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If HONORABLE DISCHARGE or SEPARATION submit photocopy of your separation papers and specify DATE OF SEPARATION below SIGNATURE OF COMMISSIONED OFFICER IN CHARGE is not required. NAME OF APPLICANT First Name Middle Initial Last Name RANK REGISTRATION NUMBER MOTOR VEHICLE MARINE VESSEL MAILING ADDRESS No* Street Town State CT OPERATOR LICENSE NO. IF NOT LICENSED IN CT SPECIFY STATE ISSUING CONNECTICUT RESIDENT ADDRESS No* Street Town - If same as above write SAME CHECK ONE FOR ACTIVE DUTY STATUS ...

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