STATE OF NEW JERSEY CP&P 1098 DEPARTMENT OF CHILDREN

STATE OF CALIFORNIA C THE RESOURCES AGENCY PRIMARY
EMPLOYEES’ COMPENSATION DIVISION LABOUR DEPARTMENT STATEMENT OF
LOGO [NAME OF ORGAN OF STATE] G4(FR) ACCEPTANCE

BILL LOCKYER STATE OF CALIFORNIA ATTORNEY GENERAL DEPARTMENT OF
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STATEMENT ON RESTITUTION

DYFS Form 10-98, Family Unification Program Referral

State of New Jersey CP&P 10-98

Department of children and families (rev. 6/2012)

Child Protection and Permanency

REFERRAL TO FAMILY UNIFICATION PROGRAM

The following family may be eligible for a Family Unification, Section 8 Housing Certificate:

Case Name: [Enter full name]	Case ID #: [Enter]
Primary head of Household: [Enter full name]	SS #: [Enter]
Other head of Household: [Enter full name]	SS #: [Enter]

Child # 1: [Enter full name]	Sex: M F	DOB: [Enter]
Child # 2: [Enter full name]	Sex: M F	DOB: [Enter]
Child # 3: [Enter full name]	Sex: M F	DOB: [Enter]
Child # 4: [Enter full name]	Sex: M F	DOB: [Enter]
Child # 5: [Enter full name]	Sex: M F	DOB: [Enter]

(List additional children on reverse side)

Current Address: [Enter street address,city/town, zip code]

Telephone/Cellular Phone Number: [Enter area code, number, and extension]

Check the appropriate statement below:

All or some of the children are currently in placement and cannot return home because the family does not have adequate housing.

All or some of the children are at risk of out-of-home placement because the family does not have adequate housing.

Describe the family’s current housing situation: [Enter a detailed description of the current housing situation].

The above-named family has been certified by the State of New Jersey, Department of Children and Families, Child Protection and Permanency, as meeting the criteria for the Family Unification Program.

___________________________________________________________________________________

Signature of Assigned Worker Date

[Enter name of Worker]

Printed Name of Worker

___________________________________________________________________________________

Signature of Supervisor Date

[Enter name of Supervisor]

Printed name of Supervisor

___________________________________________________________________________________

Signature of CP&P Family Unification Liaison Date

[Enter name of Liaison]		[Enter Number]
Printed Name of Liaison	Telephone Number

VICTIM IMPACT STATEMENT
FOR DEATH PRIOR TO 01061959 ADMINISTRATION (INTESTATE)
CONFIGURING USER STATE MANAGEMENT FEATURES 73 CHAPTER 7 IMPLEMENTING

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