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2023-544-E-Health Dept-Transplanting Traditions -Outside Agency Agreement
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2023-544-E-Health Dept-Transplanting Traditions -Outside Agency Agreement
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Last modified
10/5/2023 2:34:52 PM
Creation date
10/5/2023 2:34:31 PM
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Contract
Date
9/27/2023
Contract Starting Date
9/27/2023
Contract Ending Date
10/5/2023
Contract Document Type
Contract
Amount
$12,000.00
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Cover Page P a g e 9 o f 32 <br /> <br /> Executive Director Date <br /> <br />Signature: 1/12/2023 <br /> Board Chairperson Date <br /> <br />Application Signatures: Please submit a wet signature or electronic signature, MS Word cursive fonts are not <br />acceptable. <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: D2C31311-1A1A-4A30-9007-2F17D64E6227
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