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# of Copies

Name Name	Date of Birth Date of Birth	Address Address	City City	State State	ZIP ZIP	Phone Phone	Status Status
Smith James	10/07/1978	88 Center Rd	Bedford	OH	44146	715-361-4850	Active
Maria Rodriguez	10/07/1976	2349 Spinnaker Lane	Joliet	LA	60432	724-376-4350	Active
Smith James	10/07/1978	1566 Elm Drive	Cambridge	NY	12816	532-247-7219	Active