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Get Va Med 4 2010

S related to or incurred as part of the completion of this form are your responsibility. DMV USE ONLY CSC STAFF - do NOT send MED 4 back with daily work unless there is an ocular condition or customer cannot be licensed due to a visual defect. CUSTOMER INFORMATION (To be completed by customer PRIOR to vision examination) If you change either your residence/home address or mailing address to a non-Virgina address, your driver license or photo identification (ID) card may be cancelled. NAME (las.

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