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Form 100, Page 1 of 4 / January 2012 FOR OFFICE USE ONLY / PARA USO DE LA OFFICIAL Date Form 100 is Requested/Issued Status Application Date Identifiable Form100 is Received Case Record Number Appointment

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The purpose of form 100 11-29-11--jcdoc is to collect financial information for tax or regulatory purposes.

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Form 100 11-29-11--jcdoc requires reporting specific financial details as outlined in the form instructions.

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