REQUEST FOR WAIVER OF DEFERRED PAYMENT FEE by ito20106

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									      REQUEST FOR WAIVER OF DEFERRED PAYMENT FEE

Documentation supporting request should be attached to this form.
Please return form to the University Billing Office, 5 Calvin Hall


DATE__________________________

UNIVERSITY ID#_______________________________

NAME_______________________________________

ADDRESS______________________________________________________________


REASON FOR REQUEST:




SIGNATURE__________________________________________________


************************FOR OFFICE USE ONLY*************************

Fee Waived? YES       NO               One-Time Waiver? YES          NO

Reasoning: ___________________________________________________________

Signature _____________________________________ University Billing Office

								
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