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Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

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Page 1: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 2: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 3: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 4: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 5: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 6: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 7: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 8: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 9: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

Page 10: Healthcare in Southern IL - Community Health and ......(circle one) per month/year Total income before taxes (if married - total combined income before taxes): $ Number of le undera

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