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Yes No <br /> e, P olice P mtectbn <br /> f, Fire P mtectbn <br /> g. RecreatbnalFaciliies <br /> h, P ub lic U this s <br /> r . 0 Cher <br /> Forthose checked "yes",phase e-laborate whattype orkizds ofinprovem ents <br /> and/or assistance are needed. <br /> S ignature: <br /> Address: <br /> Tebphone: <br /> Date: <br /> -4- <br />