Assignment Of Rights Form Page 2

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Location: _____________________ [city or county where signed]
Address:__________________
__________________
Assignor 2's signature: ____________________________________________
Date: _______________
Print name: ____________________
Location: _____________________ [city or county where signed]
Address:__________________
__________________
Assignee 1's signature: ____________________________________________
Date: _______________
Print name: ____________________
Location: _____________________ [city or county where signed]
Address:__________________
__________________
Assignee 2's signature: ____________________________________________
Date: _______________
Print name: ____________________
Location: _____________________ [city or county where signed]
Address:__________________
__________________

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