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Get MA MVU-33 2011-2022

Check applicable box: Exemption is based on a loss of two or more limbs. Complete only Part A below. Exemption is based on a loss of use of two or more limbs. Complete both Parts A and B below. Part A Name of disabled person I, Address , of City/Town State Zip certify that I suffer the loss of two or more limbs, or the permanent loss of use of at least 80% of each of two or more limbs. I hereby authorize the Department of Revenue to have access to my medical records to verify this clai.

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