]]]] WorkerInfoNamec:\glwin\cistowrd.ini (%d' 0 WorkerInfoAreaCodec:\glwin\cistowrd.ini (%d' 2 WorkerInfo PhoneNumberc:\glwin\cistowrd.ini (%d' 4 WorkerInfo CountyNamec:\glwin\cistowrd.ini (%d' 6 WorkerInfoDistrictc:\glwin\cistowrd.ini (%d' 8 WorkerInfoSectionc:\glwin\cistowrd.ini (%d' : WorkerInfoUnitc:\glwin\cistowrd.ini (%d' < WorkerInfoWorkerc:\glwin\cistowrd.ini (%d' >ApWorkerDistrictNumberc:\glwin\cistowrd.ini (%d' @ApWorker UnitNumberc:\glwin\cistowrd.ini (%d' BApWorker WorkerNumberc:\glwin\cistowrd.ini (%d' DFsWorkerDistrictNumberc:\glwin\cistowrd.ini (%d' FFsWorker UnitNumberc:\glwin\cistowrd.ini (%d' HFsWorker WorkerNumberc:\glwin\cistowrd.ini (%d' JSvWorkerDistrictNumberc:\glwin\cistowrd.ini (%d' LSvWorker UnitNumberc:\glwin\cistowrd.ini (%d' NSvWorker WorkerNumberc:\glwin\cistowrd.ini (%d' P ClientInfo FirstNamec:\glwin\cistowrd.ini (%d' R ClientInfoLastNamec:\glwin\cistowrd.ini (%d' T ClientInfo CaseNumberc:\glwin\cistowrd.ini (%d' V ClientInfo CountyNumberc:\glwin\cistowrd.ini (%d' X ClientInfoCareOfc:\glwin\cistowrd.ini (%d' Z ClientInfoAddress1c:\glwin\cistowrd.ini (%d' \ ClientInfoCityc:\glwin\cistowrd.ini (%d' ^ ClientInfoStatec:\glwin\cistowrd.ini (%d' ` ClientInfoZipc:\glwin\cistowrd.ini (%d' b FirstName (%fG FirstName R (B@hjLastName (%fGLastName T (B@hjAddress1 (%fGAddress1 \ (B@hj ClientCity (%fG ClientCity ^ (B@hj ClientState (%fG ClientState ` (B@hj ClientZip (%fG ClientZip b (B@hj CaseNumber (%fG CaseNumber V (B@hj CountyNumber (%fG CountyNumber X (B@hjCareOf (%fGCareOf Z (B@hj ApDistrict (%fG ApDistrict @ (B@hjApUnit (%fGApUnit B (B@hjApWorker (%fGApWorker D (B@hj FsDistrict (%fG FsDistrict F (B@hjFsUnit (%fGFsUnit H (B@hjFsWorker (%fGFsWorker J (B@hj SvDistrict (%fG SvDistrict L (B@hjSvUnit (%fGSvUnit N (B@hjSvWorker (%fGSvWorker P (B@hj FirstName2 (%fG FirstName2 R (B@hj LastName2 (%fG LastName2 T (B@hjGranteeFirstName (%fGGranteeFirstName R (B@hjGranteeLastName (%fGGranteeLastName T (B@hj WorkerName (%fG WorkerName 0 (B@hjDistrict (%fGDistrict 8 (B@hjSection (%fGSection : (B@hjUnit (%fGUnit < (B@hjWorker (%fGWorker > (B@hjAreaCode (%fGAreaCode 2 (B@hj PhoneNumber (%fG PhoneNumber 4 (B@hj CountyName (%fG CountyName 6 (B@hjoAttribute VB_Name = "InsertCisAddress" Public Sub MAI`N() ".DescriptionReeves CIS Client a info from c:\\glwin\\cistowrd`.ini wbProcDatanInvoke_FuncnTemplate"jec4t. .TDim Worker$ Are aCodePhoneNumberCountyDUrictS9{Uni 5 Ap Ap$Ap Fs FsIFs Sv SvSv,irsteLaCas ?c?nCarelOf5u1zCity St@gJZip&#q@dBasic.[GetPrivt fileSngP$](" I", "C "w4 HtG J i13 eg r Z ba a Q$   ʼnA 0c D A%_  & H_ D &fA &iC C?Mr &Pwa d YY%foYdjoonola_oOONoԊm Ffurul/Tz___"OH8ooo""lZ Rooo 41/:r OY "/.???"ONAw///" IfEx0QBookmark("7) ThenSetFormResult , V 6H9 "h%)",q??Q"OOnte%#ooa"OOn~t%#&"?>#SN_\, T+Basic.ExistingBookmark("CareOf") Then WordSetFormResult , ^$ 0 If^ApDrict*,  ecUni?!_&-+ke~r\-.Ffs, aF>sz FFs?<_ FSv3F , FSvF FSv d Pho@neNumb"i,  CountyQ}~0 End Sub H &8 ""0@superphonenumber, (B@*op\158oH@Attribute VB_Name = "SuperPhoneNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="spnEnd ID="{439DD9E8-0D36-11D3-866A-000502AE150C}" Document=ThisDocument/&H00000000 Module=SuperPhoneNumber Module=InsertCisAddress Module=GranteeFirstName Module=WorkerExtension Module=GranteeLastName Module=GranteeClientID Module=GranteeAddress1 Module=AddChildInfoRow Module=WorkerAreaCode Module=SupervisorName Module=SuperExtention Module=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=lastname2 Module=FirstName Module=CoAddress Module=ClientZip Module=RowBreak Module=LastName Module=District Module=CaseInfo Module=Address1 Module=Section Module=OtherID Module=CoState Module=Correct Module=AddRows Module=Worker Module=MyInfo Module=County Module=CoCity Module=CareOf Module=FaxAC Module=Date1 Module=CoZip Module=Unit Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="4547EEAF16081A081A081A081A" DPB="A2A009166717671767" GC="FFFD54F5EC0F48104810B7" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C SuperPhoneNumber=0, 0, 0, 0, C InsertCisAddress=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 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 CoState=0, 0, 0, 0, C Correct=0, 0, 0, 0, C AddRows=0, 0, 0, 0, C Worker=0, 0, 0, 0, C MyInfo=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 ThisDocumentThisDocumentSuperPhoneNumberSuperPhoneNumberInsertCisAddressInsertCisAddressGranteeFirstNameGranteeFirstNameWorkerExtensionWorkerExtensionGranteeLastNameGranteeLastNameGranteeClientIDGranteeClientIDGranteeAddress1GranteeAddress1AddChildInfoRowAddChildInfoRowWorkerAreaCodeWorkerAreaCodeSupervisorNameSupervisorNameSuperExtentionSuperExtentionAddSvcReferralAddSvcReferralSvcRefHeadingSvcRefHeadingSuperAreaCodeSuperAreaCodeGranteeCareofGranteeCareofCoSuppaddressCoSuppaddressCoPhoneNumberCoPhoneNumberClearCaseInfoClearCaseInfoNewParagraphNewParagraphGranteeStateGranteeStatecountynumbercountynumberWorkerPhoneWorkerPhoneGranteeCityGranteeCityCoExtensionCoExtensionClientStateClientStateWorkerNameWorkerNameGranteeZipGranteeZipCountyNameCountyNameCoAreaCodeCoAreaCodeClientCityClientCityCaseNumberCaseNumberWorkerFaxWorkerFaxlastname2lastname2FirstNameFirstNameCoAddressCoAddressClientZipClientZipRowBreakRowBreakLastNameLastNameDistrictDistrictCaseInfoCaseInfoAddress1Address1SectionSectionOtherIDOtherIDCoStateCoStateCorrectCorrectAddRowsAddRowsWorkerWorkerMyInfoMyInfoCountyCountyCoCityCoCityCareOfCareOfFaxACFaxACDate1Date1CoZipCoZipUnitUnit  F Microsoft Word 97-2003 Document{  bjbjBrBr *"  va0a0QQM\Ɯ@ tgSSSSSSS~0S-###S####S##S##Y8#0 똾##?0Ɯ#0#0#0#########SS####Ɯ####0#########)x I:  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      !"#$%&'()*+,-./0123456( * > @ N P R f h v x z                     ( * 4 6 8 L N \ ^ ` t v          j8h Uj~h Uj~h Uj}h Uj|h Uj|h UjZ{h Ujzh Uj+zh Ujeyh Uh jh U4          02@BDXZbdfz|轸jh Ujh Ujzh Ujɂh Uj?h 5U h 5jh 5Ujh Uj6h Ujsh Uh jh Ujh U-  Bd"Jr:\Bj210/.-,+*)('&%$#"!  "$8:HJL`bprt(*8:<PRZ\^rt诤j?h Ujh Ujh UjYh UUjԈh Uj?h Ujkh Ujh Ujh Uh jh Ujh U3       FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        46@BDXZhjljh Ujh Ujh UjNh Ujh Uj h Ujh Ujh Ujh Uh jh Ujh U2j"Jr<;:9876543  "$8:HJL`bprtjEh Ujh Ujh Ujh Uj h Uh jh Ujh U(/ =!"#$% CompObjruite or Apartment Number, C/O)Address1D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)D ClientCity UppercaseEnter the Addressee's City. ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD 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  CoAreaCode000Enter the County's Area Code CoPhoneNumberDCoCity UppercaseEnter the County's City.D CoExtension6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH L@LNormal#CJ OJQJ_HmHnHsH tH uDAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List VOV Address1d8(OJQJ_HkHmH sH tH ROR CareOfd8(OJQJ_HkHmH sH tH ZOZ CaseNumberd8(OJQJ_HkHmH sH tH ZO"Z ClientCityd8(OJQJ_HkHmH sH tH \O2\ ClientStated8(OJQJ_HkHmH sH tH \OB\ ClientZipdt CJOJQJ_HkHmH sH tH XORX CoAddressd8(OJQJ_HkHmH sH tH ZObZ CoAreaCoded8(OJQJ_HkHmH sH tH ROrR CoCityd8(OJQJ_HkHmH sH tH \O\ CoExtensiond8(OJQJ_HkHmH sH tH `O` CoPhoneNumberd8(OJQJ_HkHmH sH tH TOT CoStated8(OJQJ_HkHmH sH tH `O` CoSuppaddressd8(OJQJ_HkHmH sH tH ROR Countyd8(OJQJ_HkHmH sH tH ZOZ CountyNamed8(OJQJ_HkHmH sH tH ^O^ CountyNumberd8(OJQJ_HkHmH sH tH TOT CoZipdt CJOJQJ_HkHmH sH tH POP Date1 d8(OJQJ_HkHmH sH tH VOV District!d8(OJQJ_HkHmH sH tH PO"P FaxAC "d` CJOJQJ_HkHmH sH tH XO2X FirstName#d8(OJQJ_HkHmH sH tH ZOBZ FirstName2$d8(OJQJ_HkHmH sH tH dORd GranteeAddress1 %d` CJOJQJ_HkHmH sH tH `Ob` GranteeCareof &d` CJOJQJ_HkHmH sH tH \Or\ GranteeCity 'd` CJOJQJ_HkHmH sH tH hOh GranteeClientID(d8(5OJQJ_HkHmH sH tH fOf GranteeFirstName)d8(OJQJ_HkHmH sH tH dOd GranteeLastName*d8(OJQJ_HkHmH sH tH ^O^ GranteeState +d` CJOJQJ_HkHmH sH tH ZOZ GranteeZip ,d` CJOJQJ_HkHmH sH tH VOV LastName-d8(OJQJ_HkHmH sH tH XOX LastName2.d8(OJQJ_HkHmH sH tH TOT OtherID/d8(OJQJ_HkHmH sH tH TOT Section0d8(OJQJ_HkHmH sH tH `O` SuperAreaCode1d8(OJQJ_HkHmH sH tH bO"b SuperExtension2d8(OJQJ_HkHmH sH tH fO2f SuperPhoneNumber3d8(OJQJ_HkHmH sH tH bOBb SupervisorName4d8(OJQJ_HkHmH sH tH NORN Unit5d8(OJQJ_HkHmH sH tH RObR Worker6d8(OJQJ_HkHmH sH tH bOrb WorkerAreaCode7d8(OJQJ_HkHmH sH tH dOd WorkerExtension8d8(OJQJ_HkHmH sH tH XOX WorkerFax 9d` CJOJQJ_HkHmH sH tH ZOZ WorkerName:d8(OJQJ_HkHmH sH tH \O\ WorkerPhone;d8(OJQJ_HkHmH sH tH \O\ WorkerTitle <d` CJOJQJ_HkHmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] v ".Address1CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress County CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherID Section! SuperAreaCode"SuperExtension#SuperPhoneNumber$SupervisorName%Unit&Worker'WorkerAreaCode(WorkerExtension) WorkerFax* WorkerName+ WorkerPhone, WorkerTitle-.Address1CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle(<Pau !2FZk} .BVj~%9Mauv 0 HR6 !1#M$?&T'(>*+--/(  !',/26;?@CFIMQTX\_cgkotc 2 X BVr`h48Lb% !""/##:$$%%&>'D''(()=*C**++V,-^---a..4/p///z j "#$%&()*+-.01345789:<=>ABDEGHJKLNOPRSUVWYZ[]^`abdefhijlmnpqrsuv}~  &(4:<HNP\_amsu  !-02>DFRXZfikw{} ),.:@BNTVbhjv|~ #%179EKMY_amsvFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF.Address1CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountynumberCoZipdate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGrenteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle)=Qbv"3G[l~ /CWk&:Nbx  !"#$%&'()*+,-';O`t  1EYj|-AUi}$8L`tx vx(v UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewI" Arial (W1)Arial5. *aTahomaA$BCambria Math"h0@P? 2!xx MSWordDocWord.Document.89q