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Text File  |  1992-09-23  |  309b  |  9 lines
  1. Social Security:                         Age:    Sex:    Ethnicity:
  2. Birth Date:                 Driver's License:                State:
  3. Automobile:                    License Plate:                State:
  4. Registered to:
  5. Registration expires:
  6. Imsurance Company:
  7. Insurance Policy Number:
  8.  
  9. Other comment: