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Sleading statement with respect to this application and any supporting document, including the concealment of any material fact, may result in the refusal to issue a passport, the revocation of a currently valid passport, and/or the imposition of a period of refusal of passport services, and may be grounds for criminal prosecution as per subsection 57 (2) of the Criminal Code (R.C.S. 1985, C-46). Read Instructions Type or print in CAPITAL LETTERS using black or dark blue ink. 1 PERSONAL INFO.

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