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Last Name or Company Name:  First Name:  Middle Name:  Suffix:      Affaint Name:  Title :  You MUST use an attorney/agent NAME if filing for a business or the filing will be rejected. Address Address 1: Address 2: City: State: Zip Code:      Work Address Address 1:  Address 2:  City:  State:  Zip Code:           Phone Numbers Home:  Work: Email Address:     You MUST use an attorney/agent NAME if filing for a business or the filing will be rejected.