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Get SBA 912 2009

Other: Date Disposition Completed: 2) Charge: Month/Year of Arrest: City, County, State of Arrest: Disposition of Charge (List Specific Details) Sentence: Fine: Other: Date Disposition Completed: 3) Charge: Month/Year of Arrest: City, County, State of Arrest: Disposition of Charge (List Specific Details) Sentence: Fine: Other: Date Disposition Completed: Signature: Date: Attach additional sheets if necessary Version 03/26/09 9 .

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