Emergency Home Energy Assistance for the Elderly ...

Box 4. Legibly write the 5-digit . zip code. for the address. Box 5. Legibly write the . county. number that goes with the address. (See county listing on the pop-down menu for two digit code.) ROW 4. Box 1. Legibly write the . phone number. of the elder. If the elder has no phone, write the phone. number for a telephone where the elder can be ... ................
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