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Authorization

The undersigned, _____________________, hereby authorizes ________________ (name, names or firm) to enter the premises at ____________________ on __________

(Date) and remove the following specific articles: _______________________________

______________________________________________________________________

This shall be your good and sufficient authority for so doing, which authority shall expire on _______________ (Date) at ________________ (time).

Give this authorization to: _____________________ at _________________ (Location)

_________________________

Authorized Person Dated:

_________________________

Witness

Authorization #: ____________