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Physician's Statement This statement is submitted to the Election Commission of RUTHERFORD COUNTY, TENNESSEE pursuant to Tennessee Code Annotated 26201(3)(A), as follows: Patient's Name: Date of Birth:
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This statement is submitted to disclose certain information or declarations.
The individuals or organizations specified by the governing body are required to file this statement.
This statement can be filled out electronically or manually, following the instructions provided by the governing body.
The purpose of this statement is to ensure transparency and compliance with regulations.
The required information to be reported on this statement may include financial data, personal information, and other relevant details.
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