ࡱ>   @ Vzbjbjqq \DH6" " " 8DD lZ *******+\a/\105))))))$RjM`6++`6`6M****fSSS`6****S`6SSUV**< @&=n" dH VW>|0V Q (V Vp23SG4t4222MM DS  Case NameCHILD PLACING AGENCY FORMTEXT      CASE REPORTCase NumberLog NumberMichigan Department of Human Services FORMTEXT       FORMTEXT      Telephone Number( FORMTEXT    ) FORMTEXT      Please complete this form in detail. Indicate any discrepancy noted.DHS Worker Name FORMTEXT      *Refer to data code sheet at end of form.POS Worker Name FORMTEXT      Contract AgencyLocal DHS Office FORMTEXT       FORMTEXT      A. CHILD INFORMATIONLast NameFirst NameMiddle Name FORMTEXT       FORMTEXT       FORMTEXT      AKA NameSocial Security #Client ID Number FORMTEXT       FORMTEXT       FORMTEXT      SexDate of BirthWas Date of Birth Estimated? FORMCHECKBOX FEMALE FORMCHECKBOX MALE FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOReligionPreviously Adopted?Age at Adoption FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOIf Yes Complete Section B FORMTEXT     FORMCHECKBOX MOS FORMCHECKBOX YRLanguage FORMTEXT      Is this child a US Citizen or Qualified Alien?Alien Status Code FORMCHECKBOX YES FORMCHECKBOX NO FORMTEXT      Race/SovereigntyMigrant Status FORMTEXT       FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOMultiple Race Codes:SECONDARY RACE  1st FORMTEXT      SECONDARY RACE  3rd FORMTEXT      SECONDARY RACE  2nd FORMTEXT      SECONDARY RACE  4th  FORMTEXT      Hispanic or Latino Ethnicity* FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX UNABLE TO DETERMINE Has the question been asked  does this child have any North American Indian heritage ? FORMCHECKBOX YES FORMCHECKBOX NOTribal DocumentationTribe FORMCHECKBOX Pending FORMCHECKBOX Verified FORMCHECKBOX None FORMTEXT      RECOMMENDED TYPE OF FOSTER HOME:TYPE# OF PARENTSCOED FORMCHECKBOX Family FORMCHECKBOX Group FORMCHECKBOX Other FORMCHECKBOX One Parent FORMCHECKBOX Two Parents FORMCHECKBOX Yes FORMCHECKBOX NoCARETAKER FAMILY STRUCTURE AT TIME OF REMOVAL FORMCHECKBOX Married Couple FORMCHECKBOX Unmarried Couple FORMCHECKBOX Single Female FORMCHECKBOX Single Male FORMCHECKBOX Unable to DetermineBiological Father is Known  FORMCHECKBOX  Yes  FORMCHECKBOX  NoBiological Mother is Known  FORMCHECKBOX  Yes  FORMCHECKBOX  NoChild has known relatives  FORMCHECKBOX  Yes  FORMCHECKBOX  NoChild is attending school  FORMCHECKBOX  Yes  FORMCHECKBOX  NoDESCRIPTION OF DISABILITIES:Has child ever been diagnosed with any of the following disabilities? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Emotionally Impaired FORMCHECKBOX Mentally Impaired FORMCHECKBOX Other Medically Diagnosed Condition FORMCHECKBOX Physically Disabled FORMCHECKBOX Visually Impaired FORMCHECKBOX Hearing Impaired FORMCHECKBOX Specific Learning Disability FORMCHECKBOX Speech and Language FORMCHECKBOX Not Yet Determined Case Name REF CaseName  B. PREVIOUS ADOPTION INFORMATIONDate of Adoptive PlacementWas dated estimated? FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOType of Adoption FORMCHECKBOX DOMESTIC FORMCHECKBOX FOREIGNAgency Handling AdoptionIf out of state agency, which state? FORMTEXT       FORMTEXT      Disrupted prior to finalization? FORMCHECKBOX YES FORMCHECKBOX NO FORMCHECKBOX STILL INTACTIf yes, Date of DisruptionWas date estimated? FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOIf no, Date of FinalizationWas date estimated?Date of DissolutionWas date estimated? FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NO FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NOReason for Disruption or Dissolution FORMCHECKBOX Parent/child conflict or interaction FORMCHECKBOX Attachment difficulties FORMCHECKBOX Sibling conflict FORMCHECKBOX Relationship between child and birth parents FORMCHECKBOX Childs behavior, constitution or personality FORMCHECKBOX Adoptive parents marriage or relationship FORMCHECKBOX Neighborhood conflict FORMCHECKBOX Extended family conflict FORMCHECKBOX Lack of post-adoption services FORMCHECKBOX Other (Specify) FORMTEXT      If still intact, Date of Finalization:Was date estimated? FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NODepartment of Human Services (DHS) will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, sexual orientation, 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. Case Name REF CaseName  Attach additional copies of this page as needed.C. MEMBER DATA TEMPLATE(1): Complete for each parent and each adult member.NameRelationship to Child FORMTEXT       FORMTEXT      Address FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT      CountryPhone NumberAlt. Phone Number FORMTEXT      ( FORMTEXT    ) FORMTEXT      ( FORMTEXT    ) FORMTEXT      SexDate of Birth(Date of Birth ESTLegal Parent of Child FORMCHECKBOX MALE FORMCHECKBOX FEMALE FORMTEXT       FORMCHECKBOX  YES FORMCHECKBOX NO FORMCHECKBOX  YES FORMCHECKBOX NOMarital Status*Was mother married at time of child s birth? FORMTEXT       FORMCHECKBOX  YES FORMCHECKBOX NO FORMCHECKBOX Unable to DetermineSocial Security NumberReligion FORMTEXT       FORMTEXT      LanguageEducation FORMTEXT       FORMTEXT      OccupationRace(s) FORMTEXT       FORMTEXT      At the time of removal was the youth living with this person? FORMCHECKBOX  YES FORMCHECKBOX NO(If yes, continueDoes this person have primary caretaking responsibilities? FORMCHECKBOX  YES FORMCHECKBOX NODoes this person have secondary caretaker responsibilities? FORMCHECKBOX  YES FORMCHECKBOX NODoes this person show an active interest in the ward? FORMCHECKBOX  YES FORMCHECKBOX NOIs this person to be contacted in case of an emergency? FORMCHECKBOX  YES FORMCHECKBOX NOBefore removal, did this person have legal custody? FORMCHECKBOX  YES FORMCHECKBOX NO***COMPLETE THIS SECTION FOR LEGAL PARENTS ONLYGovernment BenefitsDeceased?Date of Death FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      Retired?Date of Retirement FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      DisabledDate of Disability FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      VeteranDate of Service FORMCHECKBOX YES FORMCHECKBOX NO IF YES(FROM FORMTEXT      TO FORMTEXT       Case Name REF CaseName  Attach additional copies of this page as needed.C. MEMBER DATA TEMPLATE(2): Complete for each Parent and each adult member.NameRelationship to Child FORMTEXT       FORMTEXT      Address FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT      CountryPhone NumberAlt. Phone Number FORMTEXT      ( FORMTEXT    ) FORMTEXT      ( FORMTEXT    ) FORMTEXT      SexDate of Birth(Date of Birth ESTLegal Parent of Child FORMCHECKBOX MALE FORMCHECKBOX FEMALE FORMTEXT       FORMCHECKBOX  YES FORMCHECKBOX NO FORMCHECKBOX  YES FORMCHECKBOX NOMarital Status*Was mother married at time of child s birth? FORMTEXT       FORMCHECKBOX  YES FORMCHECKBOX NO FORMCHECKBOX Unable to DetermineSocial Security NumberReligion FORMTEXT       FORMTEXT      LanguageEducation FORMTEXT       FORMTEXT      OccupationRace(s) FORMTEXT       FORMTEXT      At the time of removal was the youth living with this person? FORMCHECKBOX  YES FORMCHECKBOX NO(If yes, continueDoes this person have primary caretaking responsibilities? FORMCHECKBOX  YES FORMCHECKBOX NODoes this person have secondary caretaker responsibilities? FORMCHECKBOX  YES FORMCHECKBOX NODoes this person show an active interest in the ward? FORMCHECKBOX  YES FORMCHECKBOX NOIs this person to be contacted in case of an emergency? FORMCHECKBOX  YES FORMCHECKBOX NOBefore removal, did this person have legal custody? FORMCHECKBOX  YES FORMCHECKBOX NO***COMPLETE THIS SECTION FOR LEGAL PARENTS ONLYGovernment BenefitsDeceased?Date of Death FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      Retired?Date of Retirement FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      DisabledDate of Disability FORMCHECKBOX YES FORMCHECKBOX NO IF YES( FORMTEXT      VeteranDate of Service FORMCHECKBOX YES FORMCHECKBOX NO IF YES(FROM FORMTEXT      TO FORMTEXT       Case Name REF CaseName  D. FUNDING SOURCE DATA:Did the youth live with a parent, stepparent, grandparent, brother, sister, aunt, uncle, niece, nephew, or cousin at the time of court action? FORMCHECKBOX YES FORMCHECKBOX NOIf Yes, NameRelationship FORMTEXT       FORMTEXT      If no, if youth did not live with a specified relative at time of court action, did youth live with a specified relative six months prior to court action? FORMCHECKBOX YES FORMCHECKBOX NOIf yes, NameRelationshipDate Left Home FORMTEXT       FORMTEXT       FORMTEXT      YOUTH LIVING WITH ONE PARENT:Primary reason other parent is absent: FORMCHECKBOX Divorce Pending FORMCHECKBOX Separation FORMCHECKBOX Divorced FORMCHECKBOX Imprisonment FORMCHECKBOX Single/Unmarried FORMCHECKBOX Institutionalized FORMCHECKBOX Deserted FORMCHECKBOX DeceasedABSENT PARENT FORMCHECKBOX Father FORMCHECKBOX MotherLastFirstMI FORMTEXT       FORMTEXT       FORMTEXT  Address FORMTEXT      CityStateZipPhone FORMTEXT       FORMTEXT       FORMTEXT      ( FORMTEXT    ) FORMTEXT      YOUTH LIVING WITH BOTH PARENTSAre one or both parents too sick to work?  FORMCHECKBOX YES FORMCHECKBOX NO  If no; skip If yes, list belowFather s Type of DisabilityExpected Duration of Disability FORMTEXT       FORMCHECKBOX SSI FORMCHECKBOX RSDI FORMCHECKBOX Physician StatementMother s Type of DisabilityExpected Duration of Disability FORMTEXT       FORMCHECKBOX SSI FORMCHECKBOX RSDI FORMCHECKBOX Physician StatementParents Income and Employment Which parent earned the greater amount of money during the 24 month period prior to filing of petition? FORMCHECKBOX Father FORMCHECKBOX MotherDid parent work less than 100 hours in the calendar month the petition was filed? FORMCHECKBOX Yes FORMCHECKBOX NoDoes that parent receive unemployment compensation? FORMCHECKBOX Yes FORMCHECKBOX NoDid that parent receive unemployment compensation during the 12 month period prior to the filing of the petition? FORMCHECKBOX Yes FORMCHECKBOX YesDid that parent work at least 6 quarters of the last 3 and a quarter (3) years preceding the filing of the petition? FORMCHECKBOX Yes FORMCHECKBOX No Case Name REF CaseName  YOUTH LIVING WITH BOTH PARENTS: Parents Recent Work HistoryPlace of EmploymentEmployment Start DateEmployment End Date FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Use these sections to add information regarding earned income of the parent(s) or a sibling 16 years or older living in the home who is working and not attending school. Only report income that was received the month the removal order was issued. (Income for the entire calendar month must be listed.)INCOME DETAILS: List persons with earned income: (Use Attachment for Additional Detail)Last NameFirstMI FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT       FORMTEXT   FORMTEXT       FORMTEXT       FORMTEXT   List by pay date the amounts of income received during the month for which the removal order was issued for each employed member.INCOME DETAILS  EARNED INCOMENameCheck DateCheck Amount FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      (Use additional sheet[s] if necessary.) Case Name REF CaseName  DAY CARE EXPENSES PAID BY THE PARENT FOR DEPENDENTS DURING THE MONTH THAT THE REMOVAL PETITION WAS FILEDIndicate number of dependents under age 2 yearsIndicate number of dependents ages 2 to 14 years FORMTEXT FH\^`jl     ( * , . 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In $Between 2 to 14 yrs. In $1. $ FORMTEXT      6. $ FORMTEXT      1. $ FORMTEXT      7. $ FORMTEXT      2. $ FORMTEXT      7. $ FORMTEXT      2. $ FORMTEXT      8. $ FORMTEXT      3. $ FORMTEXT      8. $ FORMTEXT      3. $ FORMTEXT      9. $ FORMTEXT      4. $ FORMTEXT      9. $ FORMTEXT      4. $ FORMTEXT      10. $ FORMTEXT      5. $ FORMTEXT      10. $ FORMTEXT      5. $ FORMTEXT      11. $ FORMTEXT      6. $ FORMTEXT      12. $ FORMTEXT      ASSET DETAIL: This section must be completed for funding determinationVehicles -Value of Primary VehicleValue of Vehicle  2Value of Vehicle  3Value of Vehicle - 4$ FORMTEXT      $ FORMTEXT      $ FORMTEXT      $ FORMTEXT      Value Amount for Entire FamilyValue Amount Available to Youth for His/Her Use FORMCHECKBOX Real Estate (non Homestead)$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Social Security  Lump Settlement$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Trust Funds$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Saving and/or Checking Accounts$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Cash on Hand or Held by Another$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Stocks and/or Bonds$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Life Insurance Policies (Cash or Loan Value)$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Motorcycles, Boats, Snowmobiles, Campers, etc.$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Other (Specify) FORMTEXT      $ FORMTEXT      $ FORMTEXT      UNEARNED INCOMEMonthly Amount Available To Entire FamilyMonthly Amount Available To Child for His/Her Use FORMCHECKBOX Unemployment$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Child Support$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Social Security Benefits (RSDI)$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Supplemental Security Income (SSI)$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Veteran s Benefits$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Worker s Benefits$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Disability Benefits$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Retirement Benefits$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Military Allotments$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Gaming Distributions & Casino$ FORMTEXT      $ FORMTEXT       FORMCHECKBOX Other Income (Specify) FORMTEXT      $ FORMTEXT      $ FORMTEXT       FORMTEXT      $ FORMTEXT      $ FORMTEXT      If a parent in the home pays child support for a child not in the home, enter the total of the child support paid in the month that the petition was filed.AmountMonth/Yr$ FORMTEXT      $ FORMTEXT       Case Name REF CaseName  E. LEGAL DATA:Date of PetitionLast Order Date FORMTEXT       FORMTEXT      Petition TypeOrder Type FORMTEXT       FORMTEXT      Legal StatusOrder Type FORMTEXT       FORMTEXT      Next Hearing DateOrder Type FORMTEXT       FORMTEXT   : FORMTEXT   AM/PM FORMTEXT      Date Parental Rights of Mother terminatedCourt Report Due Date FORMTEXT       FORMTEXT      Date Parental Rights of Father terminated FORMTEXT      F. PLACEMENT DATA: (Licensed or Unlicensed) A member information page must be completed for each Unlicensed Relative.Provider s #s FORMTEXT      Foster Home s #Agency s # FORMTEXT       FORMTEXT      Placement Begin date FORMTEXT      Foster Parents / Relatives Names FORMTEXT       FORMTEXT      Unlicensed Care Family Structure* FORMTEXT      G. EDUCATIONAL DATASchool DistrictName of School FORMTEXT       FORMTEXT      Address FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT      Phone NumberFax Number( FORMTEXT    )  FORMTEXT      ( FORMTEXT    )  FORMTEXT      Type of EducationSchool Program FORMTEXT       FORMTEXT      GradeAttended FORMTEXT      From FORMTEXT      To FORMTEXT      SPECIAL EDUCATION DETAILS:Special Education Code NumberA copy of the IEP has been received? FORMTEXT       FORMCHECKBOX  YES FORMCHECKBOX NODoes the agency have parental consent to enroll the child in special education? FORMCHECKBOX  YES FORMCHECKBOX NO Case Name REF CaseName  H. MEDICAL DATA:Present Check-Ups:Date of Last PhysicalDate Physician Signed ReportName of PhysicianWas Copy Given to Foster Parents? FORMTEXT       FORMTEXT       FORMTEXT       FORMCHECKBOX YES FORMCHECKBOX NODate of Last DentalDate Signed ReportName of Dentist FORMTEXT       FORMTEXT       FORMTEXT      Forward Copies of Medical and Dental Reports to DHSI. INSURANCE DATA: (NON-MEDICAID)Name of Insurance Company FORMCHECKBOX  FORMTEXT      Primary FORMCHECKBOX Secondary FORMTEXT      Policy Holder s Last NameFirst NameSocial Security Number FORMTEXT       FORMTEXT       FORMTEXT      Employer FORMTEXT      Employer Address FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT      Group/Policy NumberCertificate/Contract NumberService/Coverage Code FORMTEXT       FORMTEXT       FORMTEXT       Child Placing Agency Codes DHS-719Education (Adult Members)Caretaker Family StructureMarital StatusEL-8th Grade or less1-Married CoupleD-DivorcedSH-Some High School2-Unmarried CoupleL-Legally SeparatedHG-High School Grad3-Single FemaleM-MarriedTC-Tech Training4-Single MaleS-SingleSC-Some College Courses5-Unable to DetermineU-UnknownCG-College GraduateW-WidowedPG-Post Grad EducationRelationship to ChildUK-UnknownAC-Adopted ChildRace CodesAP-Adopted ParentAS-Adoptive Sibling1-WhiteType of EducationAU-Aunt/Uncle2-Africian AmericanAD-Adult Ed./GEDBP-Biological Parent3-American Indian/Alaskan NativeAE-Alternative Ed.CH-Biological Child4-AsianCO-CollegeCO-Cousin5-Nat. Hawaiian/Pacific IslanderCS-Charter SchoolEX-Ex Spouse6-Unable to determineDC-Day CareFC-Foster ChildHS-Home SchoolFP-Foster ParentReligionIN-InstitutionalGC-GrandchildBA-BaptistOT-OtherGU-GuardianCA-CatholicPP-PreprimaryHS-Half SiblingEP-EpiscopalianPR-PrivateLT-Living Together PartnerJE-JewishPU-PublicNN-Niece/NephewLU-LutheranTP-Training ProgramNR-Non-RelativeME-MethodistVO-Vocational-Full TimeOR-Other RelativeMO-MormonPP-Putative ParentMU-MuslimLanguage CodesSC-Step ChildNP-No PreferenceA-ArabicSE-SelfOT-OtherB-ChaldeanSL-SiblingPR-PresbyterianC-ChineseSP-SpouseSD-Seventh Day AdventistD-American Sign LanguageSS-Step SiblingUK-UnknownE-EnglishST-Step ParentF-FrenchUK-UnknownG-GermanH-CambodianI-American Indian/EskimoQualified Alien YESJ-JapaneseK-KoreanLawfully admitted for permanent ResidenceL-FilipinoGrand AsylumM-SamoanRefugeeN-Other (Non-English)Paroled into the USP-PortugueseDeportation withheldQ-DutchGranted conditional entryR-PolishCuban/Haitian entrantS-SpanishT-LaotianQualified Alien NOV-VietnameseOther aliensX-Spanish (reads)Non-immigrant Order Type/ActionGrade of EducationPetition Type1-EmergencyDC-Day Care1-Initial2-PreliminaryHD-Head Start2-Amended3-Pretrial ConferencePS-Preschool3-Supplemental4-AdjudicationPK-Pre-Kindergarten4-Guardianship5-DispositionKI-Kindergarten5-Termination6-Adjudication & DispositionNG-No Grade6-Relinquishment7-Removal Disposition01-First7-Emancipation8-Terminate Parental Rights02-Second8-Show Case9-Commitment03-Third9-Motion and order10-Review Hearing04-Fourth10-Delinquency11-Discharge05-Fifth11-Adoption12-Dismissal of Petition06-Sixth12-Change of Placement13-Adjournment07-Seventh13-Extension to 2114-Permanency Planning08-Eighth14-Request for writ15-Administrative Review09-Ninth15-Discharge16-Foster Care Review Board Review10-Tenth16-Other17-OTR after release or consent11-Eleventh18-Order placing child after consent12-Twelfth19-Order of Supervision13-Freshman (College)20-Order of Adoption14-Sophmore (College21-Escalation15-Junior (College)22-De-escalation16-Senior (College23-Writ of apprehension24-Best Interest  Out of StateSpecial Education Codes25-Extension to 2126-Pre-Sentence InvestigationAI-Autism27-Transfer to DOCEI-Emotionally Impaired28-OtherEMI-Educably Mentally Impaired29-Denial of Termination PetitionLD-Learning Disability30-Dismissal of Adoption PetitionHI-Hearing ImpairmentPOHI-Physically/Otherwise Health ImpairmentPPI-Preprimary ImpairedSLI-Speech and Language ImpairedSMI-Severely Mentally ImpairedSXI-Severely Multiple ImpairedTMI-Trainably Mentally ImpairedVI-Visually Impaired DHS-719 (Rev. 3-08) Previous edition obsolete. 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QtQ._  '=!.2/ Co paddressGbA&pdpr s02+ /% `J[aZe1 ( /! aNewParauTphSnNwdaѠagRppeSngSna? :? countynnwc9uRcyPubbP r 1 3 ? < .I"GBBaG26z$>j$G>7jComCli0StñClIÑSpsaseRO; ]7]2a_0Q,wQ5,{C.OspZQoZCowT"Cit,yGI"C"tyko0Attribute 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 \c%q%xCoStateOtherIDSectionAddress1MEH 8 "(8costate  B@oPHqAttribute VB_Name = "CoState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cosEnd| \c%s%xMEH 8 "(8otherid  B@oPHsAttribute VB_Name = "OtherID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=$"oidEnd| \c%u%xMEH 8 "(8Section  B@oPHjAttribute VB_Name = "Section" Public Sub MAIN() WordBasic.WW7_EditGoTo Desti$nar:=End| \c%w%xMEH 8 "(8Address1  B@oPHnAttribute VB_Name = "Address1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:"= End~ \c%y%xMEH DistrictLastNameClientZipCoAddress8 "(8district  B@oPHoAttribute VB_Name = "Disct" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=""dEnd~ \c%{%xMEH 8 "(8lastname  B@'oPHsAttribute VB_Name = "LastX" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="lnEnd~ \c%}%xMEH 8 "(8 clientZip  B@oPHqAttribute VB_Name = "ClientZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cEnd \c%%     !"#$%&'()*,-./0123456789;<=>?@ABCDEFGHJKLMNOPQRSTUVWYZ[\]^_`abcdefhijklmnopqrstuwxyz{|}~xMEH 8 "(8 coaddress  B@oPHsAttribute VB_Name = "CoAddress" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination@:="coaEnd \c%%xFirstName lastname2CaseNumber+ClientCity:MEH 8 "(8 firstname  B@oPHtAttribute VB_Name = "First`" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="fnEnd \c%%xMEH 8 "(8 LastName2  B@oPHtAttribute VB_Name = "lastnX2" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="LEnd \c%%xMEH 8