WPC cE('6=ٹk;'Hf.=1JMv$ -"%ܖZ9 j|¸Qz?:.n>e UEc,[t]k ^733XQ Ԑ̂Wzl>;);HR>muk\p/)iD ,<4qoji?h}͋9Q̒2SZk,u"j2SНQAh5Sm^4m{K<*;тz)_3}Ske-\#=,e& |(l=oKL6 l)mA$"#ج8iAg|rdȁj0LjYvYޕqE&/bV,/{nwFZbRM&Y%/Nf(tl# U?N % 0( B% fB fD aF aZ fn vp Cw4  ^ /; m=NTaVfjflanfafaafa 0P B(fEaGf[a]fqasfafafa 0D D5  0DBB B B AS 0D B* AGGG C B* B5                   DYA B@HP LaserJet 8150 PCL 60(@ Z 6Times New Roman RegularX($  dTABLE BTABLE A0UCFS-2012 Notice of Department Finding 7/97  &4 ' DON0DON .   ddq13|xwtO2 UTABLE I STABLE ETABLE FTABLE GTABLE C=TABLE D((3/Q$ !   d  d0UTABLE HXBTABLE JP]TABLE LTABLE MTABLE KTABLE N(3$ !  !!!!)!dxdx(3$ !   d d`ZVaE<<CLevel 1Level 2Level 3Level 4Level 5($$   1  &0 d dV{  <<= 8Cdd&P d d1Large Dashed dM($Wavy Double Border!dxdx<Wavy Double^ H d d !  _TRX3'Avery 5160 AddressX3' Letter3'Letter261R White Rtn AddX3' Letter3'LetterT  5XX*ddd Xdd Xdd XT$T$, dd ,dd +  $   $#X7X5#^]\XX7  StateofKansas pd DepartmentofSocialandRehabilitationServices  ChildrenandFamilyServices#X7X\^]#5XX7 x    #X7X5#+XX7""D##X7X+G#^]\XX7CFS2015 pd Ѐ."."C#July2004  !!A#Page1of1#X7X\^]#5XX7Ԉ x #X7X5J#*dd dd dd T$T$, dd +   @WWKANSASDEPARTMENTOFSOCIALANDREHABILITATIONSERVICES   @  r"XX7ReferraltoInfantandToddlerServices#X7Xr"#    *edd dd T$T$e,'dd ,wdd ,dd ,dd ,dd , dd ,dd ,dd , dd +  x '6* 6* '&;Q%XX7xDateofMailing: 0&!  0 '  '/ '  ' '  '/ ' ' ' ' 0& 0_SRS_ԀOffice: 0&! 0(  (#X7X%&;Q#*!d d'dd 'wdd wdd dd dd dd dd dd  dd T$T$,Xdd ,8dd ,fdd ,Xdd ,dd ,Xdd ,dd ,dd ,9dd ,dd ,edd +   '!   '&;Q%XX79 TO: 7!*! !  7#X7X%&;Qp #&;Q%XX7 :!-  ! :#X7X%&;Q#&;Q%XX7FROM: :!-$ !  : .$  ! . @ #X7X%&;Q~#&;Q%XX7 7-r f 7#X7X%&;Q9#&;Q%XX7TELEPHONE#: 7-$r f  7 7-r f  7ADDRESS:   Street/P.O.Box 7-$  7#X7X%&;Q#&;Q%XX7 7-  7#X7X%&;Q#&;Q%XX7ADDRESS:   Street/P.O.Box 7-$  7 3)  3City 4*!"  4#X7X%&;QJ#&;Q%XX7 3)" ! 3State#X7X%&;Q\#&;Q%XX7 0&!" " 0 0&" # 0#X7X%&;Q#&;Q%XX7City 4*!" $ 4 3)" % 3State 0&!" & 0 0&" ' 0ZIP 4*! ( 4#X7X%&;Qx#&;Q%XX7 3) ) 3#X7X%&;Q#&;Q%XX7ZIP  *  4*! + 4g+! ,   +#X7X%&;QF#**! d dXdd X8dd 8fdd fXdd Xdd Xdd Xdd dd 9dd 9dd edd e!T$T$*,hdd ,hdd +  &i, &CHILDSNAME 8i#2&-i 8DATEOFBIRTH 2#!2&.i 2 -/ - +0 + -2&1 -(2&2   (*&!'ddhdd hhdd h! T$T$,z dd ,*dd +  )i:.3:. )LOCATIONOFTHECHILD 4 (ifchildisinanoutofhomeplacement) /i~5i /+XX7NOTE:pleasedonotincludeinformationtolocatethechildonparents 6 copyifparentsareunawareofthechildslocation#X7X+C#(NB7 i (*(!)ddz dd z *dd *&!'T$T$, dd , dd ,edd ,dd +  &i7 &CAREGIVERSNAME $ 8i $   9    :  i  ; ADDRESS $~<i $  ~=   ~>  i ~? CITY $ @i $ i  A ZIPCODE $ Bi $ i  C TELEPHONENUMBER $~Di $  ~E   ~F  ~G  *!dd dd  dd edd edd (!)T$T$,4dd ,dd +  /i H  /PARENTSNAME 6#! Ii 6( J  (*!dd4dd 4dd !T$T$,4dd ,dd +  /i"J" /ADDRESS 6#!v"jKi 6(v"jL  (*"!#dd4dd 4dd !T$T$,4dd ,[dd ,edd ,dd +  /i# L#  /CITY -#!# Mi - )i # N )ZIPCODE 6#!# Oi 6(# P  (* !dd4dd 4[dd [edd edd "!#T$T$, dd ,dd +  /i%"P%" /TELEPHONENUMBER 6#!v%j"Qi 6(v%j"R  (AttentionParent:Federalmandatesrequire_SRS_ԀtoreferyourchildtothelocalInfantToddlerServices &#R asaresultofsubstantiatedabuseand/orneglect. ~'r$S *$!%dd dd  dd  !T$T$,dd ,Edd ,xdd +  "XX7 'V)J&UV)J& '#X7X"c&#"XX7Distribution:An7intheboxindicatespersonsreceivingacopyofthisnotice.   X 6^^^^#!)&V 6 0&)&W^^^^ 0FILE1'%)&X  1#X7X"&#+XX7  #X7X+(#*,!-dddd Edd Exdd x$!%T$T$,wdd ,dd ,wdd ,dd +  $^^^^+(Y+( $ 0&+(Z^^^^ 0"XX7PARENTS/CAREGIVEROFCHILD#X7X")# 6^^^^#!+([  6 0&+(\^^^^ 0"XX7INFANTTODDLERPROGRAM#X7X"*#1'%+(]  1*/!0ddwdd wdd wdd wdd ,!-T$T$,hdd ,wdd ,dd +  &i-*]-* &+XX7NOTE:pleasedonotincludeinformationtolocatethechildon ~-r*^ parentscopyifparentsareunawareofthechildslocation#X7X+3,# 0^^^^.."+_i 0 '~-r*`^^^^ '"XX7CONTRACTORPROVIDINGSERVICES ~-r*a #X7X"b-# XX7ifapplicable#X7X -#"XX7Ԁ#X7X"%.#(B.6+b  ( XX7_SRS_ԀChildrenandFamilyServices,_D.S.O.B._,915SWHarrison,5thFloorSouth,Topeka,KS66612;(785)2964653#X7X .#