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Get VA 21-22 2014

not extend to any other organization without my further written consent. This authorization will remain in effect until the earlier of the following events: (1) I file a written revocation with VA; or (2) I appoint another representative, or (3) I have been determined unable to manage my financial affairs and the individual or organization named in Item 3A is not my appointed fiduciary. I, the claimant named in Items 1 or 6, hereby appoint the service organization named in Item 3A as my represe.

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