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Social Security Administration Form Approved Please read ...

Social Security Administration Please read the back of the last copy before you complete this form. Form Approved OMB No. 0960-0527 Name (Claimant) (Print or Type) Social Security Number Wage Earner (If Different) Social Security Number Part I APPOINTMENT OF REPRESENTATIVE I appoint this …

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Transcription of Social Security Administration Form Approved Please read ...

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