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VERIFICATION OF VEMCLE COMMiSSARY <br /> piease pi e alt jnFcr.naEicq p <br /> requested. An incvmeta apptica loa MMY fav Sppnrv--:-L <br /> M EM <br /> Name <br /> 12 <br /> 1 —7-3 C ,S 6F L1,f�, (TZ �--4 c-,,,� <br /> shet <br /> s ,) Licemse PiatL-- 41r <br /> 21 Vehicf-a vin <br /> IC7 TV <br /> 3) State Decal 53 Co#o- <br /> r <br /> t <br /> r &test Address ' € <br /> Tht mcb4e€r- fEcgriY shaia data Ma Of a comgtissary asza shaii repoft tia the r-ommissary at: cue ear <br /> rfav for derg rocs and Servic€ng (Catcode Sec-bons 944-795 & 114297). #€he use of the <br /> 4 f ttia psmik <br /> �y tt f'#-f-_ a.., `e !tq s`---esssa� �Rcx� c- Falkt e t <br /> ;1[4'�?F Crit t rlct3s G-F►s�.r= tc. cct+in� _ - <br /> a5fc;gray i- it ii� kt ravot"tion and pzpaIff as. / <br /> . �€vehict=-vim, orator C-2 LP <br /> owwz <br /> : <br /> 6 3, <br /> my <br /> 1,the to�missary owrtert can # rXs pa the rrse. ss fe gor t o bo�r�rr F � <br /> s > y as Checked, beia: <br /> t. s <br /> C SWe ftozel zw,C: <br /> (4-ffo 'oompad-ts) hafid aas# ry &ore r igerzte�jfood 2.Rut&c�gd water fodeeming <br /> � � p-atatte yia;er -Fe- - - 'LP ; <br /> ?" <br /> ; <br /> s � € of Cory€mmedope''awt Cate <br /> HE&LT DE <br /> S <br /> (f QTS G:3SLtmissaaryfff d eattab§ ,"F znt is cv---lam. c?Joaquin `.�.'�unt :Ftp 3&SjcE EEesi-- niF3r rEmvr t <br /> C-dlTant heafth oaf by signing beicw. Commissar /food establ shme-rit is in <br /> Signatt e or County RENS Satz <br /> o. <br /> .r�4sg <br /> r"' <br />