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Upon completing this application return the original completed form to your local county public health nursing office or mail to Wyoming Department of Health 6101 Yellowstone Road Suite 420 Cheyenne WY 82002 Attn Immunization Exemptions. List the specific immunizations to be exempted Signature of Parent/Guardian To be signed in the presence of a Notary Public Date of Signature NOTARY ACKNOWLEDGEMENT County of On this Day of 20 Place Seal or Stamp Below Witness my hand and official seal....
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