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101
!["Verification of Employment/Loss of Income Form" - Sarasota County, Florida](https://data.templateroller.com/pdf_docs_html/327/3279/327994/verification-employment-loss-income-form-sarasota-county-florida.png ""Verification of Employment/Loss of Income Form" - Sarasota County, Florida")
"Verification of Employment/Loss of Income Form" - Sarasota County, Florida
Size: 123 KB
2 pages
This is a legal document needed to confirm an applicant's eligibility for several assistance programs in Sarasota County, Florida to apply for and manage for benefits.
![Form DH527 "Certified Statement of Final Decree of Adoption" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260578/form-dh527-certified-statement-of-final-decree-of-adoption-florida.png "Form DH527 "Certified Statement of Final Decree of Adoption" - Florida")
![AHCA MedServ Form 004 Part A1 "Preadmission Screen and Resident Review (Pasrr) Resident Review - Evaluation Request Form" - Florida](https://data.templateroller.com/pdf_docs_html/1729/17292/1729295/ahca-medserv-form-004-part-a1-preadmission-screen-and-resident-review-pasrr-resident-review-evaluation-request-form-florida.png "AHCA MedServ Form 004 Part A1 "Preadmission Screen and Resident Review (Pasrr) Resident Review - Evaluation Request Form" - Florida")
![Form DH728 "Application for Florida Certificate of Birth Resulting in Stillbirth" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22606/2260672/form-dh728-application-for-florida-certificate-of-birth-resulting-in-stillbirth-florida.png "Form DH728 "Application for Florida Certificate of Birth Resulting in Stillbirth" - Florida")
![Form DH430 "Affidavit of Amendment of Certificate of Live Birth" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260576/form-dh430-affidavit-of-amendment-of-certificate-of-live-birth-florida.png "Form DH430 "Affidavit of Amendment of Certificate of Live Birth" - Florida")
![Form DH261 "Application for a Marriage Record for Licenses Issued in Florida" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260588/form-dh261-application-for-a-marriage-record-for-licenses-issued-in-florida-florida.png "Form DH261 "Application for a Marriage Record for Licenses Issued in Florida" - Florida")
![Formulario DH727 "Solicitud De Partida De Defuncion O De Defuncion Fetal En Florida" - Florida (Spanish)](https://data.templateroller.com/pdf_docs_html/2260/22606/2260624/formulario-dh727-solicitud-de-partida-de-defuncion-o-de-defuncion-fetal-en-florida-florida-spanish.png "Formulario DH727 "Solicitud De Partida De Defuncion O De Defuncion Fetal En Florida" - Florida (Spanish)")
![Form DH-430 "Affidavit of Amendment of Certificate of Live Birth" - Florida](https://data.templateroller.com/pdf_docs_html/74/743/74355/form-dh-430-affidavit-amendment-certificate-live-birth-florida.png "Form DH-430 "Affidavit of Amendment of Certificate of Live Birth" - Florida")
![Form DH-MQA1030 "Physician Office Adverse Incident Report" - Florida](https://data.templateroller.com/pdf_docs_html/2214/22143/2214378/form-dh-mqa1030-physician-office-adverse-incident-report-florida.png "Form DH-MQA1030 "Physician Office Adverse Incident Report" - Florida")
![Form DH-MQA5002 "Osteopathic Physician Application for Temporary Certificate for Active Duty Military and Veterans Practicing in Areas of Critical Need" - Florida](https://data.templateroller.com/pdf_docs_html/2214/22143/2214379/form-dh-mqa5002-osteopathic-physician-application-for-temporary-certificate-for-active-duty-military-and-veterans-practicing-in-areas-of-critical-need-florida.png "Form DH-MQA5002 "Osteopathic Physician Application for Temporary Certificate for Active Duty Military and Veterans Practicing in Areas of Critical Need" - Florida")
![Form DH-MQA1031 "Office Surgery Registration Application" - Florida](https://data.templateroller.com/pdf_docs_html/2208/22084/2208443/form-dh-mqa1031-office-surgery-registration-application-florida.png "Form DH-MQA1031 "Office Surgery Registration Application" - Florida")
![Form DH260A "Application for Florida Dissolution of Marriage Certificate (Divorce or Annulment)(For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260585/form-dh260a-application-for-florida-dissolution-of-marriage-certificate-divorce-or-annulment-for-purpose-of-obtaining-an-apostille-or-notarial-certificate-florida.png "Form DH260A "Application for Florida Dissolution of Marriage Certificate (Divorce or Annulment)(For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida")
![Form DH727A "Application for Florida Death Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260586/form-dh727a-application-for-florida-death-certificate-for-purpose-of-obtaining-an-apostille-or-notarial-certificate-florida.png "Form DH727A "Application for Florida Death Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida")
![Form DH261A "Application for Florida Marriage Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260583/form-dh261a-application-for-florida-marriage-certificate-for-purpose-of-obtaining-an-apostille-or-notarial-certificate-florida.png "Form DH261A "Application for Florida Marriage Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida")
![Form DH726A "Application for Florida Birth Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260582/form-dh726a-application-for-florida-birth-certificate-for-purpose-of-obtaining-an-apostille-or-notarial-certificate-florida.png "Form DH726A "Application for Florida Birth Certificate (For Purpose of Obtaining an Apostille or Notarial Certificate)" - Florida")
![Form DH2143 "Patient Information Request" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224751/form-dh2143-patient-information-request-florida.png "Form DH2143 "Patient Information Request" - Florida")
![Form DH433A "Affidavit of Amendment to a Florida Certificate of Fetal Death" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260577/form-dh433a-affidavit-of-amendment-to-a-florida-certificate-of-fetal-death-florida.png "Form DH433A "Affidavit of Amendment to a Florida Certificate of Fetal Death" - Florida")
![Form DH1178 "Application for Certificate of Foreign Birth" - Florida](https://data.templateroller.com/pdf_docs_html/2260/22605/2260579/form-dh1178-application-for-certificate-of-foreign-birth-florida.png "Form DH1178 "Application for Certificate of Foreign Birth" - Florida")
![Form DH3075 "Florida Wic Program Medical Referral Form" - Florida](https://data.templateroller.com/pdf_docs_html/328/3289/328977/form-dh-3075-florida-wic-program-medical-referral-form-florida.png "Form DH3075 "Florida Wic Program Medical Referral Form" - Florida")
![Form DH4157 "Pool Owner/Operator Verification of Entrapment Safety Features" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244790/form-dh4157-pool-owner-operator-verification-of-entrapment-safety-features-florida.png "Form DH4157 "Pool Owner/Operator Verification of Entrapment Safety Features" - Florida")
![Form DH4159 "Application for a Swimming Pool Operating Permit" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244788/form-dh4159-application-for-a-swimming-pool-operating-permit-florida.png "Form DH4159 "Application for a Swimming Pool Operating Permit" - Florida")
![Form DH3203 "Authorization to Disclosure Confidential Information" - Florida](https://data.templateroller.com/pdf_docs_html/570/5703/570385/form-dh-3203-authorization-to-disclosure-confidential-information-florida.png "Form DH3203 "Authorization to Disclosure Confidential Information" - Florida")
![Form DH1120 "Acceptable Use and Confidentiality Agreement" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224722/form-dh1120-acceptable-use-and-confidentiality-agreement-florida.png "Form DH1120 "Acceptable Use and Confidentiality Agreement" - Florida")
![Form DH3135 "Infant Risk Screen" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224727/form-dh3135-infant-risk-screen-florida.png "Form DH3135 "Infant Risk Screen" - Florida")
![Form DOH-MQA1014 "Financial Responsibility" - Florida](https://data.templateroller.com/pdf_docs_html/1728/17284/1728433/form-doh-mqa1014-financial-responsibility-florida.png "Form DOH-MQA1014 "Financial Responsibility" - Florida")
![Form DH5067 "911 Public Safety Telecommunicator Training Program Application" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224748/form-dh5067-911-public-safety-telecommunicator-training-program-application-florida.png "Form DH5067 "911 Public Safety Telecommunicator Training Program Application" - Florida")
![Form DH5066 "911 Public Safety Telecommunicator Initial/Original Certificate Application" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224744/form-dh5066-911-public-safety-telecommunicator-initial-original-certificate-application-florida.png "Form DH5066 "911 Public Safety Telecommunicator Initial/Original Certificate Application" - Florida")
![Form C-0039 "Staff Roster" - Pinellas County, Florida](https://data.templateroller.com/pdf_docs_html/294/2948/294891/form-c-0039-staff-roster-pinellas-county-florida.png "Form C-0039 "Staff Roster" - Pinellas County, Florida")
![Form DH4066 "Application for Maintenance Service Permit" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784167/form-dh-4066-application-maintenance-service-permit-florida.png "Form DH4066 "Application for Maintenance Service Permit" - Florida")
![Form DH1322 "Application for Radioactive Materials License" - Florida](https://data.templateroller.com/pdf_docs_html/73/732/73251/form-dh-1322-application-radioactive-materials-license-florida.png "Form DH1322 "Application for Radioactive Materials License" - Florida")
![Form DH4057 "Application for Variance From Chapter 64e-6, Fac" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784173/form-dh-4057-application-variance-from-chapter-64e-6-fac-florida.png "Form DH4057 "Application for Variance From Chapter 64e-6, Fac" - Florida")
![Form DH4015 "Onsite Sewage Treatment and Disposal System Existing System and System Repair Evaluation" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784152/form-dh-4015-onsite-sewage-treatment-and-disposal-system-existing-system-and-system-repair-evaluation-florida.png "Form DH4015 "Onsite Sewage Treatment and Disposal System Existing System and System Repair Evaluation" - Florida")
![Form DH4016 "System Repair Certification - Onsite Sewage Treatment and Disposal System" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784163/form-dh-4016-system-repair-certification-onsite-sewage-treatment-and-disposal-system-florida.png "Form DH4016 "System Repair Certification - Onsite Sewage Treatment and Disposal System" - Florida")
![Form DH4015 "Application for Construction Permit - Site Plan" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784148/form-dh-4015-application-construction-permit-site-plan-florida.png "Form DH4015 "Application for Construction Permit - Site Plan" - Florida")
![Form DH4015 "Onsite Sewage Treatment and Disposal System Application for Construction Permit" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784158/form-dh-4015-onsite-sewage-treatment-and-disposal-system-application-construction-permit-florida.png "Form DH4015 "Onsite Sewage Treatment and Disposal System Application for Construction Permit" - Florida")
![Form DH4015 "Site Evaluation and System Specifications - Onsite Sewage Treatment and Disposal System" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784160/form-dh-4015-site-evaluation-and-system-specifications-onsite-sewage-treatment-and-disposal-system-florida.png "Form DH4015 "Site Evaluation and System Specifications - Onsite Sewage Treatment and Disposal System" - Florida")
![Form DH1576 "Application for Air Ambulance Permit" - Florida](https://data.templateroller.com/pdf_docs_html/2076/20767/2076788/form-dh1576-application-for-air-ambulance-permit-florida.png "Form DH1576 "Application for Air Ambulance Permit" - Florida")
![Form DH4080 "Application for Variance From Chapter 64e-9, Florida Administrative Code - Swimming Pools and Bathing Places" - Florida](https://data.templateroller.com/pdf_docs_html/2244/22447/2244787/form-dh4080-application-for-variance-from-chapter-64e-9-florida-administrative-code-swimming-pools-and-bathing-places-florida.png "Form DH4080 "Application for Variance From Chapter 64e-9, Florida Administrative Code - Swimming Pools and Bathing Places" - Florida")
![Form DH3212 "Health Insurance Application for Extended Family Planning Benefits" - Florida](https://data.templateroller.com/pdf_docs_html/2049/20495/2049505/form-dh3212-health-insurance-application-for-extended-family-planning-benefits-florida.png "Form DH3212 "Health Insurance Application for Extended Family Planning Benefits" - Florida")
![Form DH4060 "Migrant Labor Camp or Residential Migrant Housing Inspection Report" - Florida](https://data.templateroller.com/pdf_docs_html/2224/22247/2224777/form-dh4060-migrant-labor-camp-or-residential-migrant-housing-inspection-report-florida.png "Form DH4060 "Migrant Labor Camp or Residential Migrant Housing Inspection Report" - Florida")
