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        <BusinessNameLine1>The Parent Teacher Council of Stamford-Stillmeadow School</BusinessNameLine1>
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        <City>Stamford</City>
        <State>CT</State>
        <ZIPCode>06902</ZIPCode>
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    <Officer>
      <Name>Michael Seitz</Name>
      <Title>Treasurer</Title>
      <DateSigned>2014-02-05</DateSigned>
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    <Preparer>
      <Name>Scott Herckis CPA</Name>
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      <DatePrepared>2014-02-05</DatePrepared>
      <SelfEmployed>X</SelfEmployed>
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      <WebSite>www.stillmeadowct.org</WebSite>
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