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MacOS 8.1

Win98

DOS

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+--------+-------------------------+-------------------------+--------+--------+
|00000000| 00 16 43 75 73 74 6f 6d | 20 43 6f 76 2f 44 70 6e |..Custom| Cov/Dpn|
|00000010| 64 6e 74 20 43 61 72 65 | 00 00 00 00 00 00 00 00 |dnt Care|........|
|00000020| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000030| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000040| 00 53 54 43 4b 4b 43 46 | 4d 01 00 00 00 00 00 00 |.STCKKCF|M.......|
|00000050| 00 00 00 00 00 33 0e 00 | 00 02 ce a1 74 78 95 a1 |.....3..|....tx..|
|00000060| 8d 8b 93 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000070| 00 00 00 00 00 00 00 00 | 00 00 81 81 97 ea 00 00 |........|........|
|00000080| 00 0c 00 02 00 00 00 30 | 00 00 23 54 00 00 01 de |.......0|..#T....|
|00000090| 00 00 1f 80 00 00 1f 82 | 00 00 32 42 00 00 00 00 |........|..2B....|
|000000a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000000b0| 09 90 0c 60 00 01 00 01 | 00 00 00 00 00 01 00 00 |...`....|........|
|000000c0| 00 00 00 00 00 03 00 01 | 00 00 00 03 00 00 00 48 |........|.......H|
|000000d0| 00 48 00 00 00 00 03 08 | 02 40 ff f8 ff ee 03 10 |.H......|.@......|
|000000e0| 02 52 03 47 05 28 03 fc | 00 02 00 00 00 48 00 48 |.R.G.(..|.....H.H|
|000000f0| 00 00 00 00 03 08 02 40 | 00 01 00 00 00 64 00 00 |.......@|.....d..|
|00000100| 00 01 00 01 01 01 00 00 | 00 01 27 0f 00 01 00 01 |........|..'.....|
|00000110| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 19 |........|........|
|00000120| 01 90 00 00 00 00 00 70 | 00 00 00 00 00 00 00 00 |.......p|........|
|00000130| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000140| 00 00 00 00 01 13 00 01 | 00 06 00 06 40 38 00 00 |........|....@8..|
|00000150| 00 00 00 00 40 38 00 00 | 00 00 00 00 00 15 00 03 |....@8..|........|
|00000160| 00 01 00 01 00 00 00 03 | 01 26 01 26 00 3c 00 38 |........|.&.&.<.8|
|00000170| 00 01 00 14 00 01 00 0a | 00 01 5f da 00 00 00 15 |........|.._.....|
|00000180| 00 01 00 0c 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000190| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|000001a0| ff ff ff ff ff ff 00 01 | 00 01 00 4d e5 4e 00 4d |........|...M.N.M|
|000001b0| e5 54 00 4a 75 e8 00 4a | 75 e8 00 00 00 00 00 00 |.T.Ju..J|u.......|
|000001c0| 00 01 00 01 00 01 00 01 | 00 01 00 01 00 00 00 00 |........|........|
|000001d0| 00 00 00 01 00 00 00 00 | 00 00 00 00 00 00 00 90 |........|........|
|000001e0| 00 07 00 00 00 01 09 90 | 0c 60 00 20 00 48 0c 3d |........|.`. .H.=|
|000001f0| 09 45 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |.E......|........|
|00000200| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000210| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000220| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000230| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000240| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000250| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00000260| 00 00 00 34 00 24 00 4c | 0b d0 09 44 00 01 00 01 |...4.$.L|...D....|
|00000270| 00 03 00 01 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|00000280| 00 00 00 00 00 00 00 01 | 00 28 00 28 00 28 00 28 |........|.(.(.(.(|
|00000290| 00 00 00 00 00 00 00 00 | 00 07 00 00 00 64 00 38 |........|.....d.8|
|000002a0| 01 3c 00 a4 09 20 00 01 | 00 00 ff ff ff ff ff ff |.<... ..|........|
|000002b0| ff ff 00 01 00 00 00 00 | 00 00 00 02 00 38 01 3c |........|.....8.<|
|000002c0| 00 a4 09 20 00 00 00 00 | 00 14 00 0e 00 01 00 00 |... ....|........|
|000002d0| 00 03 00 03 00 01 00 10 | 43 55 53 54 4f 4d 20 43 |........|CUSTOM C|
|000002e0| 4f 56 45 52 41 47 45 0d | 00 00 00 16 00 01 00 00 |OVERAGE.|........|
|000002f0| 00 00 00 0f 00 0c 00 14 | 01 00 00 0e 00 00 00 00 |........|........|
|00000300| 00 00 00 0d 00 00 00 cc | 00 5c 00 94 00 d0 00 fc |........|.\......|
|00000310| 00 01 00 00 00 00 00 00 | 00 00 00 02 00 07 00 00 |........|........|
|00000320| 00 56 00 5c 00 94 00 d0 | 00 fa 00 01 00 00 ff ff |.V.\....|........|
|00000330| ff ff ff ff ff ff 00 01 | 00 00 00 00 00 00 00 02 |........|........|
|00000340| 00 5c 00 94 00 d0 00 fa | 00 00 00 00 00 14 00 18 |.\......|........|
|00000350| 00 00 00 00 00 03 00 03 | 00 01 00 01 f0 00 00 00 |........|........|
|00000360| 00 16 00 01 00 00 00 00 | 00 18 00 12 00 14 00 00 |........|........|
|00000370| 00 18 00 00 00 00 00 00 | 00 07 00 00 00 56 00 a1 |........|.....V..|
|00000380| 00 df 00 ba 00 fc 00 01 | 00 00 ff ff ff ff ff ff |........|........|
|00000390| ff ff 00 01 00 00 00 00 | 00 00 00 02 00 a1 00 df |........|........|
|000003a0| 00 ba 00 fc 00 00 00 00 | 00 14 00 04 00 00 00 00 |........|........|
|000003b0| 00 03 00 03 00 01 00 01 | a8 00 00 00 00 16 00 01 |........|........|
|000003c0| 00 00 00 00 00 05 00 04 | 00 14 00 00 00 04 00 00 |........|........|
|000003d0| 00 00 00 00 00 01 00 00 | 00 ac 00 b1 07 dc 01 41 |........|.......A|
|000003e0| 09 20 00 01 00 01 00 00 | 00 15 00 00 00 0c 00 00 |. ......|........|
|000003f0| 00 03 00 03 00 00 00 01 | 00 03 00 01 00 00 00 03 |........|........|
|00000400| 00 01 ff ff ff ff ff ff | ff ff 00 00 00 00 00 00 |........|........|
|00000410| 00 00 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00000420| 00 90 00 90 00 3c 00 34 | 00 00 00 f4 00 02 00 01 |.....<.4|........|
|00000430| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000440| 00 02 00 b2 07 dd 00 ed | 09 20 01 01 01 01 00 14 |........|. ......|
|00000450| 00 0a 00 80 00 00 00 03 | 00 03 00 01 00 0d 45 4d |........|......EM|
|00000460| 50 4c 4f 59 45 45 20 20 | 4e 4f 2e 10 00 00 00 16 |PLOYEE  |NO......|
|00000470| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 0a |........|........|
|00000480| 00 00 00 00 00 00 00 01 | 00 00 00 a2 00 b1 06 98 |........|........|
|00000490| 01 41 07 dc 00 01 00 01 | 00 00 00 15 00 00 00 0c |.A......|........|
|000004a0| 00 00 00 03 00 03 00 00 | 00 01 00 03 00 01 00 00 |........|........|
|000004b0| 00 03 00 01 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|000004c0| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000004d0| ff ff 00 88 00 88 00 3c | 00 38 00 00 00 f5 00 01 |.......<|.8......|
|000004e0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000004f0| 00 00 00 02 00 b2 06 99 | 00 ed 07 dc 01 01 01 01 |........|........|
|00000500| 00 14 00 0a 00 80 00 00 | 00 03 00 03 00 01 00 04 |........|........|
|00000510| 44 41 54 45 00 00 00 16 | 00 01 00 00 00 00 00 0b |DATE....|........|
|00000520| 00 08 00 14 00 00 00 0a | 00 00 00 00 00 00 00 01 |........|........|
|00000530| 00 00 00 a8 01 41 04 df | 01 d1 05 de 00 01 00 01 |.....A..|........|
|00000540| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 00 |........|........|
|00000550| 00 01 00 03 00 01 00 00 | 00 03 00 01 ff ff ff ff |........|........|
|00000560| ff ff ff ff 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00000570| 00 00 ff ff ff ff ff ff | ff ff 00 90 00 90 00 3c |........|.......<|
|00000580| 00 34 00 00 00 f6 00 06 | 00 01 00 00 00 00 00 00 |.4......|........|
|00000590| 00 00 00 00 00 00 00 00 | 00 00 00 02 01 42 04 e0 |........|.....B..|
|000005a0| 01 7d 05 de 01 01 01 01 | 00 14 00 0a 00 80 00 00 |.}......|........|
|000005b0| 00 03 00 03 00 01 00 0a | 4d 41 49 4c 20 20 53 54 |........|MAIL  ST|
|000005c0| 4f 50 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |OP......|........|
|000005d0| 00 14 00 00 00 0a 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000005e0| 00 a8 01 41 07 dc 01 d1 | 09 20 00 01 00 01 00 00 |...A....|. ......|
|000005f0| 00 15 00 20 00 0c 00 00 | 00 03 00 03 00 00 00 01 |... ....|........|
|00000600| 00 03 00 01 00 00 00 03 | 00 01 ff ff ff ff ff ff |........|........|
|00000610| ff ff 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
|00000620| ff ff ff ff ff ff ff ff | 00 94 00 94 00 3c 00 38 |........|.....<.8|
|00000630| 00 00 00 f7 00 08 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00000640| 00 00 00 00 00 00 00 00 | 00 02 01 42 07 dd 01 7d |........|...B...}|
|00000650| 09 20 01 01 01 01 00 14 | 00 0a 00 80 00 00 00 03 |. ......|........|
|00000660| 00 03 00 01 00 09 41 50 | 50 4c 45 4c 49 4e 4b 00 |......AP|PLELINK.|
|00000670| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00000680| 00 00 00 0a 00 00 00 00 | 00 00 00 01 00 00 00 ac |........|........|
|00000690| 01 41 05 de 01 d1 07 dc | 00 01 00 01 00 00 00 15 |.A......|........|
|000006a0| 00 00 00 0c 00 00 00 03 | 00 03 00 01 00 01 00 03 |........|........|
|000006b0| 00 01 00 00 00 03 00 01 | ff ff ff ff ff ff ff ff |........|........|
|000006c0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|000006d0| ff ff ff ff ff ff 00 90 | 00 90 00 3c 00 34 00 00 |........|...<.4..|
|000006e0| 00 f8 00 07 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000006f0| 00 00 00 00 00 00 00 02 | 01 42 05 df 01 7d 07 dc |........|.B...}..|
|00000700| 01 01 01 01 00 14 00 0a | 00 80 00 00 00 03 00 03 |........|........|
|00000710| 00 01 00 0e 54 45 4c 45 | 50 48 4f 4e 45 20 20 4e |....TELE|PHONE  N|
|00000720| 4f 2e 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |O.......|........|
|00000730| 00 14 00 00 00 0a 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00000740| 00 a6 01 41 03 49 01 d1 | 04 14 00 01 00 01 00 00 |...A.I..|........|
|00000750| 00 15 00 00 00 0c 00 00 | 00 03 00 03 00 00 00 01 |........|........|
|00000760| 00 03 00 01 00 00 00 03 | 00 01 ff ff ff ff ff ff |........|........|
|00000770| ff ff 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
|00000780| ff ff ff ff ff ff ff ff | 00 70 00 70 00 3c 00 34 |........|.p.p.<.4|
|00000790| 00 00 00 f9 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000007a0| 00 00 00 00 00 00 00 00 | 00 02 01 42 03 4a 01 7d |........|...B.J.}|
|000007b0| 04 14 01 01 01 01 00 14 | 00 0a 00 80 00 00 00 03 |........|........|
|000007c0| 00 03 00 01 00 08 44 49 | 56 2e 20 4e 4f 2e 00 00 |......DI|V. NO...|
|000007d0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|000007e0| 00 0a 00 00 00 00 00 00 | 00 01 00 00 00 a8 01 41 |........|.......A|
|000007f0| 04 14 01 d1 04 df 00 01 | 00 01 00 00 00 15 00 00 |........|........|
|00000800| 00 0c 00 00 00 03 00 03 | 00 00 00 01 00 03 00 01 |........|........|
|00000810| 00 00 00 03 00 01 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|00000820| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00000830| ff ff ff ff 00 90 00 90 | 00 3c 00 34 00 00 00 fa |........|.<.4....|
|00000840| 00 05 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000850| 00 00 00 00 00 02 01 42 | 04 15 01 7d 04 df 01 01 |.......B|...}....|
|00000860| 01 01 00 14 00 0a 00 80 | 00 00 00 03 00 03 00 01 |........|........|
|00000870| 00 09 44 45 50 54 2e 20 | 4e 4f 2e 20 00 00 00 16 |..DEPT. |NO. ....|
|00000880| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 0a |........|........|
|00000890| 00 00 00 00 00 00 00 01 | 00 00 00 ac 01 41 00 70 |........|.....A.p|
|000008a0| 01 d1 03 49 00 01 00 01 | 00 00 00 15 00 00 00 0c |...I....|........|
|000008b0| 00 00 00 03 00 03 00 2a | 00 01 00 03 00 01 00 00 |.......*|........|
|000008c0| 00 03 00 01 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|000008d0| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000008e0| ff ff 01 98 01 98 00 3c | 00 38 00 00 00 fb 00 03 |.......<|.8......|
|000008f0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000900| 00 00 00 02 01 42 00 71 | 01 7d 03 49 01 01 01 01 |.....B.q|.}.I....|
|00000910| 00 14 00 0a 00 80 00 00 | 00 03 00 03 00 01 00 0e |........|........|
|00000920| 45 4d 50 4c 4f 59 45 45 | 20 20 4e 41 4d 45 00 00 |EMPLOYEE|  NAME..|
|00000930| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00000940| 00 0a 00 00 00 00 00 00 | 00 02 00 00 00 22 00 b1 |........|....."..|
|00000950| 07 dc 00 ee 07 dc 00 01 | 00 01 00 03 00 00 00 00 |........|........|
|00000960| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000970| 00 02 00 00 00 22 01 40 | 07 dc 01 7e 07 dc 00 01 |.....".@|...~....|
|00000980| 00 01 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000990| 00 00 00 00 00 00 00 00 | 00 02 00 00 00 22 01 3e |........|.....".>|
|000009a0| 05 de 01 7c 05 de 00 01 | 00 01 00 03 00 00 00 00 |...|....|........|
|000009b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000009c0| 00 02 00 00 00 22 01 40 | 04 de 01 7e 04 de 00 01 |.....".@|...~....|
|000009d0| 00 01 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000009e0| 00 00 00 00 00 00 00 00 | 00 02 00 00 00 22 01 3e |........|.....".>|
|000009f0| 04 14 01 7c 04 14 00 01 | 00 01 00 03 00 00 00 00 |...|....|........|
|00000a00| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000a10| 00 02 00 00 00 22 01 3e | 03 48 01 7c 03 48 00 01 |.....".>|.H.|.H..|
|00000a20| 00 01 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000a30| 00 00 00 00 00 00 00 00 | 00 07 00 00 00 68 0b f4 |........|.....h..|
|00000a40| 00 4c 0c 3c 02 38 00 01 | 00 01 ff ff ff ff ff ff |.L.<.8..|........|
|00000a50| ff ff 00 01 00 00 00 00 | 00 00 00 02 0b f4 00 4c |........|.......L|
|00000a60| 0c 3c 02 38 00 00 00 00 | 00 14 00 0e 00 20 00 00 |.<.8....|..... ..|
|00000a70| 00 01 00 03 00 01 00 14 | 41 70 70 6c 65 20 43 6f |........|Apple Co|
|00000a80| 6d 70 75 74 65 72 2c 20 | 49 6e 63 2e 00 00 00 16 |mputer, |Inc.....|
|00000a90| 00 01 00 00 00 00 00 0f | 00 0c 00 14 20 00 00 0e |........|.... ...|
|00000aa0| 00 00 00 00 00 00 00 07 | 00 00 00 62 0b f4 08 1c |........|...b....|
|00000ab0| 0c 3c 09 44 00 01 00 00 | ff ff ff ff ff ff ff ff |.<.D....|........|
|00000ac0| 00 01 00 00 00 00 00 00 | 00 02 0b f4 08 1c 0c 3c |........|.......<|
|00000ad0| 09 44 00 00 00 00 00 14 | 00 0a 00 00 00 00 00 02 |.D......|........|
|00000ae0| 00 03 00 01 00 0e 42 45 | 4e 32 30 30 20 28 31 31 |......BE|N200 (11|
|00000af0| 2f 38 39 29 00 00 00 16 | 00 01 00 00 00 00 00 0b |/89)....|........|
|00000b00| 00 08 00 14 00 00 00 0a | 00 00 00 00 00 00 00 07 |........|........|
|00000b10| 00 00 00 6a 00 a8 01 3c | 01 07 06 98 00 01 00 00 |...j...<|........|
|00000b20| ff ff ff ff ff ff ff ff | 00 01 00 00 00 00 00 00 |........|........|
|00000b30| 00 02 00 a8 01 3c 01 07 | 06 98 00 00 00 00 00 14 |.....<..|........|
|00000b40| 00 0c 00 01 00 00 00 03 | 00 03 00 01 00 15 44 45 |........|......DE|
|00000b50| 50 45 4e 44 45 4e 54 20 | 43 41 52 45 20 43 4c 41 |PENDENT |CARE CLA|
|00000b60| 49 4d 20 7e 00 00 00 16 | 00 01 00 00 00 00 00 0d |IM ~....|........|
|00000b70| 00 0a 00 14 01 00 00 0c | 00 00 00 00 00 00 00 01 |........|........|
|00000b80| 00 00 00 ae 01 d1 03 48 | 02 61 09 20 00 01 00 00 |.......H|.a. ....|
|00000b90| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 00 |........|........|
|00000ba0| 00 01 00 03 00 01 00 00 | 00 03 00 01 00 00 00 00 |........|........|
|00000bb0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00000bc0| 00 00 ff ff ff ff ff ff | ff ff 01 98 01 98 00 3c |........|.......<|
|00000bd0| 00 38 00 00 01 00 00 0a | 00 01 00 00 00 00 00 00 |.8......|........|
|00000be0| 00 00 00 00 00 00 00 00 | 00 00 00 02 01 d2 03 49 |........|.......I|
|00000bf0| 02 0d 09 20 01 01 01 01 | 00 14 00 0a 00 00 00 00 |... ....|........|
|00000c00| 00 03 00 03 00 01 00 10 | 20 20 57 4f 52 4b 20 20 |........|  WORK  |
|00000c10| 4c 4f 43 41 54 49 4f 4e | 00 00 00 16 00 01 00 00 |LOCATION|........|
|00000c20| 00 00 00 0b 00 08 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00000c30| 00 00 00 01 00 00 00 c0 | 01 d1 00 70 02 61 03 48 |........|...p.a.H|
|00000c40| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00000c50| 00 03 00 00 00 01 00 03 | 00 01 00 00 00 03 00 01 |........|........|
|00000c60| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000c70| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 01 98 |........|........|
|00000c80| 01 98 00 3c 00 38 00 00 | 01 01 00 09 00 01 00 00 |...<.8..|........|
|00000c90| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00000ca0| 01 d2 00 71 02 0d 03 48 | 01 01 01 01 00 14 00 0a |...q...H|........|
|00000cb0| 00 00 00 00 00 03 00 03 | 00 01 00 22 45 4d 50 4c |........|..."EMPL|
|00000cc0| 4f 59 45 45 20 20 20 53 | 4f 43 49 41 4c 20 20 20 |OYEE   S|OCIAL   |
|00000cd0| 53 45 43 55 52 49 54 59 | 20 20 20 4e 4f 2e 00 00 |SECURITY|   NO...|
|00000ce0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00000cf0| 00 0a 00 00 00 00 00 00 | 00 07 00 00 00 62 0a 8b |........|.....b..|
|00000d00| 00 70 0a df 02 f2 00 01 | 00 00 ff ff ff ff ff ff |.p......|........|
|00000d10| ff ff 00 01 00 00 00 00 | 00 00 00 02 0a 8b 00 70 |........|.......p|
|00000d20| 0a df 02 f2 00 00 00 00 | 00 14 00 0e 00 03 00 00 |........|........|
|00000d30| 00 01 00 01 00 01 00 0e | 42 45 4e 45 46 49 54 53 |........|BENEFITS|
|00000d40| 20 4f 4e 4c 59 3a 00 00 | 00 16 00 01 00 00 00 00 | ONLY:..|........|
|00000d50| 00 0f 00 0c 00 14 03 00 | 00 0e 00 00 00 00 00 00 |........|........|
|00000d60| 00 01 00 00 00 ac 0a db | 00 e3 0b 60 03 b3 00 01 |........|...`....|
|00000d70| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 02 |........|........|
|00000d80| 00 0a 00 01 00 05 00 00 | 00 00 00 04 00 01 00 00 |........|........|
|00000d90| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000da0| 00 03 00 00 ff ff ff ff | ff ff ff ff 01 24 01 24 |........|.....$.$|
|00000db0| 00 3c 00 3c 00 00 01 02 | 00 00 00 00 00 00 00 00 |.<.<....|........|
|00000dc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 0b 24 |........|.......$|
|00000dd0| 00 e3 0b 61 03 b4 00 01 | 81 81 00 14 00 0a 00 00 |...a....|........|
|00000de0| 00 00 00 03 00 03 00 01 | 00 0d 41 44 4d 49 4e 49 |........|..ADMINI|
|00000df0| 53 54 52 41 54 4f 52 00 | 00 00 00 16 00 01 00 00 |STRATOR.|........|
|00000e00| 00 00 00 0b 00 08 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00000e10| 00 00 00 01 00 00 00 ac | 0a db 04 8a 0b 60 06 3a |........|.....`.:|
|00000e20| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00000e30| 00 02 00 00 00 01 00 05 | 00 00 00 00 00 04 00 01 |........|........|
|00000e40| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000e50| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 01 24 |........|.......$|
|00000e60| 01 24 00 3c 00 3c 00 00 | 01 03 00 00 00 00 00 00 |.$.<.<..|........|
|00000e70| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00000e80| 0b 24 04 8a 0b 61 06 3b | 00 01 81 81 00 14 00 0a |.$...a.;|........|
|00000e90| 00 00 00 00 00 03 00 03 | 00 01 00 0d 44 41 54 45 |........|....DATE|
|00000ea0| 20 41 50 50 52 4f 56 45 | 44 61 00 00 00 16 00 01 | APPROVE|Da......|
|00000eb0| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 0a 00 00 |........|........|
|00000ec0| 00 00 00 00 00 01 00 00 | 00 aa 0a db 07 03 0b 60 |........|.......`|
|00000ed0| 08 b3 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00000ee0| 00 03 00 02 00 00 00 01 | 00 05 00 00 00 00 00 04 |........|........|
|00000ef0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000f00| 00 00 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00000f10| 01 24 01 24 00 3c 00 3c | 00 00 01 04 00 00 00 00 |.$.$.<.<|........|
|00000f20| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000f30| 00 02 0b 24 07 03 0b 61 | 08 b4 00 01 81 81 00 14 |...$...a|........|
|00000f40| 00 0a 00 00 00 00 00 03 | 00 03 00 01 00 0c 43 4c |........|......CL|
|00000f50| 41 49 4d 20 4e 55 4d 42 | 45 52 00 00 00 16 00 01 |AIM NUMB|ER......|
|00000f60| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 0a 00 00 |........|........|
|00000f70| 00 00 00 00 00 07 00 00 | 02 c2 08 27 00 e2 09 ba |........|...'....|
|00000f80| 08 b2 00 01 00 00 ff ff | ff ff ff ff ff ff 00 01 |........|........|
|00000f90| 00 00 00 00 00 00 00 02 | 08 27 00 e2 09 ba 08 b2 |........|.'......|
|00000fa0| 00 00 00 00 00 14 00 0c | ff 00 00 02 00 04 00 01 |........|........|
|00000fb0| 00 07 02 59 0d 49 20 72 | 65 71 75 65 73 74 20 70 |...Y.I r|equest p|
|00000fc0| 61 79 6d 65 6e 74 20 66 | 72 6f 6d 20 6d 79 20 43 |ayment f|rom my C|
|00000fd0| 75 73 74 6f 6d 20 43 6f | 76 65 72 61 67 65 20 41 |ustom Co|verage A|
|00000fe0| 63 63 6f 75 6e 74 20 66 | 6f 72 20 74 68 65 20 65 |ccount f|or the e|
|00000ff0| 78 70 65 6e 73 65 73 20 | 69 74 65 6d 69 7a 65 64 |xpenses |itemized|
|00001000| 20 61 62 6f 76 65 2e 20 | 20 49 20 63 65 72 74 69 | above. | I certi|
|00001010| 66 79 20 74 68 61 74 20 | 49 20 68 61 76 65 20 6e |fy that |I have n|
|00001020| 6f 74 20 72 65 71 75 65 | 73 74 65 64 20 72 65 69 |ot reque|sted rei|
|00001030| 6d 62 75 72 73 65 6d 65 | 6e 74 20 75 6e 64 65 72 |mburseme|nt under|
|00001040| 20 74 68 69 73 20 50 6c | 61 6e 20 6f 72 20 66 72 | this Pl|an or fr|
|00001050| 6f 6d 20 61 6e 79 20 6f | 74 68 65 72 20 73 6f 75 |om any o|ther sou|
|00001060| 72 63 65 20 66 6f 72 20 | 74 68 65 73 65 20 65 78 |rce for |these ex|
|00001070| 70 65 6e 73 65 73 2e 20 | 20 49 20 61 6c 73 6f 20 |penses. | I also |
|00001080| 63 65 72 74 69 66 79 20 | 74 68 61 74 20 74 68 65 |certify |that the|
|00001090| 20 74 6f 74 61 6c 20 64 | 65 70 65 6e 64 65 6e 74 | total d|ependent|
|000010a0| 20 63 61 72 65 20 65 78 | 70 65 6e 73 65 73 20 66 | care ex|penses f|
|000010b0| 6f 72 20 77 68 69 63 68 | 20 49 20 61 6d 20 72 65 |or which| I am re|
|000010c0| 71 75 65 73 74 69 6e 67 | 20 72 65 69 6d 62 75 72 |questing| reimbur|
|000010d0| 73 65 6d 65 6e 74 20 74 | 68 69 73 20 70 6c 61 6e |sement t|his plan|
|000010e0| 20 79 65 61 72 20 64 6f | 20 6e 6f 74 20 65 78 63 | year do| not exc|
|000010f0| 65 65 64 20 74 68 65 20 | 6c 65 73 73 65 72 20 6f |eed the |lesser o|
|00001100| 66 20 6d 79 20 6f 72 20 | 6d 79 20 73 70 6f 75 73 |f my or |my spous|
|00001110| 65 27 73 20 65 61 72 6e | 65 64 20 69 6e 63 6f 6d |e's earn|ed incom|
|00001120| 65 20 66 6f 72 20 74 68 | 65 20 79 65 61 72 2e 20 |e for th|e year. |
|00001130| 20 49 20 66 75 72 74 68 | 65 72 20 63 65 72 74 69 | I furth|er certi|
|00001140| 66 79 20 74 68 61 74 20 | 65 78 70 65 6e 73 65 73 |fy that |expenses|
|00001150| 20 6d 65 65 74 20 61 6c | 6c 20 6f 66 20 74 68 65 | meet al|l of the|
|00001160| 20 72 65 71 75 69 72 65 | 6d 65 6e 74 73 20 66 6f | require|ments fo|
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|00001180| 64 65 6e 74 20 63 61 72 | 65 20 65 78 70 65 6e 73 |dent car|e expens|
|00001190| 65 73 2e 49 20 75 6e 64 | 65 72 73 74 61 6e 64 20 |es.I und|erstand |
|000011a0| 74 68 61 74 20 72 65 69 | 6d 62 75 72 73 65 64 20 |that rei|mbursed |
|000011b0| 65 78 70 65 6e 73 65 73 | 20 63 61 6e 6e 6f 74 20 |expenses| cannot |
|000011c0| 62 65 20 63 6c 61 69 6d | 65 64 20 69 6e 20 74 68 |be claim|ed in th|
|000011d0| 65 20 64 65 70 65 6e 64 | 65 6e 74 20 63 61 72 65 |e depend|ent care|
|000011e0| 20 74 61 78 20 63 72 65 | 64 69 74 20 6f 6e 20 6d | tax cre|dit on m|
|000011f0| 79 20 70 65 72 73 6f 6e | 61 6c 20 69 6e 63 6f 6d |y person|al incom|
|00001200| 65 20 74 61 78 20 72 65 | 74 75 72 6e 2e 00 00 00 |e tax re|turn....|
|00001210| 00 2a 00 02 00 00 00 00 | 00 0c 00 09 00 14 01 00 |.*......|........|
|00001220| 00 0c 00 00 00 00 00 00 | 00 00 00 01 00 0d 00 0a |........|........|
|00001230| 00 14 00 00 00 0c 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00001240| 00 c6 04 93 06 53 05 48 | 09 20 00 01 00 00 00 00 |.....S.H|. ......|
|00001250| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 85 00 01 |........|........|
|00001260| 00 05 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|00001270| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
|00001280| ff ff ff ff ff ff ff ff | 01 58 01 58 00 3c 00 6c |........|.X.X.<.l|
|00001290| 00 00 01 05 00 0c 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000012a0| 00 00 00 00 00 00 00 00 | 00 02 04 dc 06 53 05 49 |........|.....S.I|
|000012b0| 09 21 00 01 81 81 00 14 | 00 0a 00 00 00 00 00 03 |.!......|........|
|000012c0| 00 03 00 02 00 28 54 4f | 54 41 4c 20 41 4d 4f 55 |.....(TO|TAL AMOU|
|000012d0| 4e 54 20 52 45 51 55 45 | 53 54 45 44 20 46 4f 52 |NT REQUE|STED FOR|
|000012e0| 20 52 45 49 4d 42 55 52 | 53 45 4d 45 4e 54 00 00 | REIMBUR|SEMENT..|
|000012f0| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00001300| 00 0a 00 00 00 00 00 00 | 00 01 00 00 00 ac 06 57 |........|.......W|
|00001310| 00 e2 06 c3 05 5f 00 01 | 00 00 00 00 00 15 00 00 |....._..|........|
|00001320| 00 0c 00 00 00 03 00 02 | 00 00 00 01 00 05 00 00 |........|........|
|00001330| 00 00 00 04 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001340| 00 00 00 00 00 00 00 01 | 00 03 00 00 ff ff ff ff |........|........|
|00001350| ff ff ff ff 02 40 02 40 | 00 30 00 30 00 00 01 0b |.....@.@|.0.0....|
|00001360| 00 0d 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001370| 00 00 00 00 00 02 06 93 | 00 e2 06 c4 05 60 00 01 |........|.....`..|
|00001380| 81 81 00 14 00 0a 00 00 | 00 00 00 03 00 01 00 01 |........|........|
|00001390| 00 0e 50 52 4f 56 49 44 | 45 52 53 20 4e 41 4d 45 |..PROVID|ERS NAME|
|000013a0| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|000013b0| 00 00 00 0a 00 00 00 00 | 00 00 00 01 00 00 00 b8 |........|........|
|000013c0| 06 53 05 e3 06 bf 08 b3 | 00 01 00 00 00 00 00 15 |.S......|........|
|000013d0| 00 00 00 0c 00 00 00 03 | 00 02 00 00 00 01 00 05 |........|........|
|000013e0| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000013f0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|00001400| ff ff ff ff ff ff 01 68 | 01 68 00 30 00 38 00 00 |.......h|.h.0.8..|
|00001410| 01 0c 00 0e 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001420| 00 00 00 00 00 00 00 02 | 06 87 05 e3 06 c0 08 b4 |........|........|
|00001430| 00 01 81 81 00 14 00 0a | 00 00 00 00 00 03 00 01 |........|........|
|00001440| 00 01 00 1a 54 41 58 50 | 41 59 45 52 20 49 2e 44 |....TAXP|AYER I.D|
|00001450| 2e 20 20 4f 52 20 20 20 | 53 2e 53 2e 4e 2e 00 00 |.  OR   |S.S.N...|
|00001460| 00 16 00 01 00 00 00 00 | 00 0b 00 08 00 14 00 00 |........|........|
|00001470| 00 0a 00 00 00 00 00 00 | 00 07 00 00 01 00 05 87 |........|........|
|00001480| 00 e2 06 44 08 b4 00 01 | 00 00 ff ff ff ff ff ff |...D....|........|
|00001490| ff ff 00 01 00 00 00 00 | 00 00 00 02 05 87 00 e2 |........|........|
|000014a0| 06 44 08 b4 00 00 00 00 | 00 14 00 00 ff 00 00 02 |.D......|........|
|000014b0| 00 01 00 01 00 03 00 97 | 50 72 6f 76 69 64 65 72 |........|Provider|
|000014c0| 27 73 20 53 74 61 74 65 | 6d 65 6e 74 0d 49 66 20 |'s State|ment.If |
|000014d0| 61 70 70 6c 69 63 61 62 | 6c 65 2c 20 61 74 74 61 |applicab|le, atta|
|000014e0| 63 68 20 69 74 65 6d 69 | 7a 65 64 20 62 69 6c 6c |ch itemi|zed bill|
|000014f0| 20 66 72 6f 6d 20 70 72 | 6f 76 69 64 65 72 2e 20 | from pr|ovider. |
|00001500| 20 53 69 67 6e 61 74 75 | 72 65 20 6f 66 20 70 72 | Signatu|re of pr|
|00001510| 6f 76 69 64 65 72 20 69 | 73 20 72 65 71 75 69 72 |ovider i|s requir|
|00001520| 65 64 20 6f 6e 6c 79 20 | 69 66 20 79 6f 75 20 64 |ed only |if you d|
|00001530| 6f 20 6e 6f 74 0d 69 6e | 63 6c 75 64 65 20 61 6e |o not.in|clude an|
|00001540| 20 69 74 65 6d 69 7a 65 | 64 20 62 69 6c 6c 2e 00 | itemize|d bill..|
|00001550| 00 00 00 2a 00 02 00 00 | 00 00 00 0f 00 0c 00 14 |...*....|........|
|00001560| 01 00 00 0e 00 00 00 00 | 00 00 00 00 00 15 00 0d |........|........|
|00001570| 00 0a 00 14 00 00 00 0c | 00 00 00 00 00 00 00 01 |........|........|
|00001580| 00 00 00 b0 06 c7 00 df | 07 40 08 b3 00 01 00 00 |........|.@......|
|00001590| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 02 00 00 |........|........|
|000015a0| 00 01 00 05 00 00 00 00 | 00 04 00 01 00 00 00 00 |........|........|
|000015b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|000015c0| 00 00 ff ff ff ff ff ff | ff ff 02 40 02 40 00 30 |........|...@.@.0|
|000015d0| 00 38 00 00 01 0d 00 0f | 00 01 00 00 00 00 00 00 |.8......|........|
|000015e0| 00 00 00 00 00 00 00 00 | 00 00 00 02 07 08 00 df |........|........|
|000015f0| 07 41 08 b4 00 01 81 81 | 00 14 00 0a 00 00 00 00 |.A......|........|
|00001600| 00 03 00 02 00 01 00 11 | 50 52 4f 56 49 44 45 52 |........|PROVIDER|
|00001610| 53 20 41 44 44 52 45 53 | 53 00 00 00 00 16 00 01 |S ADDRES|S.......|
|00001620| 00 00 00 00 00 0b 00 08 | 00 14 00 00 00 0a 00 00 |........|........|
|00001630| 00 00 00 00 00 01 00 00 | 00 a2 09 c7 06 df 0a 57 |........|.......W|
|00001640| 08 8f 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|00001650| 00 03 00 02 00 00 00 01 | 00 05 00 00 00 00 00 04 |........|........|
|00001660| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001670| 00 00 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00001680| 00 d4 00 d4 00 14 00 3c | 00 00 01 0e 00 00 00 00 |.......<|........|
|00001690| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000016a0| 00 02 0a 1b 06 df 0a 58 | 08 90 00 01 81 81 00 14 |.......X|........|
|000016b0| 00 0a 00 00 00 00 00 03 | 00 01 00 01 00 04 44 41 |........|......DA|
|000016c0| 54 45 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |TE......|........|
|000016d0| 00 14 00 00 00 0a 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|000016e0| 00 a8 09 c7 01 07 0a 57 | 05 87 00 01 00 00 00 00 |.......W|........|
|000016f0| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 0a 00 01 |........|........|
|00001700| 00 05 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|00001710| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
|00001720| ff ff ff ff ff ff ff ff | 00 d4 00 d4 00 14 00 3c |........|.......<|
|00001730| 00 00 01 0f 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001740| 00 00 00 00 00 00 00 00 | 00 02 0a 1b 01 07 0a 58 |........|.......X|
|00001750| 05 88 00 01 81 81 00 14 | 00 0a 00 00 00 00 00 03 |........|........|
|00001760| 00 01 00 01 00 09 53 49 | 47 4e 41 54 55 52 45 2e |......SI|GNATURE.|
|00001770| 00 00 00 16 00 01 00 00 | 00 00 00 0b 00 08 00 14 |........|........|
|00001780| 00 00 00 0a 00 00 00 00 | 00 00 00 01 00 00 00 a2 |........|........|
|00001790| 07 57 06 df 07 e7 08 8f | 00 01 00 00 00 00 00 15 |.W......|........|
|000017a0| 00 00 00 0c 00 00 00 03 | 00 02 00 00 00 01 00 05 |........|........|
|000017b0| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000017c0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|000017d0| ff ff ff ff ff ff 00 d4 | 00 d4 00 14 00 3c 00 00 |........|.....<..|
|000017e0| 01 10 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000017f0| 00 00 00 00 00 00 00 02 | 07 ab 06 df 07 e8 08 90 |........|........|
|00001800| 00 01 81 81 00 14 00 0a | 00 00 00 00 00 03 00 01 |........|........|
|00001810| 00 01 00 04 44 41 54 45 | 00 00 00 16 00 01 00 00 |....DATE|........|
|00001820| 00 00 00 0b 00 08 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00001830| 00 00 00 01 00 00 00 b4 | 07 57 01 07 07 e7 05 87 |........|.W......|
|00001840| 00 01 00 00 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00001850| 00 02 00 0a 00 01 00 05 | 00 00 00 00 00 04 00 01 |........|........|
|00001860| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001870| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 d4 |........|........|
|00001880| 00 d4 00 14 00 3c 00 00 | 01 11 00 00 00 00 00 00 |.....<..|........|
|00001890| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000018a0| 07 ab 01 07 07 e8 05 88 | 00 01 81 81 00 14 00 0a |........|........|
|000018b0| 00 00 00 00 00 03 00 01 | 00 01 00 15 53 49 47 4e |........|....SIGN|
|000018c0| 41 54 55 52 45 20 4f 46 | 20 50 52 4f 56 49 44 45 |ATURE OF| PROVIDE|
|000018d0| 52 00 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |R.......|........|
|000018e0| 00 14 00 00 00 0a 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|000018f0| 00 22 03 3c 04 2c 03 7a | 04 2c 00 01 00 00 00 03 |.".<.,.z|.,......|
|00001900| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001910| 00 00 00 00 00 02 00 00 | 00 22 03 3b 05 bc 03 79 |........|.".;...y|
|00001920| 05 bc 00 01 00 00 00 03 | 00 00 00 00 00 00 00 00 |........|........|
|00001930| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|00001940| 00 22 03 3c 06 4f 03 7a | 06 4f 00 01 00 00 00 03 |.".<.O.z|.O......|
|00001950| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001960| 00 00 00 00 00 08 00 00 | 04 f6 02 61 00 70 04 58 |........|...a.p.X|
|00001970| 09 20 00 01 00 00 00 00 | 00 03 00 00 00 03 00 00 |. ......|........|
|00001980| 00 00 00 01 00 01 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|00001990| ff ff 00 01 00 00 00 00 | 00 00 00 00 00 00 00 40 |........|.......@|
|000019a0| 00 00 00 48 00 00 00 00 | 01 06 00 00 00 05 00 50 |...H....|.......P|
|000019b0| ff ff ff ff ff ff ff ff | ff ff ff ff ff ff ff ff |........|........|
|000019c0| aa 55 aa 55 aa 55 aa 55 | 00 05 00 02 00 01 00 0b |.U.U.U.U|........|
|000019d0| 00 01 05 15 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000019e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 cc |........|........|
|000019f0| 00 02 02 62 00 71 02 b1 | 09 20 01 01 01 01 00 14 |...b.q..|. ......|
|00001a00| 00 00 00 01 00 00 00 01 | 00 03 00 01 00 6b 44 45 |........|.....kDE|
|00001a10| 50 45 4e 44 45 4e 54 20 | 49 4e 46 4f 52 4d 41 54 |PENDENT |INFORMAT|
|00001a20| 49 4f 4e 09 09 09 20 20 | 20 20 20 20 20 20 20 20 |ION...  |        |
|00001a30| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00001a40| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00001a50| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00001a60| 20 20 20 20 20 20 20 20 | 20 44 41 54 45 53 20 4f |        | DATES O|
|00001a70| 46 20 53 45 52 56 49 43 | 45 00 00 00 00 3e 00 03 |F SERVIC|E....>..|
|00001a80| 00 00 00 00 00 0d 00 0a | 00 14 01 00 00 0c 00 00 |........|........|
|00001a90| 00 00 00 00 00 00 00 16 | 00 0f 00 0c 00 14 01 00 |........|........|
|00001aa0| 00 0e 00 00 00 00 00 00 | 00 00 00 5b 00 0b 00 08 |........|...[....|
|00001ab0| 00 14 01 00 00 0a 00 00 | 00 00 00 00 00 05 03 98 |........|........|
|00001ac0| 00 19 27 64 00 00 00 00 | 00 00 00 00 00 00 00 00 |..'d....|........|
|00001ad0| 00 b0 00 c3 00 27 01 3e | 02 3c 00 01 00 00 00 00 |.....'.>|.<......|
|00001ae0| 00 15 00 00 00 0c 00 00 | 00 01 00 03 00 2a 00 01 |........|.....*..|
|00001af0| 00 06 00 01 00 00 00 03 | 00 01 ff ff ff ff ff ff |........|........|
|00001b00| ff ff 00 00 00 00 00 00 | 00 00 00 00 00 03 00 02 |........|........|
|00001b10| ff ff ff ff ff ff ff ff | 03 0e 00 9e 03 6a 08 ee |........|.....j..|
|00001b20| 00 00 01 07 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001b30| 00 00 00 00 00 00 00 00 | 00 02 02 b2 00 71 02 f1 |........|.....q..|
|00001b40| 04 08 01 01 01 01 00 14 | 00 0a 00 80 00 00 00 03 |........|........|
|00001b50| 00 03 00 01 00 11 44 45 | 50 45 4e 44 45 4e 54 27 |......DE|PENDENT'|
|00001b60| 53 20 20 4e 41 4d 45 14 | 00 00 00 16 00 01 00 00 |S  NAME.|........|
|00001b70| 00 00 00 0b 00 08 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00001b80| 00 00 01 90 00 19 27 94 | 00 00 00 00 00 00 00 00 |......'.|........|
|00001b90| 00 00 00 00 00 aa 00 c3 | 00 da 01 3e 02 3c 00 01 |........|...>.<..|
|00001ba0| 00 00 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00001bb0| 00 00 00 01 00 06 00 01 | 00 00 00 03 00 01 ff ff |........|........|
|00001bc0| ff ff ff ff ff ff 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001bd0| 00 03 00 02 ff ff ff ff | ff ff ff ff 3d 9c 00 48 |........|....=..H|
|00001be0| 7b 1e 40 81 00 00 01 08 | 00 02 00 00 00 00 00 00 |{.@.....|........|
|00001bf0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 02 b2 |........|........|
|00001c00| 04 09 02 f1 05 98 01 01 | 01 01 00 14 00 0a 00 80 |........|........|
|00001c10| 00 00 00 03 00 03 00 01 | 00 0c 52 45 4c 41 54 49 |........|..RELATI|
|00001c20| 4f 4e 53 48 49 50 00 00 | 00 16 00 01 00 00 00 00 |ONSHIP..|........|
|00001c30| 00 0b 00 08 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00001c40| 00 94 00 19 27 b0 00 00 | 00 00 00 00 00 00 00 00 |....'...|........|
|00001c50| 00 00 00 a2 00 c3 01 3e | 01 3e 02 3c 00 01 00 00 |.......>|.>.<....|
|00001c60| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 00 |........|........|
|00001c70| 00 01 00 06 00 01 00 00 | 00 03 00 01 ff ff ff ff |........|........|
|00001c80| ff ff ff ff 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00001c90| 00 02 ff ff ff ff ff ff | ff ff 3d 9c 00 48 7b 1e |........|..=..H{.|
|00001ca0| 40 81 00 00 01 09 00 03 | 00 00 00 00 00 00 00 00 |@.......|........|
|00001cb0| 00 00 00 00 00 00 00 00 | 00 00 00 02 02 b2 05 99 |........|........|
|00001cc0| 02 f1 06 2c 01 01 01 01 | 00 14 00 0a 00 80 00 00 |...,....|........|
|00001cd0| 00 03 00 03 00 01 00 03 | 41 47 45 20 00 00 00 16 |........|AGE ....|
|00001ce0| 00 01 00 00 00 00 00 0b | 00 08 00 14 00 00 00 0a |........|........|
|00001cf0| 00 00 00 00 00 00 01 7a | 00 19 25 e8 00 00 00 00 |.......z|..%.....|
|00001d00| 00 00 00 00 00 00 00 00 | 00 a2 00 c2 01 92 01 32 |........|.......2|
|00001d10| 02 3d 00 01 00 00 00 00 | 00 15 00 00 00 0c 00 00 |.=......|........|
|00001d20| 00 03 00 03 00 00 00 01 | 00 06 00 01 00 00 00 03 |........|........|
|00001d30| 00 01 ff ff ff ff ff ff | ff ff 00 00 00 00 00 00 |........|........|
|00001d40| 00 00 00 00 00 03 00 02 | ff ff ff ff ff ff ff ff |........|........|
|00001d50| 3d 9c 00 48 7b 1e 40 81 | 00 00 01 0a 00 04 00 00 |=..H{.@.|........|
|00001d60| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001d70| 00 02 02 b2 06 2d 02 f1 | 07 a6 01 01 01 01 00 14 |.....-..|........|
|00001d80| 00 0a 00 80 00 00 00 03 | 00 03 00 01 00 04 46 52 |........|......FR|
|00001d90| 4f 4d 00 00 00 16 00 01 | 00 00 00 00 00 0b 00 08 |OM......|........|
|00001da0| 00 14 00 00 00 0a 00 00 | 00 00 00 00 01 7c 00 19 |........|.....|..|
|00001db0| 26 10 00 00 00 00 00 00 | 00 00 00 00 00 00 00 a0 |&.......|........|
|00001dc0| 00 98 01 e9 01 16 02 48 | 00 01 00 00 00 00 00 15 |.......H|........|
|00001dd0| 00 00 00 0c 00 00 00 03 | 00 03 00 00 00 01 00 06 |........|........|
|00001de0| 00 01 00 00 00 03 00 01 | ff ff ff ff ff ff ff ff |........|........|
|00001df0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 02 ff ff |........|........|
|00001e00| ff ff ff ff ff ff 9f 68 | 00 14 c0 8c 00 17 00 00 |.......h|........|
|00001e10| 01 12 00 05 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001e20| 00 00 00 00 00 00 00 02 | 02 b2 07 a7 02 f1 09 20 |........|....... |
|00001e30| 01 01 01 01 00 14 00 0a | 00 80 00 00 00 03 00 03 |........|........|
|00001e40| 00 01 00 02 54 4f 00 00 | 00 16 00 01 00 00 00 00 |....TO..|........|
|00001e50| 00 0b 00 08 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00001e60| 00 02 00 00 00 22 02 b2 | 04 08 02 f2 04 08 00 01 |....."..|........|
|00001e70| 00 00 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001e80| 00 00 00 00 00 00 00 00 | 00 02 00 00 00 22 02 b2 |........|....."..|
|00001e90| 05 98 02 f2 05 98 00 01 | 00 00 00 03 00 00 00 00 |........|........|
|00001ea0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001eb0| 00 02 00 00 00 22 02 b2 | 06 2b 02 f2 06 2b 00 01 |....."..|.+...+..|
|00001ec0| 00 00 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001ed0| 00 00 00 00 00 00 00 00 | 00 02 00 00 00 22 02 b2 |........|....."..|
|00001ee0| 07 a4 02 f2 07 a4 00 01 | 00 00 00 03 00 00 00 00 |........|........|
|00001ef0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001f00| 00 07 00 00 00 82 0b 98 | 03 58 0b cb 06 a4 00 01 |........|.X......|
|00001f10| 00 00 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|00001f20| 00 00 00 02 0b 98 03 58 | 0b cb 06 a4 00 00 00 00 |.......X|........|
|00001f30| 00 14 00 0c 00 00 00 00 | 00 01 00 01 00 01 00 2e |........|........|
|00001f40| 46 6f 6c 64 20 74 6f 20 | 74 68 69 73 20 6c 69 6e |Fold to |this lin|
|00001f50| 65 20 61 6e 64 20 70 75 | 74 20 69 6e 20 6d 61 69 |e and pu|t in mai|
|00001f60| 6c 20 64 69 73 74 72 69 | 62 75 74 69 6f 6e 00 00 |l distri|bution..|
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+--------+-------------------------+-------------------------+--------+--------+