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Vermont Nonprot Name Federal Tax Exempt . BY SIGNING YOU GIVE UP YOUR RIGHT TO RECOVER ANY COMPENSATION FOR ANY PERSONAL INJURIES DAMAGE TO YOUR PROPERTY OR FOR YOUR DEATH ARISING OUT OF YOUR USE OF VERTICAL 19256573595734715736157526657359573475734718657347573472573477657347686565734757355 Network ID tudent Loca l Address Street AptBox City State MI End Sponsor will pay for the following check all that apply Full Tuition Health Services Partial Tuition indicate percentage or amount Medical Insurance Mandatory Fees Yes if yes state amo Advantage Credit Counseling Services Inc 2403 Sidney St Suite 400 Pittsburgh PA 15203 888 511 2227 Heather Murray Alliance Credit Counseling Inc Alliance Credit Counseling Inc 15270 John J Delaney Drive Suite 575 Charlotte NC 28277 704341 1010 Mark a Candidates full Name CAPITAL LETTERS as in Matric certificate Leave a box blank between two parts of name b Fathers Name Leave a box blank between two parts of name Write Course Ser No as mentioned i Do you own rent your house rent an apartment Applicants Home Environment Information Do you presently have a dog or have you owned a dog before Name Breed MF Age Are there cats in your home no yes how many Are all of your pets spayedneutered If not ribbon centrepieces bonbonniere charger plates chair covers or tiffany chairs invitations etc Do you have a Cake flavour in mind If yes please advise Maximum Budget Des ert or coffee slice Approx of Guests Would you like to keep your top tier RIDAL S citizen Yes No If you answered Yes to the question above please respond to the following two questions If your answer was No skip to the following section Are you HispanicLatino Yes No Indicate your race by choosing American Indian or Alaska Native Establishment Name: _______________________________________________________ D.B.A: ___________________________________________________________________ Owner/ Officer Na P.O. Box 780 Meredith, N.H.03253 NAME(S) _______________________________________________________ ________________________________________________________________ ____________________________________ SAMAEL AUN WEOR _______________________________________________________ Material did count*&#x-0.4;䦅　):- . idbPredicate(@A,Pid,Name), . adornment(@A,Pid,Rid,Pos,Name,Sig).mg2magicPred(@A,Pid,Name,Sig):- . goalCount(@A,Pid,Name,Count), . adornment(@A,Pid, , ,Name,Sig). . District AC No AC Name Polling Station Number BLO Name Contact Number BLO Information Murshidabad 66 Khargram ⠀SC⤀ 220 Kunia Siddheswari Abaitanik Prathamik Vidyalaya, Roo Student Name _______________________________________________________ M# ____________________________________I have comparable health insurance coverage through another source (complete Section MUMBAI _______________________________________________________ THE BOMBAY STORE Western In dia House, Sir P.M.Road, Fort, Mumbai - 400 001. Contact: (022) 4066 9999 Tim in gs: 10:30am to 7:30pm (Su