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Get AZ FAA-1701A FORENG 2019-2024

VERIFICATION OF TERMINATED EMPLOYMENT Date: Case Number / HEA Plus App ID: Case Name (Last, First, M.I.): For questions, call 1-855-432-7587 Fax completed form to 602-257-7031 or 1-844-680-9840 The person whose name and signature appears below, or on the attached copy of the signature page of the DES/FAA Application, has requested your cooperation in releasing the following information. Please complete and return this form via fax to the number written above or in the enclosed envelope.

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