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have read and understand the statements on this form, and I hereby swear or affirm that <br />-he s-fl-atements on this form are true. Yes <br />Addial .ti onal Information: <br />L-orm submitted on: 8/27/2008 1:32:41 PM <br />Submitted from IP Address: � <br />Fc)rm P-ddress: 'nttp://www.c,i.roseville.m-ri.-US/forms.a,sp?FID=25l <br />N <br />