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SMALL ENTITY VERIFICATION FORM (Regular Application with Filing Date Before October 1, 1996) Owner: Application/Patent No. Filing Date: (October 1, 1996) Title: W e hereby declare that we have read

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Field before October 1 refers to a specific document or form that needs to be submitted prior to the first day of October.

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The requirement to file filed before October 1 generally applies to individuals or entities specified by the governing authority or regulatory body that mandates its submission.

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