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Get VA Uniform Authorization to Use and Exchange Information 2006

_________________ (Name) (Address) (Phone Number) Witness (If Required): _____________________________________________________________________________________ (Signature) Approved by the Attorney General’s Office 11/22/06 (Address) (Phone Number) COMMONWEALTH OF VIRGINIA UNIFORM AUTHORIZATION TO USE AND EXCHANGE INFORMATION Full Printed Name of Client: ___________________________________________________________________________ FOR AGENCY USE ONLY AUTHORIZATION HAS BEEN: Revoked in en.

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