OMB No. 0730-0014 DEPENDENCY STATEMENT - …
The member must complete the form in its entirety, sign and date the form, and have it notarized. If the child resides alone or with someone other than the member, the member completes Items 1, 2, and 16, signs and dates the form, and the child or child's representative completes Items 3 through 15, signs and dates the form, and has it notarized.
Download OMB No. 0730-0014 DEPENDENCY STATEMENT - …
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