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R Business name, if different from above Telephone number ( Mailing address (number and street, or P.O. Box No., if mail is not delivered to street address) ) Room or suite number City or town, state, and ZIP code If you listed a P.O. Box above, or if your street address is different from your mailing address, list your street address (including city or town, state, and ZIP code) Part II Activities. Enter the letter and a brief description of each activity for which you are applying for.

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