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  Name:
  Address:
  City, State Zip:
  Phone Number:
  Email:
  Stories:
  Construction:
  Foundation:
  Roof type/year last updated:
  Year built and square feet:
  Year purchased and price:
  Central air/heat?:
  Number of fireplaces:
  Numer of bathrooms:
  Garage and type:
  Swimming pool:
  Flood Area:
  Mine Subsidence Area:
  Bankruptcy ever filed?:
  Current carrier/expiration date:
  Additional Information:

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