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Get TriMet Honored Citizen Application 2012

Designated Administrative Agency**, to take and retain a copy of my photo. TriMet will not accept a photocopy or fax of this form. Signature of applicant __________________________________________________ Date _______________________________ v.1;09-2012 Health care provider certification section: This form is used for Individuals with permanent or temporary disabilities. This also includes individuals who may need an attendant to ride TriMet service. Patient/applicant release: I authorize: _.

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