Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (Russian) - Health And Human Services Agency

ADVERTISEMENT

State of California – Health and Human Services Agency
Department of Health Care Services
Аффидевит достаточных усилий, прилагаемых для получения
документа, подтверждающего гражданство
Заполните данную форму
(печатными буквами)
Я пытаюсь получить подтверждающий гражданство документ для
(ФИО):
Имя
Второе имя (отчество)
Фамилия
Я пытался (пыталась) получить подтверждающие гражданство документы от перечисленных ниже лиц или
учреждений.
(Также укажите даты обращения и срок, необходимый для получения подтверждающего документа.)
Имя лица или название учреждения,
Дата обещанного
Запрашиваемый документ
Дата обращения
с которыми вы связывались
ответа
Ниже вы можете сообщить любую дополнительную информацию о ваших попытках получить документ,
подтверждающий гражданство:
ФИО (печатными буквами)
Ваша подпись
Дата
Если для заполнения данной формы вам требуется помощь, пожалуйста, позвоните в местный офис социального
обслуживания (social services office).
Следующая графа заполняется округом
County fills out this box
Case No:
Case Name:
If this Affidavit is taken on the phone, fill out below:
County worker’s name and signature
Date
DHCS 0003 (06/07) – Russian
Page 1 of 1

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Dhcs 0003 - California Declaracion Jurada De Esfuerzo Razonable Para Obtener Prueba De Ciudadania - Health And Human Services Agency Form Dhcs 0003 - California Declaracion Jurada De Esfuerzo Razonable Para Obtener Prueba De Ciudadania - Health And Human Services Agency Legal
Form Dhcs 7013 - California Change Of Status Liens - Health And Human Services Agency Form Dhcs 7013 - California Change Of Status Liens - Health And Human Services Agency Legal
Form Dhcs 5085 - California Designation Of Administrative Responsibility - Health And Human Services Agency Form Dhcs 5085 - California Designation Of Administrative Responsibility - Health And Human Services Agency Financial
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (farsi) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (farsi) - Health And Human Services Agency Legal
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (korean) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (korean) - Health And Human Services Agency Legal
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (armenian) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (armenian) - Health And Human Services Agency Legal
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (vietnamese) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (vietnamese) - Health And Human Services Agency Legal
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (chinese) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (chinese) - Health And Human Services Agency Legal
Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (arabic) - Health And Human Services Agency Form Dhcs 0003 - California Affidavit Of Reasonable Effort To Get Proof Of Citizenship (arabic) - Health And Human Services Agency Legal
Dhcs 4073 - California Child Health And Disability Prevention (chdp) Program Pre-enrollment Application (russian) - Health And Human Services Agency Dhcs 4073 - California Child Health And Disability Prevention (chdp) Program Pre-enrollment Application (russian) - Health And Human Services Agency Legal

Related Categories

Parent category: Legal
Download
Go