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Please answer all questions as completely as possible. This information is necessary for our office to properly advise you on your matter. If something does not apply to your situation, please enter N/A so we know not to send a duplicate request for this information. Please make sure to hit SUBMIT at the bottom of form once completed so it is sent to our secure server. There is no need to attempt to print this form. Please be advised this form does not create an attorney - client relationship.

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