Form 49456 - Identification Of Potentially Affected Parties Page 2
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3I. Identification of Potentially Affected Persons
Please list here any and all persons whom you have reason to believe have a substantial or proprietary interest in this
matter, or could otherwise be considered to be potentially affected under the law. Failure to notify any person who is later
determined to be potentially affected could result in voiding our decision on procedural grounds. To ensure conformance
with AOPA and to avoid reversal of a decision, please list all such parties. The letter attached to this form will further
explain the requirements under the AOPA. Attach additional names and addresses on a separate sheet of paper, as
needed. Please indicate below the type of action you are requesting.
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
Name:
Name:
Street address:
Street address:
City/State/ZIP code:
City/State/ZIP code:
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