Granting Authority to Act Affirmation  affirms the truth of the following Applicant Name
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Granting Authority to Act Affirmation affirms the truth of the following Applicant Name

I am the of State relationship to business Name of business as it appears on your Business or Partnership Certificate or Certificate of Incorporation or Filing Receipt If you are applying for an Individualbased license please enter NA which is loc

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Granting Authority to Act Affirmation affirms the truth of the following Applicant Name




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