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Page 1: Scanned Document - Ohio BWCTitle: Scanned Document Created Date: 4/28/2016 1:28:34 PM

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Page 2: Scanned Document - Ohio BWCTitle: Scanned Document Created Date: 4/28/2016 1:28:34 PM

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Page 3: Scanned Document - Ohio BWCTitle: Scanned Document Created Date: 4/28/2016 1:28:34 PM

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