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Get 1-18 Request To Amend Or Add To - Hspolicy Utah

Ision of Services for People with Disabilities to request that information in the record kept by the Division be amended in accordance with Utah Code Annotated 63-2-602 (see back of form). SECTION I PLEASE COMPLETE INFORMATION REQUESTED Your Name: Your Daytime Phone: ( Your Mailing Address City State ) Zip What do you feel needs to be amended? ( Additional information attached) ( Additional information attached) Why does this information need to be amended? SECTION II: DETERMINATIO.

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