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Get Where To Fax Medical Documentation Ogs Parking Form

ONS ON REVERSE SIDE) Initial Application Short-Term Extension (Please Type or Print FIRMLY) Agency Parking Coordinator Phone No. Affirmative Action Officer/Equal Employment Opportunity Officer Phone No. Part I - TO BE COMPLETED BY APPLICANT AND RETURNED TO PARKING COORD INATOR Name Motor Vehicle ID. No. Agency Current Parking (if any) Business Phone No. Work Address License Plate No(s). NYS Employee ID No. Applicant s Signature Date PART II TO BE COMPL ETED BY APPLICATION R.

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