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D 19.1001-19.1023 and that the information provided on this form and on any attachments is true and correct. I authorize any changes requested on page 2. NO SIGNATURE REQUIRED LHL367 10/2009 Page 1 of 2 CHANGES ONLY MAY BE FAXED TO 512-490-1054 REQUEST CHANGES ONLY: COMPLETE ONLY ITEMS THAT HAVE CHANGED Feel free to use a separate sheet of paper, if there is not enough room on this form Firm Name or Alias.

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  • 107-1A
  • URL
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  • prelicensing
  • TAC
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  • COMPTROLLER
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  • NONREFUNDABLE
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