Form Dhcs 0009 - California Affidavit Of Identity For U.s. Citizen Or National Children Under 18 (Armenian) - Health And Human Services Agency
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1State of California – Health and Human Services Agency
Department of Health Care Services
18 ï³ñ»Ï³ÝÇó ÷áùñ ØdzóÛ³É Ü³Ñ³Ý·Ý»ñÇ ù³Õ³ù³óáõ ϳ٠ù³Õ³ù³óÇ ¹³ñÓ³Í
³ÝÓÇ ÆÝùÝáõÃÛ³Ý Ù³ëÇÝ Ñ³ëï³ï³·Çñ
ÌÝáÕÇÝ, ËݳٳϳÉÇÝ Ï³Ù ËݳÙáÕ ³½·³Ï³ÝÇÝ (³½·³Ï³Ý, áñÁ ËݳÙáõÙ ¿ »ñ»Ë³ÛÇÝ).
¸áõù ϳñáÕ »ù û·ï³·áñÍ»É ³Ûë Ó»õÁ, »Ã».
• ¸áõù 16 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ ÇÝùÝáõÃÛ³Ý Ù³ëÇÝ ³å³óáõÛó ãáõÝ»ù, ϳÙ`
• ¸áõù 18 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ Ñ³Ù³ñ ¹åñáó³Ï³Ý ID ù³ñï ϳ٠í³ñáñ¹³Ï³Ý
Çñ³íáõÝù ãáõÝ»ù:
Èñ³óñ»ù »õ ëïáñ³·ñ»ù Ý»ñù»õáõÙ: ÊݳÙùáí ïå»ù »õ ÑÕ»ó»ù Ó»ñ ù³áõÝÃÇÇ
êáóÇ³É³Ï³Ý ³å³ÑáíáõÃÛ³Ý Í³é³ÛáõÃÛáõÝÝ»ñÇ ·ñ³ë»ÝÛ³ÏÇÝ:
γñ»õáñ…
¸áõù ã»ù ϳñáÕ ³Ûë Ó»õÁ Éñ³óÝ»É, »Ã» ¹áõù ³ñ¹»Ý Éñ³óñ»É »ù Ý»ñù»õáõÙ
Ãí³ñÏí³Í »ñ»Ë³ÛÇ/Ý»ñÇ Ñ³Ù³ñ ù³Õ³ù³óÇáõÃÛ³Ý Ù³ëÇÝ Ð³ëï³ï³·Çñ:
ÌÝáÕÇ Ù³ëÇÝ ï»Õ»ÏáõÃÛáõÝ
ÌÝáÕÇ ³ÝáõÝÁ
(ϳ٠ËݳٳϳÉÇ Ï³Ù ËݳÙáÕ ³½·³Ï³ÝÇ) ³é³çÇÝ ³ÝáõÝ
ÙÇçÇÝ ³ÝáõÝ
³½·³ÝáõÝ
ú·ï³·áñÍí³Í ³ÛÉ ³ÝáõÝÝ»ñ
³é³çÇÝ ³ÝáõÝ
ÙÇçÇÝ ³ÝáõÝ
³½·³ÝáõÝ
ºÃ» ¹áõù »ñ»Ë³ÛÇÝ ËݳÙáÕ ³½·³Ï³ÝÝ »ù, DZÝã ¿ Ó»ñ ³½·³Ï³Ý³Ï³Ý ϳåÁ »ñ»Ë³ÛÇ Ñ»ï: (Üß»ù Ù»ÏÁ).
ä³åÁ
Ñáñ»Õμ³ÛñÁ/ù»éÇÝ
Ñáñ³ùáõÛñÁ/Ùáñ³ùáõÛñÁ
»Õμ³ÛñÁ/ùáõÛñÁ
³ÛÉ (μ³ó³ïñ»ù)
/
ºñ»Ë³ÛÇ Ù³ëÇÝ ï»Õ»ÏáõÃÛáõÝ
18 ï³ñ»Ï³ÝÇó ÷áùñ »ñ»Ë³ÛÇ ³ÝáõÝÁ
³é³çÇÝ ³ÝáõÝ
ÙÇçÇÝ ³ÝáõÝ
³½·³ÝáõÝ
ºñ»Ë³ÛÇ ÍÝÝ¹Û³Ý í³ÛñÁ »õ ³Ùë³ÃÇíÁ
³ÙÇë/ûñ/ï³ñÇ
ù³Õ³ù
ݳѳݷ (ϳ٠ûï³ñ »ñÏÇñ)
ºñ»Ë³ÛÇ Ù³ëÇÝ ³ÛÉ ï»Õ»ÏáõÃÛáõÝ
(»Ã» ÏÇñ³éíáõÙ ¿)
18 ï³ñ»Ï³ÝÇó ÷áùñ ÙÛáõë »ñ»Ë³ÛÇ ³ÝáõÝÁ
³é³çÇÝ ³ÝáõÝ
ÙÇçÇÝ ³ÝáõÝ
³½·³ÝáõÝ
ØÛáõë »ñ»Ë³ÛÇ ÍÝÝ¹Û³Ý í³ÛñÁ »õ ³Ùë³ÃÇíÁ
³ÙÇë/ûñ/ï³ñÇ
ù³Õ³ù
ݳѳݷ (ϳ٠ûï³ñ »ñÏÇñ)
ºñ»Ë³ÛÇ Ù³ëÇÝ ³ÛÉ ï»Õ»ÏáõÃÛáõÝ
(»Ã» ÏÇñ³éíáõÙ ¿)
18 ï³ñ»Ï³ÝÇó ÷áùñ ÙÛáõë »ñ»Ë³ÛÇ ³ÝáõÝÁ
³é³çÇÝ ³ÝáõÝ
ÙÇçÇÝ ³ÝáõÝ
³½·³ÝáõÝ
ØÛáõë »ñ»Ë³ÛÇ ÍÝÝ¹Û³Ý í³ÛñÁ »õ ³Ùë³ÃÇíÁ
³ÙÇë/ûñ/ï³ñÇ
ù³Õ³ù
ݳѳݷ (ϳ٠ûï³ñ »ñÏÇñ)
ºÃ» ¹áõù »ñ»ù »ñ»Ë³ÛÇó ³í»ÉÇ áõÝ»ù, Éñ³óñ»ù »õ áõÕ³ñÏ»ù »õë Ù»Ï Ó»õ:
ϳñ¹³ó»ù »õ ëïáñ³·ñ»ù Ý»ñù»õáõÙ
¼»Õͳñ³ñáõÃÛáõÝ Ï³ï³ñ»Éáõ å³ïÅáí »õ γÉÇýáñÝdzÛÇ Ý³Ñ³Ý·³ÛÇÝ ûñ»Ýùáí ѳÛï³ñ³ñáõÙ »Ù, áñ Ñ»ï»õÛ³ÉÁ
×Çßï ¿ »õ ×ßÙ³ñÇï:
²Ùë³ÃÇí
ÌÝáÕÇ, ËݳٳϳÉÇ Ï³Ù ËݳÙáÕ ³½·³Ï³ÝÇ ëïáñ³·ñáõÃÛáõÝ
DHCS 0009 (Armenian) (09/07)
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