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11/10/2020 Out of County.jpeg <br /> VERIFICATION OF <br /> . rVEHICLE COMMISSARY <br /> ►te.ea.oHd• wAn� Wt <br /> Vehkle Nerve(MA); WA+A• r N 7Ps_rl <br /> Address—Ibr V(cla: �h <br /> ae..r AMw <br /> CRY I <br /> 1) License Plate hf: � 4) Year. ZtlID <br /> 2) Vehicle Vin N:2Q4�'j?}�GVj'1ps9ryDIL�O I 5) MekefModel: +�.A�� <br /> 3) �h ecya�/lyFpf63IR p q3 s) Color. H,wLH- VJ 94apu� <br /> `�ryy�10.'�ra4Ad":�- 4�T •5}i1T' <br /> Name: dEt 0 <br /> AddreofOmler 3 ��� t_ <br /> The rnobM fced fscipty shaft operriv out of a commissary and shaft report to the commissary at teat once each <br /> openf:rr� uay fx:::s�'� s:s� ea:er_:.Tp ;Ws.u;ca soC:ns :SaiS cS SS8297',. 7 ttto use o;i.'ta cornrhiae:r�is <br /> dfsaondnwd, the pernhft holder must notffy this of les to make the necessary changes. Failure to rectify thtt <br /> rtapfl'In pqrmri avocation and ponaktes. _ <br /> l41 j0Ve,rtjyf t�' 2010 <br /> SiWWlure of ehiGe Date <br /> Bits.:^.:,55 i:a.;�e: ✓r•(D` t 1'1 f'•1QtQ.t� N TRC[L�h <br /> Owner Name Wth+bii <br /> 3&sar Addn. city <br /> phone:(5tc ) .3W.5blz <br /> 4 Yee 43eteeTwssaMY *WT W'1 ixrn aria wiii provide the necessary fadiCies for the above Mentioned vahlde at my <br /> ttc��o7taatassaty as checked below: <br /> ltfl squid d saw waste UL-n-2 wss.Mng slnk �)Stara frozen food Vehicle wash facmes <br /> tt K s 08ee+raa.est <br /> ®pnw p.11on or food ®tint a cad water for cleaning ®Todd&hand washing �] Store mhigerated food <br /> tf rr��11ry1 <br /> f till siore r ®RroNEe pob�welch ®Overnight paft1p Ad"usts ebe6kel outlets <br /> Com <br /> Data <br /> 0 the oommFeaere.00d esUbfehmettt Is outalds ftn Joagir n Camlyr the lord health Julie&C 11 must varLy <br /> current Malta pw.nNhy&I7d Q below. Corninta atyNoW estabilahment b in Cn IaVPlQA <br /> Courtly. � <br /> //-- 11 110 (10'10 <br /> Sig of County HS Data <br /> BID 15-M7 5 d a kFW APPLACAT>at'r <br /> I MArAM <br /> { <br /> httpsl/mail.google.com/mail/u/Ontab-wm&ogbl*inboxlQgrcJH rtwztSgTFHLvnf VMXgRLvgFc"tg?projector-1&messagePartid-0.1 1/1 <br />