MICHAEL A. MAURO Secretary of State State of Iowa
Security Authorization Request
USER INFORMATION: (Person who will download the file)
User's Name _____________________________________________________________________________ Phone ______________________________________ Fax _______________________________________ E-Mail Address ____________________________________________________________________________ Company Name ___________________________________________________________________________ Address _________________________________________________________________________________ City __________________________________________ State _________ Zip______________________
******************************************************************************* USER'S COMPANY APPROVAL:
Approved by ______________________________________________________________________________
(please print name)
Signature ________________________________________________________________________________ Date ______________________________ Phone ___________________________________________
******************************************************************************* SEND TO:
Secretary of State Attn: Cheryl Allen Lucas Building, 1st Floor Des Moines, IA 50319 Phone: (515) 281-5247 e-mail: [email protected]
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For Secretary of State Use Only:
User Name ____________________________________
Password ___________________________