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Rancho Cordova, CA 95670 (916) 552-9000 I www.brea.ca.gov COMPLAINT FORM INFORMATION ABOUT YOU (Complainant) 1. Name Last First M.I. 2. Telephone Number 3. E-mail Address (optional) 4. Address Street City County State Zip 5. You Are: Seller Buyer Those Seeking to Refinance Other: Authorized Representative Authorized Representative must provide the information requested below: Authorizer s Name: Authorizer s Address: Street City State Zip I Authorizer.
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