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Pictures available? <br />❑ Yes ❑No <br />Publication, software, videos available? ❑Yes ❑No <br />DISCLAIMER I declare that the data on this document Is correct <br />Authorized Grantee Signature <br />Date <br />FOR MINNESOTA DEPARTMENT OF HEALTH USE ONLY <br />How much money was spent completing this work (total to include cost share) <br />Estimate the number of people served by the PWS <br />