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Entry #52264
Proxy Request
Submitted: 2026-01-22 17:51:08
Form Fields
Your Name
ID: 8
First: Gabriela
Last: Jimenez
Your vNumber
ID: 5
V00391812
Email
ID: 17
Email address of person you are authorizing to check items out
ID: 7
vNumber of the person you are authorizing (if applicable)
ID: 11
V00392304
Name of the person you are authorizing
ID: 9
First: Maxwell
Last: Stites Jayne
When should the authorization should expire?
ID: 12
06/30/2026
Consent
ID: 14
Consent: 1
Text: I understand and agree to the above
Description: 8