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ZIP Code 7. Mailing Address 10. Administrator 11. Report Contact Person 12. E-mail Address 13. Phone Number 17. Reporting Period Began 19. Name of Home Office If Applicable 20. Home Office Phone Number CERTIFICATION I certify under penalty of perjury as follows That I am an official of and am duly authorized to sign this certification and that to the best of my knowledge and information I believe each statement and amount in the accompanying report to be true correct and in compliance with Sect ...

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