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The Louisville Asset Building Coalition and Metro United Way have partnered to bring additional resources to help you and our community during these challenging economic times. Your confidential responses to this survey will enable us to identify opportunities to better serve you.

Instructions: Please complete the following survey as accurately as possible. Please FILL IN THE CIRCLE that fits you best. All responses are CONFIDENTIAL and OPTIONAL. Filling out this information may allow us to provide you with additional resources that may benefit you or your family. Your responses will be used to help us offer better supports for you and others. Your answers will NOT affect your tax return in any way.

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1. Where are you filing this return?

Where are you filing this return?

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2. Please provide contact information.

Please provide contact information. Name:
Company:
Address:
Address 2:
City/Town:
State:
ZIP/Postal Code:
Email Address:
Phone Number:

3. How many people are in your household?

How many people are in your household? 18 years old and over
17 years old and under

*1. Where are you filing this return?

*2. Please provide contact information.

3. How many people are in your household?

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1. Where are you filing this return?

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2. Please provide contact information.