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To the head

of the Praparatory Department,


Taras Shevchenko National university of Kyiv
Usatenko G.O.
The student of the Praparatory Department
Group A-2
Name Surname
Mobile number

Application

I will go to Lviv to meet with my lawyer from __12.2021 to __. 12.2021. and
during this period I will not be able to attend classes at University.

Date Signature

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