Confidentiality Notice: The information contained in this ...
FAX COVER SHEET
Hardship Request
|Date: | |Sender: | |
|To: |Bill Brautigam |Office Name: | |
|Office Name: |APD Central Office |Address: | |
|Address: |500 Summer St NE E12 |City: | |
|City: |Salem |State: | |Zip: | |
|State: |OR |Zip: |97301 |Phone No.: | |
|Phone No.: |503.947.5204 |Fax No.: | |
|Fax No.: |503.378.7823 |Total Pages: | |
|Re: |Application for hardship waiver | |
Potential APS case
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Confidentiality Notice: The information contained in this facsimile may be confidential and legally privileged. It is intended only for use of the individual named. If you are not the intended recipient, you are hereby notified that the disclosure, copying, distribution, or taking of any action in regards to the contents of this fax – except its direct delivery to the intended recipient – is strictly prohibited. If you have received this fax in error, please notify the sender immediately and destroy this cover sheet along with its contents, and delete from your system, if applicable.
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