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Get WI A-222 2019-2024

R Spouse s last name Spouse s first name Spouse s ID number Current address Daytime telephone number ( ) City State Zip code Email address (optional) Part 2 Representative(s) If an individual(s) name is provided, authority is limited to that individual(s). If a business name is provided without specifying an individual, authority is granted to employees of the business. Check only one (see instructions): Add - appoints a new or additional representative Revoke - ends the rep.

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