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| Title | Patron's Name and Address Slip |
| FormNumber | 4232 |
| Revision | 5-50 |
| Division | |
| WhereUsed | |
| EKU | 1984 ASW |
| LKU | |
| Notes | October 2001 - specifically for Rural Customers. Original title given as "Rural Customer Delivery Instructions", but "Patron's Name and Address Slip" is at top of form. |
| Source | SS |
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