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Military Specialty Plates Application Step 1 Idaho 2019-2023
Please check appropriate box and Print clearly. Printed Name of Medical Professional Certifying Eligibility Print Legibly Address City State Zip Code Practitioners National Provider Identifier required Office Phone Number Authorized Signature Date Do Not Send Money You will be billed for your fees or you may authorize payment with your Credit Card. E-mail applications to specialplates itd. idaho. gov Fax application to 208 334-8542 You can obtain additional application forms via the Internet at...
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