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FROM: <br /> <br /> ...................... Salem, Oregon 97301 <br /> Telephone .588-5147 <br />~7~.~..,t.~,,.-., ~,,,o'e~-. ~'7~ ......... <br /> <br />..... - ~.~.~ _~ ~~,:~.~ ~., ~ ,, <br /> <br /> - / ~ , <br /> , ....... <br /> <br />DETACH AND FILE FOR FOLLOW-UP <br /> <br /> <br />