PRIVACY ACT STATEMENT AUTHORIZATION TO START, STOP, …
My permanent duty station: My dependent's location: Both my permanent duty station and dependent's location. DOB OF CHILDREN Member Dependent TOTALS Monthly Expenses: Mortgage (PITI) or Rent Insurance Other NAME OF DEPENDENT/SHARER COMPLETE CURRENT ADDRESS (Include ZIP Code) RELATIONSHIP Spouse/Former Spouse SSN Child in Custody of: START
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