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ICATE OF ACKNOWLEDGMENT OF EXECUTION OF AN STATE 3/1/1975 ORIGINATOR U.S. GOVERNMENT AGENCY: U.S. GSA POINTS OF CONTACT: GSA Forms Management Officer USERS: U.S. GSA FILE FORMATS: PDF OPTIMIZED? T PRINTABLE? T FILLABLE? T SAVABLE? T OBTAINING FROM: (1) GSA.gov, (2) USA-Federal-Forms.com, (3) Fillable.com ISSUANCES: ADOPTED? PRESCRIBED? PREVIOUS EDITIONS ACCEPTED? FORM CONTROLLED? SPONSOR: SUBSPONSOR: FUNCTION CODE: MANDATORY PRINT SPECIFICATIONS: PRIVACY ACT IMPLICATIONS? R.

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