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<br /> <br /> Yes No <br /> <br /> e. Police Protection x <br /> <br /> f. Fire Protection x <br /> <br /> g. Recreational Facilities x <br /> <br /> h. Public Utilities x <br /> <br /> i. Other x <br /> For those checked "yes," please elaborate what type or kinds of improvements <br /> and/or assistance are needed. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Signature: <br /> <br /> Address: <br /> <br /> Telephone: - <br /> <br /> Date: <br /> <br /> <br /> <br /> <br /> <br /> <br /> -4- <br />