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Make sure you note the appropriate data in the PEOPLE OF THE STATEOF CALIFORNIA, Docket or Citation Number, Section(s) Violated, California, I am the person in the above, true and correct, and Respectfully submitted area.

Note any data you are required inside the box Respectfully submitted, DATE OF, CDC Prison #__________________, Have any Staff Member of the, custody, DATE:_____________________________, Institution Staff Signature, www, and California's Best Form Solution.

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