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AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE PAGE OF PAGES 1 2. AMENDMENT/MODIFIED TON NO. 3. EFFECTIVE DA TE PS10 SEE BLOCK 16C 6. ISSUED BY: CODE QT ACA 4. REQUEST ITIN

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5. Enter the effective date in the designated field using the specified format. For example, if the format is MM/DD/YYYY, enter the month, day, and year accordingly.
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1. Individuals filling out official documents or forms that require indication of an effective date.
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