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Get FL DC3-268 2001-2022

obligation owed and no payment made, give reason and date when payment will be made: ____________________ __________________________________________________________________________________________ Official Use Only: Signature of Officer Receiving Report: __________________________________________________ Date WMR Received: _____________ Date WMR Due: _________________ Comments: I certify the above to be true and complete: Your Signature: Mailing Address: City: State:___________ Zip: E-Mail Ad.

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