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Get CO DoR DR 0563 1994

Er) Name of Firm (Buyer) I CERTIFY THAT Street Address or Post Office Box Number City WHOLESALER QUALIFIES As (Check each applicable item) ZIP Code State RETAILER LESSOR* (See note on reverse side) MANUFACTURER POLITICAL SUBDIVISION OR GOVERNMENTAL AGENCY CHARITABLE OR RELIGIOUS OTHER (Specify) and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is.

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