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Exception Request
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Exception Request
Exception Type
Variance
Exemption
Accommodation Request
Required
Classification
Individual
Required
Request Date
04/19/2024
Name
Required
Agency
Required
OMD
Required
Chief Officer
Required
Reason
0
of
4000
Required
Duration
0
of
4000
Individual Completing Request
First Name
Required
MI
Last Name
Required
Business Name
Working Title
Email
Required
Primary Phone
Alternate Phone
Address Line 1
Address Line 2
ZIP
City
State
As the author of this variance/exemption request, you are attesting to the information to be accurate and complete. If submitting on behalf of an individual, you are also attesting the individual is aware of the submission and has consented to such submission.
Required
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