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Get Interstate Endorsement Form

, the Omnibus Reconciliation Act of 1987. Although you may refuse to supply the information requested below, failure to provide requested information may result in denial of your request to be placed on the Registry. The data supplied becomes part of your permanent file which is a public record. Please type or print clearly, attach copies of any certificates or wallet cards you have, and forward this application to the address or fax number below. If you were initially trained in Iowa, you must.

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