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THE FIRST CATHOLIC SLOVAK UNION 6611 ROCKSIDE ROAD INDEPENDENCE OHIO 44131 MEMBER TRANSFER REQUEST From Branch Member Name Address Reason optional I the undersigned officer hereby certify that member shown above who holds policy s and on whose behalf this TRANSFER REQUEST is being executed is currently a member of our branch. Branch Officer Date To Branch member of our branch. Approved by President FCSU Executive Secretary FCSU rev 4/10.

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