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CLAIMANTS CERTIFICATION & DECLARATION I do solemnly declare
and certify under the penalty of the law that the within bill is correct
in all its particulars, the articles have been furnished or services
rendered as stated herein, that no bonus has been given or received by any
person or persons
within knowledge of this claimant in connection with the above claim and
that the mount charged is a reasonable one. Anne McNally, VP
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