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Get OK DLS0791-94 2004

TY) (STATE) PHYSICIAN’S SIGNATURE: FOR D PS OFFICE ON LY Expiration D ate: M ail t h is co m plet ed applicat io n w it h o n e do llar ch eck t o : O klahom a D epartm ent of P ublic S afety D river License Services D ivision P .O . B ox 11415 O klahom a C ity, O K 73136-0415 Date issued: Placard N umber: If you have any questions, please call (405)/425-2290 DPS: DLS0791-94 4 REV. 3 04 .

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