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Address ............... P,~'. 1 <br />Lot. Block <br /> <br />Acreage Property. <br /> <br />Owner ~ VA,~i~D <br /> <br />Addition <br /> <br />I~uilder <br /> <br />Type STYPTIC ~C asS~ New/Alter Cost $_ <br /> <br />I <br />I <br /> <br /> <br />