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D # M.I. Birth Date Title/Rank Base Salary Department Retirement Date (no later than 7-30-2010) Number of years of employment at ISU by retirement date Appointment Base Please review the following statements: I understand if this request is approved, Iowa State University will pay for the employer and employee share for the health and dental insurance available for Iowa State University employees for five (5) years commencing on the first day of retirement. I understand if I or my spous.

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