Form Rfa 09b - Notice Of Action To Individual Regarding Resource Family Approval Criminal Record Exemption Decision Page 4

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[This page to be kept attached only for appeals that will go to SHD. For OAH cases, please detach
before serving.]
[For County use only. Do not write in this box.]
County: ______________________________ County RF ID#: ________________
Exemptible
Non-exemptible
Both
Forum: SHD
OAH
RFA 09B (1/18)
Page ____ of ____

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