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WORTHLESS CHECK INFORMATION DUSTY GALLIVAN ECTOR COUNTY ATTORNEY Check Writer Information Name Address Driver s License State Sex Home Phone Work Date Letter sent to check writer by regular mail DOB Merchant Information Business Number Manager Business Address Mailing address for restitution Cashier s name who took the check Cashier s address What was purchased with the check Has partial payment been accepted YES NO Amount My signature below CERTIFIES that I fully understand and assert the...
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Dusty Gallivan form is a financial disclosure form required to be filed by certain individuals.
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