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“Pursuant to NRO, Section 2-256 (c), failure to complete this page will invalidate your submission.
Exceptions to specifications where non-compliant:
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NAME AND ADDRESS: Atlas PyroVision Entertainment Group, Inc.
136 Old Sharon Road / PO Box 498
Jaffrey, New Hampshire 03452
PHONE: _ 603-532-8324 FAX: __ 603-532-4530
e-mail: _ sarah@atlaspyro.com
a
Daron CG Ro nong AGW _, Date: 1/4/2016
(Authorized Signature) 4
Sarah Pelkey-Bergeron, President
(Typed/Printed Name and Title)
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