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United States Army Donations Program <br />Qualification Checklist for Donation of Combat Materiel <br />Veterans' Service Organizations <br />Please complete the following questionnaire and return this form with the required documents <br />outlined below: <br />Full. Name of Organization (ORG): <br />ORG Physical Address: <br />City: <br />State: <br />Telephone Number:w _ IT FAX Number: <br />ORG E-mail Address: , <br />ORG Mailing Address (if different than above): <br />Zip Code: <br />City: .. ........... _._ State: Zip Code: <br />ORG Representative (REP): <br />Contact Information (if Different than above), Telephone Number: <br />Contact E-mail Address (If Different than above): <br />Name of Organization that owns the display site: <br />Address of Display site (if different from ORG): „�rvrvry m <br />City: State: Zip Code: <br />GPS Display Site Coordinates: <br />Type of Combat Equipment being requested (check only one): <br />[]Tracked Vehicle ❑ Towed Artillery ❑ Helicopter <br />Size Restrictions, maximum Length and Width: Feet x <br />Do you currently possess combat equipment as static display? <br />REP's Signature <br />113 <br />❑ Any Combat Material <br />_.......m..,.,. Feet <br />_ Yes No <br />Date <br />