Free 48462.FH11 - Indiana

NOTICE OF DISCONTINUANCE OF IMPACT SERVICES
State Form 48462 (8-97) / IMP 0027

Date: County: Address (number and street, city, state, ZIP code):

FCC Telephone number Dear Effective _________________________________________ all IMPACT services, including supportive services, will be discontinued for _______________________________________________________________________________ because of _____________________________________________________________________________________________ . All outstanding claims for services which were provided prior to the above effective date are to be submitted as soon as possible for processing.

Please contact the FCC listed above if you have questions.

DISTRIBUTION: White - Client; Canary - Case File