Childers_ Tommy 662-417-4010

							REQUEST FOR EXCEPTION TO MASTER
CELLULAR AGREEMENT

AGENCY: MS Dept. of Transportation (MDOT)

EMPLOYEE NAME:_TOMMY CHILDERS_________________________

DIVISION/DISTRICT:___2 ND.______________________

TYPE OF USE (Voice, Data, Both):BOTH

REASON FOR REQUESTED EXEMPTION:

COVERAGE, NO COVERAGE IN PARTS OF MY AREA

SPECIFIC COUNTY(IES) AFFECTED: NO COVERAGE IN BENTON CO. NORTHWEST MARSHALL CO.

SPECIFIC PHYSICAL OR STREET ADDRESS AFFECTED:

205 HERITAGE DR. HOLLY SPRINGS, MS.

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Please complete and return to Jason Moulder, 97-01, or jmoulder@mdot.state.ms.us.
NOTE: This information will be used by ITS to determine whether or not cellular exception is
warranted. There is no guarantee that you will be approved for exception.