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Get NE DMV 06-104 2017

Ial Security Number MIDDLE INITIAL SUFFIX (JR, SR, 1ST, 2ND, 3RD) CURRENT RESIDENTIAL ADDRESS REQUIRED (Street address or Route and P.O. Box) CITY STATE ZIP CODE CURRENT MAILING ADDRESS (If different from residential address) CITY STATE ZIP CODE COUNTY NUMBER HEIGHT GENDER FT. IN. WEIGHT EYE COLOR HAIR COLOR RACE M BLACK AMERICAN INDIAN OTHER F WHITE ASIAN OR PACIFIC ISL HISPANIC For the purposes of complying with Neb. Rev. Stat. 60-484.04, I attest: I am a citizen of .

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