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941221KaUkaBlvd.,SuiteB202 Waipahu,HI96797 Of(808)3899369 Fax(808)6710222RegistrationForm ClientsName: DateofBirth: SocialSecurityNumber: Gender(circle one):MF Address: City: State: Zip code: Homophone:

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fax808671-0222 is a form used for reporting specific information to the relevant authorities.

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