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Please submit this form in person at the address below,or mail this form to: <br /> Coordinated Services for the Elderly <br /> West Hawaii Civic Center,Building B <br /> 74-5044 Ane Keohokalole Hwy <br /> Kailua-Kona,HI 96740 <br /> Operations Assistant Director <br /> (808)323-4320 <br /> ead2(4)hawaiicounty.gov <br /> A copy of this form can be found online at: <br /> httpli,records.hawalicounty.goviweblink/DocView.aspx?dbid=1&id=102699&cr=1 <br />