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CLIENT CONTACT INFORMATION SHEET C. Andrew Basin North Carolina, Tennessee, 7312176135 cabaskin7 Gmail. Combined Date: / / Age: Gender: Male Female Name: Address (Street and Number): City: State:

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Simonton - public member is a form required to be filed by certain individuals who are public members.

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The purpose of the simonton - public member form is to disclose any potential conflicts of interest for public members.

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Public members must report any financial interests, affiliations, gifts, or other potential conflicts of interest.

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