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The Montgomery County Department of Job and Family Services has provided the Forms listed below for your easy access.  All Forms have been created in Adobe Acrobat PDF format for easy viewing and printing. 

Once the form has been completed and signed, please drop off or mail all original forms to:

Job and Family Services  C    FINAL

Montgomery County - DJFS
1111 S. Edwin C. Moses Blvd.
P.O. Box 972
Dayton, Ohio 45422


Adobe Fill and Sign is required when filling out forms on a mobile device and can be downloaded for free from the App Store and Google Play. Once Adobe Fill and Sign has been downloaded to your mobile device, tap where you want to fill in information and start typing with your finger or stylist.

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Child Care Benefits Application(s)  Then enter search Form Number 01138
pdf icon MCDJFS Employment Verification  
pdf icon Statement of Residence, Household Composition, and Cost (Landlord Statement)
pdf icon Third Party Statement  
Request for Cash, Food Stamp, and Medical Assistance
pdf icon Healthcare Assistance Application
pdf icon Application for Medicaid Waiver