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Tal means of obtaining motor fuels and essential fluids, and to effect minor repairs for the named supplier in emergency situations. 1. Department 2. Division 3. License Plate: 4. Type of Assignment (Check one) A. Individual Assignment: Name Official Work Station Home Address B. Pool Assignment: Name of office or organizational unit Address where vehicle will be parked when not is use C. Out-of-state use: Destination: Dates: Begin Return Request for temporary assignment of out-of-state.

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