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Section C: REQUEST FOR COMPLETE DESTRUCTION OF INFORMATION I, the undersigned, request that the information recorded between January 1, 1935, and December 31, 1964, in a file that a health and social services establishment holds for the user identified in Section A above, who was under the age of 21 at the time of admission to a psychiatric Form to request the destruction of records. It can be used by individuals, corporations, trusts, partnerships and their authorized representatives.
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