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2. Description

   Complete this form to notify the Bayfield County Veterans Service Office of a veteran in need of assistance.

4. Why would you like to refer this veteran?
6. Veteran's Info
8. Name
10. Phone
12. Email
Leave This Blank:


14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field