WAKE COUNTY HUMAN SERVICES CHANGE FORM

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* First name:

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* Middle Initial

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* Last Name:

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* What is your date of birth?

Please enter your date of birth

Date

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* What is your Social Security Number? (Please enter the numbers without dashes or spaces)

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* What is your County Case Number? (your county case number is a 6 digit number)

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* What is your Worker Name or Worker Number?