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Fillable DD FORM 771, JUL 1996 (EG) - NOSTRA - med navy

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DO NOT SEND COPY OF MILITARY ID CARD (THIS FORM IS SUBJECT TO THE PRIVACY ACT OF 1974 Use DD Form 2005.) EYEWEAR PRESCRIPTION DATE ACCOUNT NUMBER TO: (Lab) ORDER NUMBER FROM: NOSTRA 160 Main Road, Suite 350 Yorktown VA NOSTRA Com: 757-887-7611 DSN 953 23691-9984 NOSTRA Com Fax: 757-887-4647 DSN 953 22312 Commercial DSN NAME (Last, First) PHONE: Commercial DSN FAX: SSN GRADE [LAST 4 ONLY]...
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