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Name �, ���'�� �-'�t� �.�-� �!0 3
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Date ��`�Dl��+�� � ��
Old Meter Number ��
Old Meter Reading �'`1� d
Replacement No����lQ�7
Replacement Reading�
Replacement Make � ' �
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Replacement ERT#
Remarks: `'1 X �L�
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