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A B C D (please circle one) APPLICANT S STATEMENT This is my application for a retirement pension. I represent that the information in this application is correct. I understand that the Pension Fund will rely upon the information supplied by me and that my pension may be in jeopardy if I have misled the Pension Fund. I also understand that any pension may be suspended in accordance with the provisions of the Pension Plan and federal law, in the event that I hereafter obtain employment in th.

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