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Get TX Designation of Applicant's Agent

Gent Agent’s Name Agent’s Name Organization Organization Official Position Official Position Mailing Address Mailing Address City, State, Zip City, State, Zip Work Phone Fax Number E-Mail Address Work Phone Fax Number E-Mail Address Cellular Phone Pager Cellular Phone Pager The above Primary and Secondary Agents are hereby authorized to execute and file Application for Public Assistance on behalf of the Organization for the purpose of obtaining certain state and federal .

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