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That I have completed all of the forms and questionnaires presented to me and that the statements contained therein are, to the best of my knowledge and belief, true and correct and that I have not knowingly and/or willfully made a false statement of fact. I also declare that since my separation from service there has been no change in my status i.e. arrests, employment residence, marital status, medical, education, driving record, etc. except for the following: If any you must explain. If none.

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