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STATE APPEAL BOARD CLAIM FORM AND AFFIDAVIT CLAIM NUMBER (for Appeal Board use only) This form is also available on the Internet at
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Document Date: 2014-11-04 13:32:58

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City

Des Moines / /

IndustryTerm

gas tax refunds / insurance carrier / /

Organization

General Assembly / APPEAL BOARD Department of Management DATE RECEIVED / My commission / State Appeal Board / Appeal Board / /

Person

Make / /

Position

General / ATTORNEY / county official / Special Assistant Attorney General / model / /

ProvinceOrState

Iowa / /

URL

http /

SocialTag