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Change Details
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Resource Transfer Evidence Details
| Household Member | [Full Name] |
|---|---|
| Recipient Name | [Full Name] |
| Resource And Item Type | |
|---|---|
| Transfer Reason |
| Transfer Date |
| Fair Market Value | |||
|---|---|---|---|---|---|
| Amount Received | Uncompensated Value | ||||
| Transfer on Behalf of this Participant | Attempted To Regain Possession | ||||
| Legally Binding Document In Place |