| Document Date: 2017-11-05 03:28:23
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Country United States / / Facility Department store (name) / IndustryTerm property insurance / real estate / bank accounts / insurance payments / real estate taxes / electricity / / Organization Forma Pauperis District Court / / Position paralegal / attorney / typist / appropriate institutional officer / /
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Affidavit to Accompany Motion for Leave to Appeal in Forma Pauperis District Court No.____________________ Appeal No. __________________________