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DEC-6-2005 21:25 FRUM:CITY OF SHUREVlbW 6514y~J4byb
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<br />I U: b183 ((313(8 P: 2~2
<br />PAGE 02/Fj2
<br />ApP>~~~AxX(}N FOR T3t;PA~t'~'MENT 0~ ~iTi ARMX' ~lr~~x f33 CFR 325) ON11i APPRf}VA1, NU. Q7ln.txr,3 Ftptres ACC
<br />:~a. zoos
<br />Thn publta Durdcn fnr utlt CAllecdpn ~lninrmnt;tm is c~timnrc0 to nvcrn~q 1 t1lrAtlro patrcapatt~C, altlraugh Ute mhjnr;ty of ~ppllcntlons should tCCjvirC S 1h3Urs or Icva,
<br />thrg fnelgdtS the llfrM (or ruvtewiTR (n,+ttVCi;e»x, xenmh4n(; eti~Iin& tints 9ot1tORR+ ~,A[hcrin~ and rtfalntnlning fltC da[a neodsa, ~[ricf cnmplarln~ :rnt1 rcv;ewifl~ tttc
<br />rn1le,alien of inform'11ion, Scnd oornrtlCnls rc~.xdlnF th;a hordes rktlRlaFC nr nny atNgr nspect of Ihi9 oolltttioh of informntlon. inRluding r;ttgpcninn~c im+vducing this
<br />huMttdn, to Th+frirtrnent a(Dcfrnno, Wnahin~ton }#t`gdC{pnrtCr~ 5crvlce 1?}i++alnr~[e of Tnik+rmoHDn bptrptions hMt Reports. I ~ (~ JefFSrepn Onvly 111phwny, Stdre 120x.
<br />Arllfl~lan, VA. 2r1ai72-y9nZ; n+Rl to the OfKnc of Ivtrtnrgerttcr[t and Bud~ct. T':tprrwork Roduetlon Pmjnat (07tn-ntmay, WnnMnFton. D[ ~Q543, RrApondcnn should hn
<br />nwnt0 dtAT nblwfthstnnglnftasy nrfit+r pmvic;on of Inur, ne pcrstm ahnlt bo suhjcc[ to any pen0.11y for faU4ng [o comply with n collcetSan oF;nformtttion if i1 dac9 no[
<br />dirplny n otrrtnntly vntld OMO ennir'nt nomhcr. PfonM DO NOT RETURN yat[r t'otm ro of{hnr of tS7(MC hddtca.9cA. CotnpletCq nppt;cntitmc Rn7Ft I±c :ubmittcd to the
<br />f];Ftrit:l enRittSCY hnvlnp f ttr1Kllatlrm ovtr [hc Incnt;ott nr thn proppced nctivlU~,
<br />t?'RIVACY A,CT ATAT£htHNZ[ ~ott+nririee; li;rrrt and Hnrl+or% lwt, Seddon 10, 33 USC A03[ Ckhn ~'attr Act. Scc[;on a04, :1i USC t ~+s+t: Mnriec 1'TOtLCGon.
<br />Rt9thtch and Snnttttarlnf[ nn, ;{~ 11SC tat 1, 9ctRnn 10~. PLSne;Pnl purpmct [nfnrfflntfon provided an fhb forts wln he used in er.+hcnipl; the spptie[ttion for n pcrmtt.
<br />tt~lrLlflC unc,a; 1'11fA fnfnrmnrjnn mqy bS a7tarrd w+1tD the I)cpnnmc7[I of lusfioe and Pltkt Fcdrrn t, stale, and Ind?I ~+vernmcnt n~onGic:;, SubtnlgGion of tCqurstad
<br />Intormatlrm it vnluntnry; t,pwFVtr, if irriormntlon is not prwldttl, tt7r, pctTUit appllaalian Chnnor Un cvn(uatnq nor ens a pcrm;t ho Earned.
<br />~x~t~s ~ 'r~zovcr~ a pro ~~ >Fx~~.~n air ~~ ~r~r~ cf~R~s
<br />!. APPLYCATION N0. f 2. FlEI-J) OFPiCE (`c)DR ' 3. DgTF, RFCEN6p ' 4, DATE APPI,ICA"i'1~N L:OMP4~T6D
<br />YOLJ p0 A101`NEED TC! CpMPR~'TE ITEMS 6-i 0 end 12-25 rn the SNAREA AREAS,
<br />cif ttpplicants most epmpleto nou~Sh9ded items S and 26, l f an agent is usod, also complete Itema 8 nn4 1). 71tis (t~7(i(ingl ,FcTferaJ fot7tt is valid
<br />For use onlg when incla_ded„as part of thin entire state annlfcation onckct.
<br />S, APPL(C:ANT"S NAMH ~ &. AL?THnRtzP_D n(i'HNT'~ NAME AND TtTLB tall agent is not mquirod)
<br />Jerry Auge Beth Kuflkt~l, Uf3S
<br />5~~5
<br />21. ST 1Tk,MIICNT OF AUTfI01R(7,AT1fON ((~oppltt'aGJc;
<br />fr+rnplr(roNa JfaurAr,rictnRanngvtr)
<br />[ hereby auThtrrixc
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