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Get Form Dsdx164 2014

Or an Illinois Person with a Disability Identification Card at no fee on the basis that I am an individual who is disabled as defined in Section 4A of the Illinois Identification Card Act. This report shall remain valid for 3 months. I affirm that the information in this affidavit is true and correct. Applicant's Signature/Date Driver s License Number and/or Identification Card Number.

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