ࡱ>   @ K bjbj5*5* W@W@\)$0)0)0)8̕P$e,h)-....u2I4@#xdxdxdxdxdxd$fRid55..5555d..Ae:::55|..@:55@::: .t ``0)5:[:TWe0e:i96i+:i+:05555:5555555555dd( :(LINE ITEM TRANSFER REQUEST Michigan Department of Human ServicesProvider s Legal NameDate FORMTEXT       FORMTEXT      Contact PersonPhone NumberContract Number FORMTEXT       FORMTEXT       FORMTEXT      Mailing AddressContract Period FORMTEXT       FORMTEXT      This change is requested for the following contract periods: (check all that apply) FORMCHECKBOX Current and all subsequent contract periods. FORMCHECKBOX Year 1 only FORMCHECKBOX Year 2 only FORMCHECKBOX Year 3 only FORMCHECKBOX Year 4 onlyLINE ITEMLATEST APPROVED BUDGETINCREASEDECREASENEW APPROVED LINE ITEM BUDGETNOTE: Total increases and decreases between cost categories must balance. Salaries FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Fringes FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Occupancy FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Communication FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Supplies FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Equipment FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Transportation FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Contracted Services FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Specific Assistance FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Miscellaneous FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Budget Total: FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       LINE ITEM INCREASE(S): State why item(s) being increased must have additional funding. Be specific as to what cost items are affected, whether a cost item is being changed or added to the budget, etc. FORMTEXT      LINE ITEM DECREASE(S): State why line item(s) being decreased will be underspent from projected levels. Be specific as to what cost items are affected whether a cost item is being changed or deleted, etc. FORMTEXT      IMPACT: What impact and impact magnitude will this change have on program performance? How will program be affected if this line item transfer is not approved? FORMTEXT      APPROVAL SECTIONFOR DHS USE ONLYDHS Contract Administrator NameApprovedDeniedDate FORMTEXT       FORMCHECKBOX  FORMCHECKBOX  FORMTEXT      The above request for a line item transfer is approved. The total contract dollar amount has not been affected. If you havequestions, please contact FORMTEXT      at FORMTEXT      DateDCRS Director FORMTEXT      The above request for line item transfer has been denied for the following reason.DateDCRS Director FORMTEXT       LINE ITEM TRANSFERS INSTRUCTIONS1.The contract stipulates that any change of more than 5% or $1,500 (whichever is greater) to a line item must receive the prior approval of the Department of Human Services (DHS). A line item overrun can sometimes be predicted in advance, so prior approval can be requested before a billing statement which exceeds a line item maximum is submitted. Transfers will not be approved after expenditures have already been made. The Contractor cannot be reimbursed for expenses in line items that have $0 (zero) amount in the budget.2.Any increase in a line item must be accompanied by an equal decrease i  f h j ~ " $ & : < > H J L N b d f p r " > jh?JUjJh?JUjh?JUjPh?JUjh?JUjVh?JUjh*WUmHnHujh?JUjh?JU h?J5h?J:6 lff-$IfJkd]$$If940p#L,p#4 9a9f4$If5kd$$If94L,L,4 9a9f4'$If*$If   , F f h PJJJ-$If]kdO$$If94Fp#L,    4 9a9f4$IfJkd$$If940p#L,p#4 9a9f4  " $ L t PJJ-$IfJkd$$If940p#L,p#4 9a9f4$If]kd8$$If94Fp#L,    4 9a9f4t v  D vm -$$Ifa$7kd$$If94L,L,4 9a9f40$IfJkd2$$If940p#L,p#4 9a9f4> @ B   6 8 : T V r t v 4 6   ",.02FHJT{j h?JUj h?JUjh*WUmHnHujl h?JUh?JOJQJ h?J6 h?J5j h*WUj= h*WUjh*WUjUh*WUh?Jjh?JUj,h*WU0  < T x 0$If -$$Ifa$Jkd$$If940L,0*4 9a9f4 4 B99999 0$$Ifa$kd% $$If94ִ 8 &B9!U#L,%    4 9a9f44 6 {u=4u d7kd $$If94L,L,4 9a9f40$Ifkdb $$If94 rp#L,4 9a9f4 0X 2rl0$Ifkd~$$If94rp#L,4 9a9f4 -$$Ifa$ TVXZnpr|~   "$.0HJ^`blnprjh?JUjBh?JUjh?JUjh?JUj'h?JUjh?JUjh?JUjh*WUmHnHuj h?JUh?Jjh?JU724Hp{ullll -$$Ifa$0$Ifkd%$$If94rp#L,4 9a9f4 *,.0DFHRTVXlnpz|~   "$jh?JUjh?JUjh?JUjh?JUjuh?JUjh?JUjah?JUjZh?JUh?Jjh?JUjh*WUmHnHu8.V~{ullll -$$Ifa$0$Ifkd$$If94rp#L,4 9a9f4 2Z{ullll -$$Ifa$0$Ifkds$$If94rp#L,4 9a9f4$.024HJLVXpr 02FHJTVXZnpr|~jjh?JUjh?JUjVh?JUjOh?JUjh?JUj7h?JUjh?JUjh?JUh?Jjh?JUjh*WUmHnHu8Z\p{ullll -$$Ifa$0$Ifkd$$If94rp#L,4 9a9f40X{ullll -$$Ifa$0$Ifkd$$If94rp#L,4 9a9f4 "$8:<FHJL`bdnprt*,.j"h?JUj,"h?JUj!h?JUj h?JUj h?JUjh?JUjh?JUjh?JUh?Jjh?JUjh*WUmHnHu8"Jr{ullll -$$Ifa$0$Ifkdh$$If94rp#L,4 9a9f4<d{ullll -$$Ifa$0$Ifkd!$$If94rp#L,4 9a9f4.8:<>RTV`b $@BVXZdfhj~jd'h?JUj&h?JU h?J5j%h?JUjc%h?JUj$h?JUjK$h?JUjD#h?JUh?Jjh?JUjh*WUmHnHu7df"{ullll -$$Ifa$0$Ifkd#$$If94rp#L,4 9a9f4"$@h{riiii -$$Ifa$ 0$$Ifa$kde&$$If94rp#L,4 9a9f4xz>@TVXbdhtZ~ڷڬڡږjm/h?JUjt,h?JUj+h?JUj)h?JU h?J5h?JOJQJjL(h?JUh?Jjh*WUmHnHujh?JUj'h?JU8vx{rl4.-$If7kdK)$$If94L,L,4 9a9f40$If dkd($$If94rp#L,4 9a9f4<>fhK7kd+$$If94L,L,4 9a9f4-$If7kd*$$If94L,L,4 9a9f40$If7kd6*$$If94L,L,4 9a9f4z 0$$Ifa$0$If7kd,$$If94L,L,4 9a9f4-$If7kd+$$If94L,L,4 9a9f4Z\np~-$If0$If -$$Ifa$$IfJkdM-$$If940L,p#4 9a9f4&hbYSYSb0$If 0$$Ifa$-$Ifkd-$$If94ֈp#L,`%`4 9a9f4"$VXlnpz|frj7h?JUj5h?JUhN 2j3h?JUjE3h?JU h?J5jh*WUmHnHuj0h?JUjW0h*WUh?Jjh?JUj/h*WU8&( "Vhb*b7kd2$$If94L,L,4 9a9f40$IfkdA1$$If94ֈp#L, % 4 9a9f4V~||$Ifpkd14$$If94\ :L, bb4 9a9f40$If-$If]Jkd56$$If940p#L,p#4 9a9f4-$If0$IfJkd5$$If940p#L,p#4 9a9f4pj-$IfJkd57$$If940p#L,p#4 9a9f4$If0$If7kd6$$If94L,L,4 9a9f4(BDJ!!"p r$rxx||}}~~Rpv|N구ܡtgthN 2h?J0J8CJaJ!jhN 2h?J0J8CJUaJhN 2h?JCJaJ hB:hyCCJOJQJ^JaJh?JCJOJQJhh~5CJhhyC5CJhhN 25CJhUh?J5>*CJhh?JOJQJhh?JOJQJh h?Jhh?J5CJhh?Jjh?JU$(BDJ!eXR$If /d$If7kd8$$If4^,|,4 af4 *d$If %d$If dJkdR8$$If940p#L,p#4 9a9f4!!!!!rvpp$If7kd9$$If4^,|,4 af4 $$Ifa$Gkd?9$$If0^,9C*4 an another line item within the contract budget. The increase/decrease can be spread across a number of line items, as long as the total of all decreases equals the total of all increases. Requests which do not balance increases and decreases will be returned unapproved.3.A line item transfer request must be accompanied by an explanation for the change to each line item. All increases and decreases must be explained fully in the appropriate section. Fully explain the cost items within each line item being changed, including reasons why each change is necessary. Add additional pages if provided space is not adequate. Requests for increases in a line item will be judged on the basis of reasonableness and need. Requested decreases will be judged on the basis of the potential for negative impact on quantity or quality of service. Where line items appear to be much larger than contractor needs, the DHS may initiate an amendment to reduce the contract amount to make the excess available to other contractors, rather than transfer the money to other cost categories within the contract for which the transfer is requested.4.Last minute transfers in an obvious attempt to unnecessarily commit funds will not be allowed. Expenditures must be made in accordance with the budget and in accordance with established DHS policy. For instance, if longevity bonuses, merit increases, cost of living allowances, etc., are paid, they must be part of an established personnel policy and be part of the originally approved budget.5.In the Approval Section, the contract administrator should enter his or her name and indicate whether the contract administrator approves or disapproves the request. If the request is approved, it should be forwarded via e-mail to the DHS Division of Contracts and Rate Setting. If it is denied, it should be returned to the contractor.6.This form (CM-4074) is to be used for all line item transfer requests. Please attach the completed CM-4074 to an email, with the contract number in the subject line, and send it to the DCRS mailbox: DHS-DCRS@michigan.gov.AUTHORITY: PA 280 OF 1939 COMPLETION: Mandatory PENALTY: Unable to adjust budget during term of contractDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, 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. 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" i0 NoRese>a# N`a!t0 oWw0 CoStat! ׄ# a~Sa`e#Wu2 rr@1$Cvor8_+s@s$>K_1 $^s_q#Sl2 qPKk0?PCoP2GPS Hidde 0q ms HB\e< v_{3S# y CoI_S)CareOf a)Of" aACA_DateSDYtFRp!_( pxG}5 :cH 8ME " 0Unit" B@ lXPiAttribute VB_Name = "Unit" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:=Endv xG}5:cH 8ME " 0cozip" B@ lXPoAttribute VB_Name = "CoZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cDozEndx xG}5:cH 8ME " 0date1" B@ lXPlAttribute VB_Name = "Date1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="dEndx xG}5:FaxAC U}CareOf cCoCityrCounty cH 8ME " 0FaxAC" B@ lXPjAttribute VB_Name = "FaxAC" Public Sub MAIN() WordBasic.WW7_EditGoTo Destina@tion:=Endx xG}5:cH 8ME " 0careof" B@ lXPqAttribute VB_Name = "CareOf" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coEndz xG}5:cH 8ME " 0cocity" B@ lXPpAttribute VB_Name = "CoCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cocEndz xG}5y:cH 8ME " 0county" B@ lXPnAttribute VB_Name = "County" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=""cEndz HiddenWorkerAddRowsCorrectx5{::v(6 << <^"9$*\Rffff*443922e060 `xp$(Makes the selection hidden text (toggle)TemplateProject.Hidden.MAIN0H@ME "10 0 pt0 pt0dArial B@:lphxAttribute VB_Name = "Hidden" Public Sub MAIN(X) D.nDescription|Makes the selec,h text (toggle)Pro cDataWInvoke_FuncWTemplaTte"jV..JWordBasic.FormatFont Points:="10", Underline:=0, Color@:=9, SkeThrough SuperjFb<:=1mallCap1)ASpacinBg=0 pt>PosiKernMinTabd ArialBoldIIta End xG}5:cH 8ME " 0worker" B@ lXPlAttribute VB_Name = "Worker" Public Sub MAIN() tdBasic.WW7_EditGoTo Destination:="wEndz x5q::(6 << <^"9$*\Rffff*423922e060 `xXp$+Adds row to table FOLLOWING cursor locationTemplateProject.AddRows.MAIN0H@ME "0@ B@ B@lH@Attribute VB_Name = "AddRows" Public Sub MAIN() D.pDescription~s row to table FOLLOWING cursor loca\NProcDataZInvoke_FuncZTemplateA"ject..KWordBasic.LineDown 1 TInserBt Numt:D="Ends x_}5s:{s`  @P ME " V*h    Z@Q This serves as a replacement to the spell checker within a protected documentCheck spelling now? %R'P P B@l B@T B@VX|n B@zhl0Attribute VB_Name = "Correct" Public Sub MAIN() Dim ans Rem This se@rves a replacement to the spell checker within @a proted docu3 ZWordBasic.MsgBox("C?King now ?", 3If4-1en  QATools4UnoDi %St`artOf"S7d>0Pg NoReset:=1, Type:=2 End If xG}5u:cH CoStateNoReset)OtherIDSection8ME "(8costate" B@ lPHqAttribute VB_Name = "CoState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cosEnd|       !"#$%&'()*+-/13579;=?ABCDEFGHIJKLMNPQRSTUVWXYZ[\]_`abcdefghijklnopqrstuvwxyz{|}xG}5w:coH 8ME " <H hx8 This saves as a form without resetting the form fields.5|n B@zX,lAttribute VB_Name = "NoReset" Public Sub MAIN() Rem This saves a form without rztin g the4fields. WordBasic.ToolsProtectDocument ~:=1, Ty pe:=2End xG}5i:cH 8ME "(8otherid" B@ lPHsAttribute VB_Name = "OtherID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=$"oidEnd| xG}5k:cH 8ME "(8Section" B@ lPHjAttribute VB_Name = "Section" Public Sub MAIN() WordBasic.WW7_EditGoTo Desti$nar:=End| rU __SRP_0__SRP_1__SRP_4,T__SRP_5.mK)^  ))0033rU~~~~~~~~~~~~~~Z O&Og5T  9 A!I q 9a 1Y )Ii )Ii  )Iay   !9Qi y i QFORMPORT ThisDocumentTemplateProjectModule1SuperPhoneNumberInsertCisAddressGranteeFirstNameWorkerExtensionGranteeLastNameGranteeClientIDGranteeAddress1AddChildInfoRowWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral SvcRefHeading SuperAreaCode GranteeCareof CoSuppaddress CoPhoneNumber ClearCaseInfo NewParagraph GranteeState countynumber WorkerPhone GranteeCity CoExtension ClientState WorkerName GranteeZip CountyName CoAreaCode ClientCity CaseNumber WorkerFax RemoveRow lastname2 FirstName CoAddress ClientZipRowBreakLastNameDistrictCaseInfoAddress1SectionOtherIDNoResetCoStateCorrectAddRowsWorkerMyInfoHiddenCountyCoCityCareOfFaxACDate1CoZipUnitF=C:\Program Files\Common Files\Microsoft Shared\VBA\VBA332.dllVBA  y ( F4C:\Program Files\Microsoft Office\Office\MSWORD8.OLBWord   80FC:\WINNT\System32\StdOle2.tlbstdole  a H}~=&C:\WINNT\System32\MSForms.TWDMSForms  Q X.E .`M }~=&C:\TEMP\VBE\MSForms.EXD  Q hL-[DR 2C:\Program Files\Microsoft Office\Office\MSO97.DLLOffice  9xMAIN $    =Retrieves CIS Client address info from c:\glwin\cistowrd.ini %TemplateProject.InsertCisAddress.MAIN -Adds a row and fields for A. Service Referral #TemplateProject.AddSvcReferral.MAINEnter Personal InformationTemplateProject.CaseInfo.MAIN +Adds row to table FOLLOWING cursor locationTemplateProject.AddRows.MAINTemplateProject.MyInfo.MAIN (Makes the selection hidden text (toggle)TemplateProject.Hidden.MAINrU~} krU $`Ap__SRP_60T__SRP_72m__SRP_84T__SRP_9#6mrU~} krU $`9prU~} krU $`p__SRP_c8T__SRP_d ":m__SRP_e<T__SRP_f!%>erU~}  krU $ `iprU~} krU $`pAddress1@CaseInfo$&!DistrictOLastName7^xG}5m:cH 8ME "(8Address1" B@ lPHnAttribute VB_Name = "Address1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:"= End~     $1 !"#%-&'()*+,.6/02]3457X8S:;<=>?@ABCDEFGHIJKLMNOPQRTUVWYgZ[\^p_`abcdefhsijklmnoqrt~uvwxyz{|}x65o:R(6 << <^"9$*\Rffff*413922e060 `bb@ PPxPa P 8P P P.PI#P@ Y%`, a$Enter Personal InformationTemplateProject.CaseInfo.MAINh`MEc " (08@HPX `"& (&0(X&(&&& $H Np*,* .P*,44.P   <FHXFJF8HLLHh 2 & FHHFJ Fp H L LP H " B DX B F B0 Dx H H DP " 6 : B8>6:N8NB 4 X` p Z@ZXZpZZZZZZZZ0OPEN FCTPSA TOOLBAR B@  FCTPSA Tools " B@DEFINE DIALOG BOXF,CaseInfo B@$  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@f# FC Case No.: B@f; FC Case Name: B@fR FC Load No.: B@fk FC Worker Name: B@f PS Case No.: B@f PS Case Name: B@f Household Ass'd Last: B@f Household Ass'd First: B@f Date Completed: B@f,X B@( B@*ZHE !.!0.,6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXUserInfoFCCaseNoC:\Windows\CaseInfo.ini %Z ,(2UserInfo FCCaseNameC:\Windows\CaseInfo.ini %Z ,(4UserInfoFCLoadNoC:\Windows\CaseInfo.ini %Z ,(6UserInfo FCWorkerNameC:\Windows\CaseInfo.ini %Z ,(8UserInfoPSCaseNoC:\Windows\CaseInfo.ini %Z ,(:UserInfo PSCaseNameC:\Windows\CaseInfo.ini %Z ,(<UserInfo HouseholdLastC:\Windows\CaseInfo.ini %Z ,(>UserInfoHouseholdFirstC:\Windows\CaseInfo.ini %Z ,(@UserInfo DCompletedC:\Windows\CaseInfo.ini %Z ,(B,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT , !D%0'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoFCCaseNo ,!2C:\Windows\CaseInfo.ini B@FUserInfo FCCaseName ,!4C:\Windows\CaseInfo.ini B@FUserInfoFCLoadNo ,!6C:\Windows\CaseInfo.ini B@FUserInfo FCWorkerName ,!8C:\Windows\CaseInfo.ini B@FUserInfoPSCaseNo ,!:C:\Windows\CaseInfo.ini B@FUserInfo PSCaseName ,!<C:\Windows\CaseInfo.ini B@FUserInfo HouseholdLast ,!>C:\Windows\CaseInfo.ini B@FUserInfoHouseholdFirst ,!@C:\Windows\CaseInfo.ini B@FUserInfo DCompleted ,!BC:\Windows\CaseInfo.ini B@FGet user info from INI fileUserInfoFCCaseNoC:\Windows\CaseInfo.ini %Z' UserInfo FCCaseNameC:\Windows\CaseInfo.ini %Z' UserInfoFCLoadNoC:\Windows\CaseInfo.ini %Z' UserInfo FCWorkerNameC:\Windows\CaseInfo.ini %Z' UserInfoPSCaseNoC:\Windows\CaseInfo.ini %Z' UserInfo PSCaseNameC:\Windows\CaseInfo.ini %Z' UserInfo HouseholdLastC:\Windows\CaseInfo.ini %Z' UserInfoHouseholdFirstC:\Windows\CaseInfo.ini %Z' UserInfo DCompletedC:\Windows\CaseInfo.ini %Z'  Update Form with user infoFCCASENO %\FFCCASENO  B@^g FCCASENAME %\F FCCASENAME  B@^gFCWORKERLOADNO %\FFCWORKERLOADNO  B@^g FCWORKERNAME %\F FCWORKERNAME  B@^gPSCASENO %\FPSCASENO  B@^g PSCASENAME %\F PSCASENAME  B@^gHOUSEHOLDASSESSEDLST %\FHOUSEHOLDASSESSEDLST  B@^gHOUSEHOLDASSESSEDFST %\FHOUSEHOLDASSESSEDFST  B@^g DATECOMPLETED %\F DATECOMPLETED  B@^g. Update other Form Fields on Form & Exit Macroa B@H'hxlphmAttribute 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?@ABDEFGHIJKLMNOPQSTUVWXYZ[\]^_`bcdefghijklmnoqrstuvwxyz{|}~xG}5W:cH 8ME "(8 coareacode" B@ lPHxAttribute VB_Name = "CoAreaCode" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coa"cEnd xG}5I:cH 8ME "(8 countyname" B@ lPHuAttribute VB_Name = "Countyh" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=4"cnEnd xG}5K:cH 8ME "(8 GranteeZip" B@  6lPHpAttribute VB_Name = "GranteeZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End xG}5M:WorkerName%ClientState464CoExtensionCGranteeCity/?RcH 8ME "(8 workername" B@  lPHtAttribute VB_Name = "Workerh" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wnEnd xG}5O:cH 8ME "(8 clientstate" B@ lPHvAttribute VB_Name = "ClientState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="csEnd xG}5A:cH 8ME "(8 coextension" B@ lPHtAttribute VB_Name = "CoExtension" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinatr@:="coeEnd xG}5C:cH 8ME "(8 GranteeCity" B@ lPHqAttribute VB_Name = "GranteeCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End xG}5E:cH WorkerPhoneacountynumber8:pGranteeStateNewParagraph9=X8ME "(8 workerphone" B@ lPHuAttribute VB_Name = "WorkerPhone" Public Sub MAIN() dBasic.WW7_EditGoTo DestinationP:="wpEnd xG}5G:cH 8ME "(8 Countynumber" B@ lPHtAttribute VB_Name = "countynumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="C End xG}55cH 8ME "(8 GranteeState" B@ lPHrAttribute VB_Name = "GranteeState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:= End xG}55cH 8ME " (@`px B@ B@l $ B@vi|n B@z B@lŰAttribute VB_Name = "NewParagraph" Public Sub MAIN() WordBasic.ScreenUpdating 0 >ToolsUnprotectDo@cument Insert Chr(13[?P = NoReset:=1, Type:=2 QCharRight 1 End ThisDocument_VBA_PROJECT<>92ClearCaseInfoPCoPhoneNumber;Cx55# (SLSS<N0{00020906-0000-0000-C000-000000000046}8(Sw$HMExAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |CreatablFalse ^PredeclaIdTru "@ExposeTemplateD0eriv$eCustomiz2a^  *\G{000204EF-0000-0000-C000-000000000046}#3.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA332.dll#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.0#409#C:\Program Files\Microsoft Office\Office\MSWORD8.OLB#Microsoft Word 8.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINNT\System32\StdOle2.tlb#OLE Automation*\G{7C79B5C0-E6E6-11D2-9439-0000C01A86E5}#2.0#0#C:\WINNT\System32\MSForms.TWD#Microsoft Forms 2.0 Object Library*\G{7DA3FC93-E07E-11D2-85DB-000502AE3D26}#2.0#0#C:\TEMP\VBE\MSForms.EXD#Microsoft Forms 2.0 Object Library.E .`M *\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.0#0#C:\Program Files\Microsoft Office\Office\MSO97.DLL#Microsoft Office 8.0 Object Library9^"9,2! )0$/-13'54+87659ThisDocument 43922e05e*D5 SuperPhoneNumber 53922e05e*D5Unit 3e3922e060*D2 :p GranteeFirstName 73922e05f*D`5HWorkerExtension 83922e05f*Db5`GranteeLastName 93922e05f*Dd5xGranteeClientID a3922e05f*Df5GranteeAddress1 b3922e05f*Dh5AddChildInfoRow e3a66f0b3*Dj5|.WorkerAreaCode d3922e05f*D~5SupervisorName e3922e05f*D5SuperExtention f3922e05f*D5AddSvcReferral 403922e060*D5 V#SvcRefHeading 113922e05f*D58 SuperAreaCode 123922e05f*D5PGranteeCareof 133922e05f*D5h CoSuppaddress 143922e05f*D5 CoPhoneNumber 153922e05f*D5 ClearCaseInfo 163922e05f*D5NewParagraph 173922e05f*D5GranteeState 183922e05f*D5countynumber 193922e05f*DNG:WorkerPhone 1a3922e05f*DE:GranteeCity 1b3922e05f*DC:(CoExtension 1c3922e05f*DA:@ClientState 1d3922e05f*DVO:XWorkerName 1e3922e05f*D&M:pGranteeZip 1f3922e05f*DK:CountyName 203922e05f*D,I: CoAreaCode 213922e05f*DW:ClientCity 223922e05f*DTU:CaseNumber 233922e05f*DLS:WorkerFax 243922e05f*DQ:RemoveRow 253922e05f*D_:klastname2 263922e05f*D]:0FirstName 273922e05f*DH[:HCoAddress 283922e05f*DY:`ClientZip 293922e05f*DXg:xRowBreak 2a3922e05f*De:GLastName 2b3922e05f*DJc:District 2c3922e05f*D.a:CaseInfo 413922e060*Do:"Address1 2e3922e05f*DRm:Section 2f3922e05f*D0k:OtherID 303922e05f*DJi: NoReset 313922e060*D|w:8oCoState 323922e060*DLu:PCorrect 333922e060*DNs:hsAddRows 423922e060*DXq:% Worker 353922e060*D4:& CoZip 3d3922e060*D:X Hidden 443922e060*D{:v( County 383922e060*Dy: CoCity 393922e060*D:* CareOf 3a3922e060*DP: FaxAC 3b3922e060*Dd:( Date1 3c3922e060*D:@0(pX@Hx`hP8 (pX@H0x`hP8 '3+=&'3+=&=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&'3+=&(3+=&(3+=&(3+=&(3+=&(3+=& (3+=& (3+=&(3+=&(3+=&(3+=&(3+=&(3+=&(3+=&(3+=&(3+=&(3+=& (3+=&"(3+=&$(3+=&&(3+=&((3+=&*(3+=&,(3+=&.(3+=&0(3+=&2(3+=&4(3+=&6(3+=&8(3+=&:(3+=&=&>(3+=&@(3+=&B(3+=&D(3+=&F(3+=&H(3+=&J(3+=&L(3+=&pHGREMWordkVBAWin16~Win32MacFORMPORT stdole`MSFormsC ThisDocument< _EvaluateOfficeuTemplateProjectEModule1bSuperPhoneNumber\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 RemoveRow0^TableDeleteRowA 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 YourStateYourZipYourCOYourDIYourSECvYourUNVYourWKRnHidden] FormatFont&Points UnderlineColor2F StrikeThrough" Superscript SubscriptV SmallCaps~cAllCapss_SpacingSPositionKerningB KerningMin1FontUBoldItalic!CountyG8CoCityr7Date11CoZip0Documentj)  '-/(1+351I#K'+M)K,(O*Q6,S*-U.W/Y%0M.1O/2Y03a4c5e6g7i8k9e7:}-; B C D E FU3GTVWX4Y5f8g2hinqrstu v!w"x$z&{|~xG}55cH 8ME "&   c:\windows\ caseinfo.inif B@c:\windows\caseinfo.ini B@lH@EAttribute VB_Name = "ClearCaseInfo" Public Sub MAIN() WordBasic.File@Find Slch:=" ",! Path c:\wJows\4Jceie.ini0ubDir:=0, Title6Autho" Keywysject Option=`MatchKex#ternDateSavedFrom# LToByC?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghijklmnoprstuvwxyz{|}~H 8ME " (8 superareacode" B@ lPH}Attribute VB_Name = "SuperAreaCode" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="sacEnd xG}55c H ?8ME@ "  (@2P  2  2 P ` p2   2  0 @2P   2   2  X h2x   4  ( 84H     0 HXh4x 4( B@l B@i B@ B@xsvcrefh1rtv B@px B@ B@nsvcrefh2rtv B@p B@ B@! B@nsvcrefh3rtv B@p B@ B@ B@nsvcrefh4rtv B@p B@ B@ B@nsvcrefh5rtv B@p B@ B@ B@nsvcrefh6rtv B@p B@ B@ B@nsvcrefh7rtv B@p B@ B@ B@nsvcrefh8rtv B@p B@ B@nsvcrefh9rtv B@p B@ B@ B@n svcrefh10rtv B@p B@ B@ B@n svcrefh11rtv B@p B@ B@Add Instruction Row B@ B@ B@x B@ B@ B@n  B@ B@ B@ B@x SvcRefH12rtv B@p B@n svcrefH13rtv B@p|n B@zlAttribute VB_Name = "SvcRefHeading" Public Sub MAIN() WordBasic.ToolsUnprotectDocu@ment Ba@bleSelf2c33c34c3567CharLeft( 30RP N@oReset, Type:=2 EndA xG}55cH 8ME ""0@GranteeAddress1" B@ lH@uAttribute VB_Name = "GranteeAddress1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End xG}55cH 8ME ""0@GranteeClientID" B@ `lH@uAttribute VB_Name = "GranteeClientID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End xG}55cH %8ME ""0@granteelastname" B@ lH@~Attribute VB_Name = "GranteeLast" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="glnEnd xG}55cWorkerExtension GranteeFirstName"LNSuperPhoneNumber"PROJECTPYH 8ME ""0@workerextension" B@ lH@xAttribute VB_Name = "WorkerExtension" Public Sub MAIN() dBasic.WW7_EditGoTo DestinaBtr:="weEnd xG}55cH 8ME ""0@granteefirstname" B@ lH@Attribute VB_Name = "GranteeFirstL" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="g5fnEnd       !"#$%&'()*+,-./0123456789:<xG}55cH lect8ME ""0@superphonenumber" B@ 01-lH@Attribute VB_Name = "SuperPhoneNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="spnEnd ID="{33DC284E-2BF9-11D4-8896-000502AE3D26}" Document=ThisDocument/&H00000000 Module=SuperPhoneNumber 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=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 Name="TemplateProject" HelpContextID="0" CMG="7C7EC8D858C65CC65CC65CC65C" DPB="6664D2F256364137413741" GC="5052E407E507E5F8" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 ThisDocumentThisDocumentSuperPhoneNumberSuperPhoneNumberGranteeFirstNameGranteeFirstNameWorkerExtensionWorkerExtensionGraPROJECTwmsCompObj;jnteeLastNameGranteeLastNameGranteeClientIDGranteeClientIDGranteeAddress1GranteeAddress1AddChildInfoRowAddChildInfoRowWorkerAreaCodeWorkerAreaCodeSupervisorNameSupervisorNameSuperExtentionSuperExtentionAddSvcReferralAddSvcReferralSvcRefHeadingSvcRefHeadingSuperAreaCodeSuperAreaCodeGranteeCareofGranteeCareofCoSuppaddressCoSuppaddressCoPhoneNumberCoPhoneNumberClearCaseInfoClearCaseInfoNewParagraphNewParagraphGranteeStateGranteeStatecountynumbercountynumberWorkerPhoneWorkerPhoneGranteeCityGranteeCityCoExtensionCoExtensionClientStateClientStateWorkerNameWorkerNameGranteeZipGranteeZipCountyNameCountyNameCoAreaCodeCoAreaCodeClientCityClientCityCaseNumberCaseNumberWorkerFaxWorkerFaxRemoveRowRemoveRowlastname2lastname2FirstNameFirstNameCoAddressCoAddressClientZipClientZipRowBreakRowBreakLastNameLastNameDistrictDistrictCaseInfoCaseInfoAddress1Address1SectionSectionOtherIDOtherIDNoResetNoResetCoStateCoStateCorrectCorrectAddRowsAddRowsWorkerWorkerHiddenHiddenCountyCountyCoCityCoCityCareOfCareOfFaxACFaxACDate1Date1CoZipCoZipUnitUnit  FMicrosoft Word Document MSWordDocWord.Document.89q @ bjbj5*5* W@W@i"i"׋̕̕P$,RҚҚҚҚҚ"|pXZZZZZZ$Ro~-0ҚҚ00~ҚҚ0000ҚҚX00X00S0Қt ``׋00L 00o0o0o000000000~~$׋0׋ 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        FORMTE(*8:<PRTZ\^`tvĝƝԝ֝؝ "68FHJxjh5UjHhUj\GhUjFhUj!FhUjEhUjDhUjhUmHnHujIDhUj|ChUhjhUjBhU.:^֝ Hjܞ(Pxȟ@bڨ[ZYXWVUTSRQPONMLKJIHGFEDJ^`bfhjlОҞԞ؞ڞܞޞ&(*>@NPRfнвȤЙȤЎȤЃxjLhUjKhUjwKhUjJhUjhUmHnHuj JhUjZIhUjhUhjh5UmHnHujh5UjHh5U h5,fhvxzƟȟʟޟ.0>@BVX`bdxzȨj/ShUjwRhUjQhUjGQhUjPhUUjhUmHnHujOhUjDFHJ^`npr©֩ةکީjXhUjXhUjWhUjVhUj2VhUjnUhUjhUmHnHujThUj9ThUhjhUjShU3ڨ$Hp(PxȪjihgfedcba`_^]\$&(*>@NPRfhvxzĪƪȪʪު j;]hUj\hUj[hUj([hUjZhUj'ZhUjhUmHnHujyYhUhjhU)/ =!"#$%fice/Unit name.DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite 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 CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond8(OJQJ_HmH sH tH XOX CaseNumber1?d8(OJQJ_HmH sH tH XOX ClientCity1@d8(OJQJ_HmH sH tH ZOZ ClientState1Ad8(OJQJ_HmH sH tH ZO"Z ClientZip1BdtCJOJQJ_HmH sH tH VO2V CoAddress1Cd8(OJQJ_HmH sH tH XOBX CoAreaCode1 Dd`CJOJQJ_HmH sH tH PORP CoCity1Ed8(OJQJ_HmH sH tH ZObZ CoExtension1Fd8(OJQJ_HmH sH tH ^Or^ CoPhoneNumber1Gd8(OJQJ_HmH sH tH ROR CoState1Hd8(OJQJ_HmH sH tH ^O^ CoSuppaddress1Id8(OJQJ_HmH sH tH XOX CountyName1Jd8(OJQJ_HmH sH tH \O\ CountyNumber1 Kd`CJOJQJ_HmH sH tH ROR CoZip1LdtCJOJQJ_HmH sH tH NON Date11 Md`CJOJQJ_HmH sH tH TOT District2 Nd`CJOJQJ_HmH sH tH LOL FaxAC Od`CJOJQJ_HmH sH tH VOV FirstName1Pd8(OJQJ_HmH sH tH XOX FirstName21Qd8(OJQJ_HmH sH tH `O"` GranteeAddress1 Rd`CJOJQJ_HmH sH tH \O2\ GranteeCareof Sd`CJOJQJ_HmH sH tH XOBX GranteeCity Td`CJOJQJ_HmH sH tH `OR` GranteeClientID Ud`CJOJQJ_HmH sH tH dObd GranteeFirstName2 Vd`CJOJQJ_HmH sH tH bOrb GranteeLastName1Wd8(OJQJ_HmH sH tH ZOZ GranteeState Xd`CJOJQJ_HmH sH tH VOV GranteeZip Yd`CJOJQJ_HmH sH tH TOT LastName1Zd8(OJQJ_HmH sH tH VOV LastName21[d8(OJQJ_HmH sH tH ROR OtherID1\d8(OJQJ_HmH sH tH ROR Section2 ]d`CJOJQJ_HmH sH tH ^O^ SuperAreaCode1 ^d`CJOJQJ_HmH sH tH `O` SuperExtension1_d8(OJQJ_HmH sH tH dOd SuperPhoneNumber1`d8(OJQJ_HmH sH tH `O` SupervisorName1ad8(OJQJ_HmH sH tH LO"L Unit2 bd`CJOJQJ_HmH sH tH PO2P Worker2 cd`CJOJQJ_HmH sH tH `OB` WorkerAreaCode1 dd`CJOJQJ_HmH sH tH bORb WorkerExtension1ed8(OJQJ_HmH sH tH TObT WorkerFax fd`CJOJQJ_HmH sH tH XOrX WorkerName1gd8(OJQJ_HmH sH tH \O\ WorkerName2hd8(5OJQJ_HmH sH tH ZOZ WorkerPhone1id8(OJQJ_HmH sH tH ^O^ WorkerTitle1jd8(5OJQJ_HmH sH tH }A0@/Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherID Section! SuperAreaCode"SuperExtension#SuperPhoneNumber$SupervisorName%Unit&Worker'WorkerAreaCode(WorkerExtension) WorkerFax* WorkerName+ WorkerName2, WorkerPhone- WorkerTitle./Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstName1GranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle(<Pdu$5I]n  1EYm(<Pdx> T$.JfȨ!$'*05IPRSVX t 4 2Zd"&V!rx{~t:ڨ "#%&()+,-./123467CDEFGHQW  &(4:<HNP\bdpsu"$035AGIU[]ilnz~   ,/1=CEQWYekmy &(4:<HNP\bdpvxFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF/Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipdate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle)=Qev%6J^o !2FZn)=Qey  !"#$%&'()*+,-.';Oct#4H\m 0DXl';Ocw@kpukk(UnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New5& zaTahoma"h0@?