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Get IA Form 430100 2011

R revoked to allow the person to drive at specified times and for specified purposes which can be verified by the Department. STATEMENTS FOR ITEMS 1 THROUGH 7 MUST BE ON BUSINESS LETTERHEAD AND SIGNED BY THE APPROPRIATE PERSON(S): 1. If the request is to provide transportation for Continuing Health Care for you or a dependent, send a statement from the health care provider verifying the need and stating the location and dates of the treatment. 2. If the request is to attend Continuing Educati.

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