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Notary Public My commission expires: ___________________________________ YOU MUST FILL THIS FORM OUT COMPLETELY AND YOU MUST FILE THIS FORM WITH YOUR APPLICATION.

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CHARLES C CABOT Jr Notary Public NOTARIAL SEAL My commission expires March 27 1965 STATE OF MASSACHUSETTS County of Suffolk ss.

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He shall give bond to the state for the faithful performance of his duties, in an amount and with sureties to be approved by the governor, and may appoint one or more deputies, for whose acts he shall be responsible.

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