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EFTA01305903
CLAIM CI ITEM N QUANTITY VALUE DESCRIPTION I t () 1) \I D • kt='- nck) 0 ivi POSO \ - __ 1. `› 05 2 9 1)(_)(7 LACi. its i i ;"( ri 7 NJC-A SE -F1 \f5 • ,..5 1 • TOTAL PACKAGE WEIGHT I hereby acknoMedpe that the above list represents al properly taken from me and that I have received a
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