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Michael E. Gallagher d/b/a Gallagher Actuarial ServicesP.O. Box 297 Sebago, ME 04029-0297(207) 650-6405 email: actuary "at" galactser.com World Wide Web URL: http://www.galactser.com/This page: ../form.htm Copyright © 2015 Gallagher Actuarial Services. All rights reserved.