Certificate Of Formation New Religious Corporation Or Religious Society Page 2

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2. NAME [PLEASE TYPE OR BLOCK PRINT]
RESIDENCE ADDRESS:
(P.O.BOX UNACCEPTABLE)
ADDRESS:
CITY:
STATE:
ZIP:
SIGNATURE:
3. NAME [PLEASE TYPE OR BLOCK PRINT]
RESIDENCE ADDRESS:
(P.O.BOX UNACCEPTABLE)
ADDRESS:
CITY:
STATE:
ZIP:
SIGNATURE:
FORM CICR-1-1.0
PAGE 2 OF 2
Rev. 7/2010

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