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  1. Please provide the person's name, relationship to you, and phone number.
  2. Please check all that apply.
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  5. If none, please type none.
  6. If none, please type none.
  7. If none, please type none.
  8. (looks, height, ethnic preference, hair, eyes, etc.)
  9. (i.e. sense of humor, intelligence, loyalty)
  10. (i.e. negative attitude, smoking, laziness)
  11. Please check all that apply.
  12. Please include date of conviction, charge, and outcome.
  13. Please provide the person's name, contact information, and relationship to you (i.e. friend, cousin, co-worker, etc.)

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