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Fillable Standard Form 95 - Department of Justice - justice

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CLAIM FOR DAMAGE, INJURY, OR DEATH 1. Submit to Appropriate Federal Agency: INSTRUCTIONS: Please read carefully the instructions on the reverse side and supply information requested on both sides of this form. Use additional sheet(s) if necessary. See reverse side for additional instructions. FORM APPROVED OMB NO. 1105-0008 2. Name, address of claimant, and claimant's personal representative if any. (See...
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