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Affidavit as to the posting of notices fixing a date for the settlement of the list of contributories

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.... 20..... ................Petitioner Affidavit as to the posting of notices fixing a date for the settlement of the list of contributories I, ..... (name and description) do solemnly affirm and say as follows:􀇦 1. That I did on the .......... day of... 20………, send to each contributory mentioned in the provisional list of contributories made out by the Company Liqui....