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Sample Nebraska State Agency Activities Authorization Request


Date: ___________


Network Manager
Nebraska Interactive
1135 M Street, Suite 220
Lincoln, NE 68508

RE: Nebraska State Agency Activities

Dear Network Manager:

The following individual(s) is/are authorized to add, delete, and change meetings on the "Nebraska State Agency Activities" for this organization:

Name_______________________________ Title_________________________
Phone Number________________________
E-mail address________________________

Name_______________________________ Title_________________________
Phone Number________________________
E-mail address________________________


Name_______________________________ Title_________________________
Phone Number________________________
E-mail address________________________

This authorization remains in effect until ___________(date) or until superceded by later correspondence.


___________________________
Signature

___________________________
Name

___________________________
Title




Nebraska State Agency Activities

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