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.........................:............................................................ ............................................. <br /> M.A Y 1 9 ig <br />*3........... .......... ........................................... ............................... ......... ...... ..................................... <br /> ""YM4 Respectfully submitted, <br /> (Signature) <br /> Petition received by ....................... ...................... . <br /> (Address) ./. .. ............ <br /> Hearing date set for .................... ................ .... 19 ...... t Z,6& ��w <br /> t / - d,2 63, <br />