PM 14-06-04-b.
NOTE: If the applicant has never been married or cannot verify the marriage, show marital status as never married.
NOTE: Institution means any residential facility, such as a prison, mental health center, or nursing home.
NOTE: A signed statement from friends or relatives may be accepted as evidence.
Illinois Department of Human ServicesJB Pritzker, Governor · Dulce Quintero, Secretary
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