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ENTITY 1b. TYPE OF ENTITY IF APPLICANT IS A BUSINESS ENTITY: Partnership IF APPLICANT IS AN INDIVIDUAL TAXPAYER: Corporation General Regular Subchapter S Trust LLC Limited NAME OF AUTHORIZED COMPANY OFFICIAL TITLE Property Owner Other (specify) MAILING ADDRESS BUSINESS ADDRESS CITY/TOWN CITY/TOWN STATE TELEPHONE ZIP CODE ZIP CODE TELEPHONE FAX STATE FAX TAXPAYER IDENTIFICATION NUMBER (OR SOCIAL SE.

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