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Address: Manufacturer Name: Software Version: Description of Problem: Date Machine Failed: Credits Left on the Machine: Yes No Number of Credits Left on the Machine: Technician Signature: Date: Technician to Contact: Telephone #: WVL Computer Room Signature: Date: Description of Work Performed: Logic Seal # Removed: West Virginia Decal #: New Logic Seal #: WVL Security Signature: Date: Date Machine Enabled: WVL Computer Room Signature: Attach audit ticket from video lottery ma.
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