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210000
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Age
6
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6
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Weight
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3(1)
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Form
67-0075
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Age
4
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Weight
9-2
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349402
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Age
4
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681700
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Age
5
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Weight
9-2
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010064
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11
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Form
401377
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7
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8340-90
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4
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363040
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308050
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814200
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239-160
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