Exception Request

Exception Type

Classification

Individual

Request Date

04/18/2025

Agency

OMD

Chief Officer

Reason

First Name

Last Name

Business Name

Working Title

Primary Phone

Alternate Phone

Address Line 1

Address Line 2

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.

Exception Request

Individual Completing Request

Hidden Items

Modify Notes