Da Form 2823 - Sworn Statement Page 2

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USE THIS PAGE IF NEEDED. IF THIS PAGE IS NOT NEEDED, PLEASE PROCEED TO FINAL PAGE OF THIS FORM.
STATEMENT OF
TAKEN AT
DATED
9. STATEMENT (Continued)
INITIALS OF PERSON MAKING STATEMENT
PAGE
OF
PAGES
APD LC v1.01ES
DA FORM 2823, NOV 2006

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