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I authorize the Town of Telluride to initiate debit entries to my checking and/or savings account at the depository(s) named below. This authorization is to remain in effect until the Town has received written notification from me (customer) of its termination with such sufficient time to afford the Town and the depository a reasonable opportunity to make such a change. I understand the Town of Telluride will not be responsible for any bank fees or charges that this payment withdrawal may cause.
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