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CONTRACT/AGREEMENT DATA SHEET A 0025 1. M/SER/CM/SD/SS Action Monitor: R 2. Date PIO/T Received: 9 /9 /82 PART ONE: COMPLETE EACH BLOCK FOR BOTH NEW ASSISTANCE/ACQUISITION AND MODIFICA1 ION ACTIONS

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Legal Form 21 (LV2-1) is a form used by individuals or entities to report certain financial information to the relevant authority.

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