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Rev. 1/124/96 Date Submitted October 25, 2001 (Submitter Provide) DM NUMBER (Secretariat Only) ASC X12 WORK REQUEST FORM A. SUBMITTER INFORMATION: Submitter Name Kim Van Pelt Company Address 5444
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Employees or representatives of CMS Energy who need to communicate with Kevin Van Pelt, a contact person within the company.
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