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Get Tobacco User Change Form - Texas A&M University-Kingsville - Tamuk

Request, receive, review and correct information about yourself collected using this form. Section 1 Employee/Retiree name (please print) Last First UIN or Social Security number MI Please be sure to sign this form and send it to your Human Resources office. Office use: ED Section II List the required information for each employee/retiree/dependent, whose tobacco user status you wish to change. Name (last, first, MI) Birthdate (mm/dd/yyyy) Tobacc.

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