This government document is issued by Michigan Cash Assistance for use in Michigan
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https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Doing-Business-with-MDHHS/Forms-and-Applications/Solicitud_Para_Ayuda_De_Emergencia_Del_Estado_-_DHS-1514SP_419865_7.pdf?rev=a763159aa9a946998e1aebc206f9e535&hash=34E353AB9D0B9402A2ECD7378F75CCD6