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Get Request For Encumbrance Of Records - Middle Tennessee State ...

Umber: Amount Owed to Chapter: Breakdown of Charges (Must be specific): Charge (House rent, house maintenance fee, etc.) Amount Total Charges: I attest that the hold placed on this record is due to the member s delinquency in paying fees associated specifically with maintaining the chapter house. This hold has not been requested due to delinquency in paying general membership dues or other fees. Signature of House Corporation Officer Date Phone: House Corporation Officer (Please Print).

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