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AFFIDAVIT <br />STATE OF MINNESOTA) <br />)SS <br />COUNTY OFIRAMSEY ) <br />, being first duly sworn <br />depost4l <br />and says that (he,she) lives at <br />�• , T 1-/4F n .4Ol9 <br />`-RQseviIng Minnesota; that (he,she) is the owner and head of the household <br />on these premises; that (he,she) is presently receiving Retirement Survivors <br />1%� Insurance or Disability Insurance, under the Social Security Act, 42 U.S.C. <br />9 301, as amended. <br />DATED: <br />Clerk's exhibit no. 5 J :) <br />meeting 9-8-76 <br />