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Victorville California online Form 4506-A: What You Should Know

Health Services Dept. Victorville CA 92345 Health Services Dept. VENTURA CA 92663 Veterans Services Bureau Veterans Services Bureau Note: Please review the instructions for making changes. Note: The deadline to request a copy of Form 945-2 is March 31, 2017. NOTE : This form requires a signature; however, one is not required for this form. NOTE: This form cannot be completed by telephone. The City of Victorville Health Department, Community Action (A) Fund, is authorized to take on a limited responsibility for the administration, payment, collection, and distribution of non-cash benefits granted to persons 65 years of age or older.   In the event the benefits granted to a senior citizen (or any person authorized to receive a non-cash benefit for any reason) are terminated under the terms of this agreement, the City of Victorville Health Department is empowered to provide the non-cash benefits to the senior citizen in accordance with the terms of the agreement.   The City of Victorville is not responsible for the cost of administering or arranging the non-cash benefits, and is not obligated to provide non-cash benefits to the senior citizen for a period of time prior to termination. The City of Victorville does not have the authority to provide non-cash benefits to beneficiaries after termination. This is a partnership agreement between the City of Victorville, Health Services Corp. and Neighborhood Partnership Housing Services, Inc. All parties (City of Victorville, Health Services Corp., Neighborhood Partnership Housing Services, Inc.) hereby enter into and agree to be bound by this agreement. In consideration for the City waiving its reasonable legal fees in connection with its agreement to make this agreement, Health Services Corp., the City, and the Neighborhood Partnership Housing Services, Inc. agree that such attorney fees are waived. This agreement is between the City of Victorville Health Services Corp.

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