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2016-700 Emergency Svc - South Orange Rescue - Application for Services Franchise by Ordinance
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2016-700 Emergency Svc - South Orange Rescue - Application for Services Franchise by Ordinance
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Last modified
9/10/2019 9:31:00 AM
Creation date
12/15/2016 11:32:15 AM
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Template:
BOCC
Date
12/13/2016
Meeting Type
Regular Meeting
Document Type
Others
Agenda Item
6h
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SOUTH ORANGE <br /> RESCUE SQUAD <br /> 1 S O " D AN GE <br /> R E S C L S F1L �© <br /> Semper Aptus Muneris - Volunteers Since 1971 <br /> Employee Information <br /> Name of person driving SORS vehicle: <br /> Department: <br /> Personnel Phone Number: - - <br /> Date of Birth: / / Driver's License Number: <br /> Other Party Information(if applicable) <br /> Name of other party: <br /> Address: <br /> Phone Number: - Driver's License Number: <br /> Vehicle Make/Model/Year: Plate: <br /> Description of Damage <br /> Please provide a description of the damage: <br /> Employee Signature: Date: / / <br /> Assistant Chief Signature: Date: / /. <br /> Drug Testing Required: Yes No (Required if involved in incident involving two <br /> vehicles) <br /> Drug Testing Performed: Yes No <br />
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