Health and Human Services Commission PO Box 149027 Austin TX 78714-9027 TEXAS Health and Human Services Commission REQUEST FOR DOMICILE VERIFICATION Case Number: Contact Tel # 1023699659 Date: 02/26/2024 2-1-1 or 1-877-541-7905 Name of Client Erika Aiyana Villarreal Address 1510 N King HWY #4 Nash TX 75569-2646 Case No. 1023699659 The person listed above has told us that you are not related to them but are familiar with their family. To help us correctly evaluate the household's situation, we need your assistance. Please complete the information requested on page 2 of this letter and return it to me in the postage paid envelope provided or fax to HHSC at 1-877-447-2839 Please return it as soon as possible, but no later than Your help is greatly appreciated. Form 1155/02-23 Page 1 03/12/2024 (date) T-01155-0792272370