ИНФОРМАЦИЯ

Председателю комиссии

По оценке нуждаемости

Л.В. Володченко

От __________________________

проживающего по адресу

______________________________

______________________________

Заявление

Прошу предоставить мне социальный уход на дому. Согласен (на) на проведение обследования и передачу информации личного характера в комиссию по оценке нуждаемости

«____»___________ 20_____г.

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