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                    "text": "\\begin{array}{c} State~Zip~Code\\\\ Fax~Number~(optional)-include~area~code\\end{array}",
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                        "text_span": 9,
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            "text": "5. I understand that I must file this form in the Prothonotary’s Office and that I must file a new form every time my address or telephone number changes. Please see Pennsylvania Rule of Civil Procedure 1930.8 for more information."
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            "text": "SIGNATURE"
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