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Get Arpin Van Lines Form PA1-22

For AVL Use ONLY Did Your Employer Pay for the Move (select one) ? Inventory Number Zip Article Description Agent / Storage Company Name, City, State No Yes; Specify Employer Name-Next Field Description of Damage or Loss Employer Name (If Employer Paid Only) Estimated Weight Age or Date Purchased Original Cost I am the owner of the property described. I did not cause or contribute to the damage set forth herein. All statements made in this statement of claim and any attached documents ar.

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