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P.O. Box 490 Albany, OR 97321 541-917-7710 Information Form PRIMARY MEMBER: Name: Birth Date: Albany Firemen Mailing Address: City/State/Zip: Phone Number: Ambulance Membership Program Signature:

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Start by writing the complete address in the appropriate spaces. The first line should have the recipient's name or business name. The second line should include the street address, including any apartment or suite number. The third line should have "Albany" as the city name. Finally, write "OR" for Oregon and include the ZIP code "97321" on the last line.

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Albany, OR 97321 is a zip code for the city of Albany in the state of Oregon.

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Individuals or businesses located in Albany, OR 97321 may be required to file certain tax forms or documents.

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