Fillable DISABILITY SERVICE APPLICATION FOR SOLID WASTE SERVICES (City of College Station)

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DISABILITY SERVICE APPLICATION FOR SOLID WASTE SERVICES (City of College Station)

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The DISABILITY SERVICE APPLICATION FOR SOLID WASTE SERVICES (City of College Station) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for City of College Station

BROWSE CITY OF COLLEGE STATION (TX) FORMS

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Applicant Name:
Physical Address:
Phone Number: Date:
Applicant’s Physician/Medical Provider must complete and sign this form before service can begin.
Check one of the boxes:
Patient is temporarily disabled from / / to / / .
Patient is permanently disabled.
Name of Physician/Medical Provider:
Address:
Phone:
Signature: Date:
Completed forms can be faxed to 979.764.3489 or emailed to rwaller@cstx.gov.
DISABILITY SERVICE APPLICATION
FOR SOLID WASTE SERVICES
C
IT
Y
OF
C
OLLEGE
S
TATION
PUBLIC WORKS
cstx.gov/publicworks
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DISABILITY SERVICE APPLICATION FOR SOLID WASTE SERVICES (City of College Station)

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Completed 20 July 2020

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