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5. Date business began: / / Date business began in Connecticut: / / Section 3 - Declaration and Signature Declaration: I declare under penalty of law that I have examined the information contained on this questionnaire and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a ne of not more than $5,000 or imprisonment for not m.

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