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Knowledge and belief. I understand that any false statement herein may subject me to the criminal penalties of 18 U.S.C. 1001. Signature (in blue ink) of applicant/person responsible for permit (No photocopied or stamped signatures) Date of signature (mm/dd/yyyy) Form 3-200-37 Rev. 02/2014 Page 1 of 6 E. EXPORT/RE-EXPORT/IMPORT/INTERSTATE AND FOREIGN COMMERCE/TAKE OF NONN.

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