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(Year)
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NOTARY PUBLIC
Doc No.
Page No.
Book No.
Series of 200___
p. 2
PART II. PROCESSING OF REQUIREMENTS
(To be accomplished by the processor in the RO)
Date Received:
By: ____________________________________
Processor
(Signature over printed name)
Date ____________________________________
Recommended by:
_________________________
Director/Head Field Office
____________________
Date
________________________
Name of Releasing Officer
____________________
Date