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Get Nc Dwi Authorization Fee Form

Cansler Secretary Steven Jordan Director DWI Services Authorization Fee NEW APPLICANTS ONLY Submit this form and the 250 authorization fee to the state DWI Services office at the following address NC DMH/DD/SAS BUDGET FINANCE TEAM 3013 MAIL SERVICE CENTER RALEIGH NC 27699-3013 MAKE CHECK PAYABLE TO NC DMH/DD/SAS Facility Owners Name Clinical Supervisor Facility Name Facility Address Telephone Number Email address Website Location 325 N. Salisbury.

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