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Entry #32285
Proxy Request
Submitted: 2024-11-15 22:29:51
Form Fields
Your Name
ID: 8
First: Trey
Last: Wilmot
Your vNumber
ID: 5
V00398956
Email
ID: 17
Email address of person you are authorizing to check items out
ID: 7
Name of the person you are authorizing
ID: 9
First: Maddie
Last: Camacho
When should the authorization should expire?
ID: 12
05/16/2025
Consent
ID: 14
Consent: 1
Text: I understand and agree to the above
Description: 8