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Get IL DOC 0148 2006

T: Middle: Other Names used (include Maiden Name): Home Address: Street & Apt. # Home Phone #: ( ) Date of Birth: / Male Female City State Zip Code Place of Employment: / Relationship to Offender: Race: Height: ft. in. Weight: lbs. Hair: Eyes: (color) Photo ID: Drivers License or State ID Number: (color) State of Issue: Other (specify) 1. Are you on any other offender’s approved visiting list? Yes No If yes, provide each offender’s name, number, and facili.

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