PERMFILE121002

• Permit No: M1986079
• IBM Index Class Name: Permit File
• Doc Date: 6/4/1986
• Doc Name: POLLYANNA F MANN MARITAL TRUST M & G PIT APPLICATION FOR MLR PERMIT IN ADAMS CNTY
• Media Type: D
• Archive: No

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' ADDITIONAL INFORMATION
' This space can be referenced for further information of any of the items in this form.
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' To the best of my knowledge, all the information presented in this application is true
and correct.
/ ~
Date• ~ ~'~2- Sir By: _L%GliL-~r~- y/ ~Zc°.~
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Tit e
(Signature by individual legally authorized to
bind the operator to this application)
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' (Rev. 4/84)
Ooc. No. 5547
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