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Client No. FA: Julie Valentine Center Intake / Referral Form JC Staff handling intake(Page 1of 2)Referral Date AgencyReferral Source Name Reason for ReferralSexual AbuseServices RequestedForensicPhysical

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It is a form used to report information about a company's letterhead in accordance with the law.

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All companies that are legally obligated to comply with the regulations surrounding letterhead use must file this form.

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