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{\title Your Agency:}{\author Patricia  Hayden}{\operator Murphy, Suzanne M}{\creatim\yr2023\mo7\dy31\hr12\min5}{\revtim\yr2023\mo7\dy31\hr12\min5}{\printim\yr2011\mo5\dy4\hr10\min27}{\version2}{\edmins0}{\nofpages1}{\nofwords520}{\nofchars2965}
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\par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}
{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8
\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\ltrrow\trowd \irow0\irowband0\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1970 \cellx1862\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth9059 \cellx10921\pard\plain \ltrpar\s16\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1440\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\rin0\lin0\pararsid424048 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4275364 Your Agency: \cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4275364 {\*\bkmkstart Text5} FORMTEXT }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4275364 {\*\datafield 000000001400000005546578743500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text5}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid4275364 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4275364 {\*\bkmkend Text5}\cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4275364 
\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1970 \cellx1862\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth9059 \cellx10921\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2496 \cellx2388\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3873 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1945 \cellx8206\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2715 \cellx10921\pard\plain \ltrpar\s16\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1440\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\rin0\lin0\pararsid424048 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14963343 Agency Contact Name:\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\bkmkstart Text8}
 FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\datafield 000000001400000005546578743800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text8}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid4483979 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14963343 {\*\bkmkend Text8}\cell 
Contact Phone:\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\bkmkstart Text9} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\datafield 000000001400000005546578743900000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text9}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4483979 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14963343 {\*\bkmkend Text9}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14963343 \trowd \irow1\irowband1\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2496 \cellx2388\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3873 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1945 \cellx8206\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2715 \cellx10921\row \ltrrow}\trowd \irow2\irowband2\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1794 \cellx1686\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4575 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1945 \cellx8206\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2715 \cellx10921\pard\plain \ltrpar\s16\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1440\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\rin0\lin0\pararsid424048 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12454898 Contact E-mail:\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\bkmkstart Text10
} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\datafield 00000000140000000654657874313000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text10}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid4483979 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12454898 {\*\bkmkend Text10}\cell 
Contact Fax: \cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\bkmkstart Text11} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979 {\*\datafield 00000000140000000654657874313100000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text11}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4483979 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12454898 {\*\bkmkend Text11}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12454898 \trowd \irow2\irowband2\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1794 \cellx1686\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4575 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1945 \cellx8206\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2715 \cellx10921\row \ltrrow}\trowd \irow3\irowband3\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4338 \cellx4230\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2031 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1119 \cellx7380\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1387 \cellx8767\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1225 \cellx9992\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth929 \cellx10921\pard\plain \ltrpar\s16\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1440\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\rin0\lin0\pararsid424048 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977 Exact Street Address of  premise }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cs18\super\insrsid8332977 \chftn {\footnote \ltrpar 
\pard\plain \ltrpar\s17\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1973867 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \cs18\super\insrsid8332977 \chftn }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8457481 Post office boxes and rural route numbers are unacceptable.  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8011019 
The 911 address is required. }}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977 : \cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979\charrsid6363353 {\*\bkmkstart Text12} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid4483979\charrsid6363353 {\*\datafield 00000000140000000654657874313200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text12}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid4483979\charrsid6363353 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8332977\charrsid6363353 {\*\bkmkend Text12}\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4923595 Town:}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977  \cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979\charrsid6363353 
{\*\bkmkstart Text13} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4483979\charrsid6363353 {\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\rtlch\fcs1 
\af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid4483979\charrsid6363353 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8332977\charrsid6363353 {\*\bkmkend Text13}\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977 Zip Code\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid4483979\charrsid424048 {\*\bkmkstart Text14} FORMTEXT }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \ul\insrsid4483979\charrsid424048 {\*\datafield 00000000140000000654657874313400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text14}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\ul\lang1024\langfe1024\noproof\insrsid4483979\charrsid424048 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\ul\insrsid8332977\charrsid424048 {\*\bkmkend Text14}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8332977 \trowd \irow3\irowband3\ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4338 \cellx4230\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2031 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1119 \cellx7380\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1387 \cellx8767\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1225 \cellx9992\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth929 \cellx10921\row \ltrrow}\trowd \irow4\irowband4\lastrow \ltrrow
\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2718 \cellx2610\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3651 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4660 \cellx10921\pard\plain \ltrpar
\s16\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1440\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\rin0\lin0\pararsid424048 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid12598037 Building property name: \cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037\charrsid6363353 {\*\bkmkstart Text18} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037\charrsid6363353 {\*\datafield 
00000000140000000654657874313800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text18}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid12598037\charrsid6363353 \u8194\'20\u8194\'20\u8194\'20
\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037\charrsid6363353 {\*\bkmkend Text18}\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037 
Risk Mgmt Mcode: }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid12598037\charrsid424048 {\*\bkmkstart Text19} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid12598037\charrsid424048 {\*\datafield 
00000000140000000654657874313900000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text19}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid12598037\charrsid424048 \u8194\'20\u8194\'20\u8194\'20
\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037 {\*\bkmkend Text19} or  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037 
{\*\bkmkstart Check49} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8338800 {\*\datafield 650000001400000007436865636b343900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check49}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037 {\*\bkmkend Check49} unknown}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037\charrsid12598037 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12598037 
\trowd \irow4\irowband4\lastrow \ltrrow\ts11\trgaph108\trleft-108\tpvpg\tphmrg\tposxc\tposy1440\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth11029\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid424048\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2718 \cellx2610\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3651 \cellx6261\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4660 \cellx10921\row }\pard\plain \ltrpar
\s16\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8011019 \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8457481 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8011019 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 Check the type of construction that }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid3887684 best}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  describes the building:
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft0\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4860\clshdrawnil \cellx4860\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10350\pard\plain \ltrpar
\s16\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid4483979 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\insrsid4483979 {\*\bkmkstart Check4} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check4}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check4} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
(1) Combustible (typically wooden buildings)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkstart Check7} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check7}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check7} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
(2) Masonry structures with combustible frames or interiors}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \trowd \irow0\irowband0\ltrrow
\ts11\trgaph108\trleft0\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4860\clshdrawnil \cellx4860\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10350\row \ltrrow}\pard\plain \ltrpar
\s16\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid4483979 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\insrsid4483979 {\*\bkmkstart Check5} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check5}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check5} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
(3) Metal structures (all metal roof, frame and walls)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkstart Check8} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 
\ltrch\fcs0 \fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3800000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check8}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check8} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
(4) Masonry structures with masonry or metal framing}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \trowd \irow1\irowband1\ltrrow
\ts11\trgaph108\trleft0\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4860\clshdrawnil \cellx4860\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10350\row \ltrrow}\pard\plain \ltrpar
\s16\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid4483979 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\insrsid4483979 {\*\bkmkstart Check6} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check6}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check6} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
(5) Buildings with a }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3890721 1-to-2-hour}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684  fire resistive rating}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 \cell }{\field\fldpriv{\*\fldinst {
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkstart Check9} FORMCHECKBOX }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid8338800 {\*\datafield 650000001400000006436865636b3900000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check9}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid4483979 {\*\bkmkend Check9}
 }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 (6) Buildings with a }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3890721 2 or more-hour}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684  fire resistive rating}{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3887684 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3887684 \trowd \irow2\irowband2\lastrow \ltrrow\ts11\trgaph108\trleft0\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone 
\clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4860\clshdrawnil \cellx4860\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10350\row 
}\pard\plain \ltrpar\s16\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par Year of construction of building (if known or best guess): }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2314666\charrsid2314666  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2314666\charrsid2314666 {\*\datafield 
000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid2314666\charrsid2314666 \u8194\'20\u8194\'20\u8194\'20
\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 Number of floors (do not count unfinished basement and attic) }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2314666\charrsid2314666  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\ul\insrsid2314666\charrsid2314666 {\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\ul\lang1024\langfe1024\noproof\insrsid2314666\charrsid2314666 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 Is there a}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 basement}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368 /crawl space}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid16195985 ? }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid13060366 {\*\bkmkstart Check45} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 
650000001400000007436865636b343500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check45}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check45}Yes}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5312748    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid13060366 
{\*\bkmkstart Check46} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check46}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check46}No  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12717573    }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid14816368 Is the basement finished}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid13060366 {\*\bkmkstart Check47} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check47}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check47}Yes}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5312748     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid13060366 {\*\bkmkstart Check48} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343800000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check48}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check48}No

\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 Approximate }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid14816368 square footage}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  of building - do not }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3890721 include}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 basement}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368 , }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 attic}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368 
 or mezzanine}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 : \tab }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid538798\charrsid2314666  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid538798\charrsid2314666 {\*\datafield 
000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid538798\charrsid2314666 \u8194\'20\u8194\'20\u8194\'20\u8194
\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid538798\charrsid538798  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 sq. feet
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 Number of elevators in building:  }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid14645865\charrsid2314666  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid14645865\charrsid2314666 
{\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid14645865\charrsid2314666 \u8194\'20\u8194\'20
\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12398497    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14816368  }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3887684 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8457481 
\par Boiler and/or pressure vessels \endash  In this building, how many units}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid9509286  may}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8457481  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8457481\charrsid8457481 require}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid8457481  State inspection?
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2325049 Number of boilers: }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2325049 {\*\bkmkstart Text20} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2325049 {\*\datafield 
00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid2325049 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194
\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8457481 {\*\bkmkend Text20}  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2325049 Number of pressure }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3890721 vessels:}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2325049  }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2325049 {\*\bkmkstart Text21} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2325049 {\*\datafield 
00000000140000000654657874323100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid2325049 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194
\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid2325049 {\*\bkmkend Text21}
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid9509286  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 Building Occupancy Type(s) - check as many as are applicable for this building:
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8135350 {\*\bkmkstart Check12} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check12}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check12}Auditorium (18);  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8135350 {\*\bkmkstart Check13} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 
650000001400000007436865636b313300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check13}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 
\af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check13}Classroom (2);  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check14} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 
{\*\datafield 650000001400000007436865636b313400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check14}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check14}Day Care (33);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check15} FORMCHECKBOX }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check15}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check15}Dormitory (10)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 ;   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 
\af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check16} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check16}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check16}Gym (12);}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check17} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313700000000000000000000000000
}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check17}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check17}Laboratory (5);
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check18} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313800000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check18}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check18}M}{
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 aintenance Shop (6);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check19} FORMCHECKBOX }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b313900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check19}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check19}Office (1);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check20} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check20}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check20}Retail (29);   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 
\af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check21} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check21}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check21}Staff Residence (11);  }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check22} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check22}Storage (3);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid11230351  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid11230351  FORMCHECKBOX }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid11230351  Vacant (4)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14369844 {\*\bkmkstart Check23} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323300000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check23}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid6903482 
{\*\bkmkend Check23}Other - }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 Describe: {\*\bkmkstart Text15}}{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid14369844  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid14369844 
{\*\datafield 00000000140000000654657874313500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text15}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid14369844 \u8194\'20\u8194\'20\u8194\'20
\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid3887684 {\*\bkmkend Text15}
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14369844 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid16285339\charrsid14645865 Your}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  agency}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16285339 \rquote s}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  occupancy}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid16285339  type}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  (check one - only the most prevalent):
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check24} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check24}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check24}Auditorium (18);  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check25} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 
\af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check25}Classroom (2);  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check26} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 
{\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check26}Day Care (33);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check27} FORMCHECKBOX }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check27}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check27}Dormitory (10)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 ;   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 
\af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check28} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323800000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check28}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check28}Gym (12);}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check29} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323900000000000000000000000000
}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check29}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check29}Laboratory (5);
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check30} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333000000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check30}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check30}M}{
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 aintenance Shop (6);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check31} FORMCHECKBOX }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check31}Office (1);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check32} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check32}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid9509286 {\*\bkmkend Check32}Garage }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\insrsid3887684 (}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid9509286 35}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 );   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check33}
 FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check33}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check33}Staff Residence (11);  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 
{\*\bkmkstart Check34} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333400000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check34}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 {\*\bkmkend Check34}Storage (3);}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }{\field\fldpriv{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid11230351  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b323200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22
}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid11230351  Vacant (4)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid14764984 {\*\bkmkstart Check35} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333500000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check35}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 
{\*\bkmkend Check35}Other}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid6903482  - }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid3887684 Describe}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid14764984 : }{\field{\*\fldinst {\rtlch\fcs1 
\af0\afs20 \ltrch\fcs0 \fs20\ul\insrsid14764984 {\*\bkmkstart Text16} FORMTEXT }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\ul\insrsid14764984 {\*\datafield 00000000140000000654657874313600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20
{\*\ffname Text16}}}}}{\fldrslt {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\ul\lang1024\langfe1024\noproof\insrsid14764984 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid3887684\charrsid14764984 {\*\bkmkend Text16}
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par Building is:     }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check36} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check36}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check36}100% }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 Sprinklered   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check37} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 
650000001400000007436865636b333700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check37}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check37}Partially Sprinklered \endash  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid148738 state}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  % {\*\bkmkstart Text17}}{\field{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \ul\insrsid1782899  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid1782899 {\*\datafield 00000000140000000654657874313700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text17}}}}}{\fldrslt {\rtlch\fcs1 \af0 
\ltrch\fcs0 \ul\lang1024\langfe1024\noproof\insrsid1782899 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
{\*\bkmkend Text17}    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check38} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 
650000001400000007436865636b333800000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check38}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid3887684 {\*\bkmkend Check38}Not sprinklered}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  at all}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par Building has a }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 central station }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 smoke detection system:\tab  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check39}
 FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b333900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check39}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 {\*\bkmkend Check39}Yes}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5312748    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check40} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343000000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check40}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 {\*\bkmkend Check40}No
\par Building has a }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 central station }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 security system:\tab \tab  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check41}
 FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check41}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 {\*\bkmkend Check41}Yes}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5312748    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684  }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check42} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check42}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 {\*\bkmkend Check42}No
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 Building has an employee key card system: \tab \tab \tab  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check43} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343300000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check43}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check43}Yes}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5312748    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985  }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid1782899 {\*\bkmkstart Check44} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f10\insrsid8338800 {\*\datafield 650000001400000007436865636b343400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check44}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16195985 {\*\bkmkend Check44}No

\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8011019 
\par }\pard \ltrpar\s16\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid3808252 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3808252\charrsid7752711 Replacement cost insurance desired:  }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\insrsid2364630\charrsid7752711 Building: $ }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\insrsid2364630\charrsid7752711 {\*\bkmkstart Text22} FORMTEXT }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\insrsid2364630\charrsid7752711 {\*\datafield 
00000000140000000654657874323200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text22}}}}}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\lang1024\langfe1024\noproof\insrsid2364630\charrsid7752711 \u8194\'20\u8194\'20\u8194
\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2364630\charrsid7752711 {\*\bkmkend Text22}  }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\insrsid3808252\charrsid7752711 Contents $ }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\insrsid3808252\charrsid7752711  FORMTEXT }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\insrsid3808252\charrsid7752711 {\*\datafield 
000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\lang1024\langfe1024\noproof\insrsid3808252\charrsid7752711 \u8194\'20\u8194\'20\u8194\'20
\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3808252\charrsid7752711   Effective Date: }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\ul\insrsid3808252\charrsid7752711  FORMTEXT }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\insrsid3808252\charrsid7752711 {\*\datafield 000000001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text4}}}}
}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\ul\lang1024\langfe1024\noproof\insrsid3808252\charrsid7752711 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3808252\charrsid7752711 
\par 
\par }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid8011019\charrsid7752711 
\par }\pard \ltrpar\s16\qc \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2364630 Questions?  }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3827191 Call }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2364630 287-335
}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid8011019 1}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3827191   }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid8457481 
\par Either fax this form to 287-4008 or }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid8011019 E}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid8457481 mail to}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid3887684 :\tab 
\par }\pard \ltrpar\s16\qc \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid3827191 {\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8338800  HYPERLINK "mailto:Lance.Lemieux@maine.gov" }}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\cs22\ul\cf19\insrsid8011019\charrsid8394620 Lance.Lemieux@maine.gov}}}\sectd \ltrsect\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid14549930\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3887684 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5312748 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid2248443 
\par }\pard \ltrpar\qc \fi720\li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8011019 {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2248443\charrsid2248443 IF POSSIBLE,}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2248443 
 PROVIDE A}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid2248443\charrsid2248443  PHOTOGRAPH OF THE FRONT OF BUILDING}{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid12720010\charrsid2248443 
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