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Rn Application pending 07/01 , 2008, and ending Please C Name of organization use IRS Doing Business As label or print or Number and street (or P.O. box if mail is not delivered to street address) type. See Specific City or town, state or country, and ZIP + 4 Instructions. Activities & Governance D Employer identification number 43-1234200 E Telephone number Room/suite 901 S NATIONAL (417)836-5632 G Gross receipts $ SPRINGFIELD, MO 65897 H(a) Is this a group return for F Name and addr.

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