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I verify that this application is in the original format as supplied by the Department of State and has not been altered or otherwise modified in any way. Have you been employed by the federal government in the practice of your profession since your Pennsylvania license lapsed or since you placed it on inactive status I understand that any false statement made is subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities and may result in the...
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