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Document Number: DVR-20205-E
Description: This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into.
Comments: This form has tabbed fields for completion.
Content Contact: DVR Forms
Document Attachment:
DVR-20205-E (Electronic Version - pdf)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
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