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<td><table bgcolor="<X-FC-FIELD PREFS.5603 DEFAULT=LANG.49.5603.11 RGB>" cellpadding="2" cellspacing="0" border="0">
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<td id="title1" nowrap><X-FC-FIELD FORM.0.25 STRING><!--#if expr="<X-FC-ITEM DATA[Name] LENGTH>"-->: <X-FC-ITEM DATA[Name]><!--#endif--></td>
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<td id="bold" colspan="3" nowrap><X-FC-FIELD FORM.1013.9 STRING></td>
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<td><img src="<!--#if expr="<X-FC-FIELD 1002 DEFAULT=PROP.85 NUMBER>"-->/Icons/15001<!--#else-->/Icons/0<!--#endif-->" width="10" height="10" border="1"></td>
<td id="plain" nowrap><X-FC-FIELD FORM.1002.9 STRING></td>
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<td><table cellpadding="2" cellspacing="0" border="0">
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<td id="bold" colspan="3" nowrap><X-FC-FIELD FORM.1008.9 STRING></td>
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<td id="plain"> </td>
<td id="plain" align="right" nowrap><X-FC-FIELD FORM.1009.9 STRING></td>
<td id="plain" nowrap><X-FC-FIELD 1006 DEFAULT=PROP.11 LIST FORM></td>
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<td id="plain"> </td>
<td id="plain"> </td>
<td id="plain" align="right" nowrap><X-FC-FIELD FORM.1010.9 STRING></td>
<td id="plain" nowrap><X-FC-FIELD 1007 DEFAULT=PROP.11 LIST FORM></td>
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<td><img src="/Icons/0" width="1" height="10" border="0"></td>
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<td><table cellpadding="2" cellspacing="0" border="0">
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<td id="plain"> </td>
<td id="bold" colspan="3" nowrap><X-FC-FIELD FORM.2007.9 STRING></td>
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<td id="plain"> </td>
<td id="plain"> </td>
<td id="plain" align="right" nowrap><X-FC-FIELD FORM.1011.9 STRING></td>
<td id="plain" nowrap><X-FC-FIELD 1012 DEFAULT=PROP.11 LIST FORM></td>
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<td id="plain"> </td>
<td id="plain"> </td>
<td id="plain" align="right" nowrap><X-FC-FIELD FORM.1005.9 STRING></td>
<td id="plain" nowrap><X-FC-FIELD 1004 DEFAULT=PROP.11 LIST FORM></td>
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<td><img src="/Icons/0" width="1" height="10" border="0"></td>
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<td><table cellpadding="2" cellspacing="0" border="0">
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<td id="plain"> </td>
<td id="bold" colspan="3" nowrap><X-FC-FIELD FORM.2010.9 STRING></td>
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<td id="plain" rowspan="3"> </td>
<td id="plain" align="right" nowrap><X-FC-FIELD FORM.2011.9 STRING></td>
<td id="plain" nowrap><!--#if expr="<X-FC-FIELD 2008 DEFAULT=PROP.11 NUMBER>"--><!--#set var="FID" value="<X-FC-FIELD 2008 NUMBER>"--><X-FC-FIELD LANG.`$FID`.0.25 STRING><!--#else-->-<!--#endif--></td>
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<td id="plain" nowrap align="right"><X-FC-FIELD FORM.2012.9 STRING></td>
<td id="plain" nowrap><X-FC-FIELD 2009 DEFAULT=PROP.11 LIST FORM></td>
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<td colspan="2" id="plain" nowrap><img src="<!--#if expr="<X-FC-FIELD 1001 DEFAULT=PROP.85 NUMBER>"-->/Icons/15001<!--#else-->/Icons/0<!--#endif-->" width="10" height="10" border="1"> <X-FC-FIELD FORM.1001.9 STRING></td>
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<td><hr></td>
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<td id="plain"> </td>
<td id="bold" nowrap><X-FC-FIELD FORM.2000.9 STRING></td>
<td id="plain"> </td>
<td id="bold" nowrap><X-FC-FIELD FORM.2001.9 STRING></td>
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