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0 <br />Date Organized /(f f/ <br />// (( <br />&Corporation ❑ Unincorporated Association <br />Religious <br />Veterans Organization <br />Educational Organization Civic Organization <br />Organization <br />(non-profit) I <br />❑Charitable <br />❑ Volunteer ❑ ❑ <br />Fraternal Organization Other <br />Organization <br />Fire Company <br />FOR M.S.L.C. USE ONLY <br />AUT ORIZED FFICER OF ORGANIZATION SIGN 5.EUOW <br />❑TAX FORM SENT <br />x <br />OI Officer .d'-. . <br />ey <br />/./..........Date <br />DATE-. <br />NUMEBERS E AREA HOME PHONE <br />DATE OF OCCASION <br />y <br />INV. ASSIGNED. <br />y_ AREA BOUSIONESS TEL N/2 <br />NUMER OF ONS <br />....... <br />NEXTBTWELVEEC( 2q MONTHS ..... ........ Q <br />Assigned By <br />Date <br />