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Physician s Name Physician s Phone Street Address City State I certify and declare that said applicant is CHECK ONE Zip TEMPORARILY HANDICAPPED PERMANENTLY HANDICAPPED Under Iowa Administrative Code 571-15 handicapped person means an individual possessing a physical impairment of the upper extremities that makes a person PHYSICALLY INCAPABLE of shooting a bow and arrow. I understand that providing false information makes this application invalid. Therefore any and all licenses issued as a...

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