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DocuSign Envelope ID: 55A4D9B6E65140CC84AFD62FC0A471CC 342756AB12154FA79E89196E2AE4E4E4 24899943C86447C68016CE50EAF1D1CB 3ADE9D967EC946DE92335AD4162340C6STATE OF ARIZONA Department of Insurance and

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Note to form public is a document that discloses important information to the public.

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Note to form public can be filled out by providing all the necessary information and submitting it to the appropriate regulatory body.

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The purpose of note to form public is to provide transparency and information to the public about certain entities.

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Information such as financial data, business operations, and key personnel must be reported on note to form public.

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