[Your name] [Your address] [City, State, ZIP Code] [Date]
[School/Institution name] [Address] [City, State, ZIP Code]
Dear [Recipient's name],
I, [Your name], authorize [Authorized person's name] to pick up my Form 137 on my behalf. He/she has been duly informed and has my full consent to act on my behalf.
Sincerely, [Your signature] [Your printed name]
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