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2. 
3. Township of Pine
   230 Pearce Mill Road
   Wexford, PA 15090
   Phone: 724-625-1591
5. Solicitors Beware
   With regard to the Township's Ordinance Number 277, which regulates peddlers, solicitors, and canvassers, please include me on the Township's list of residents banning solicitors.
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11. City*
12. State*
13. Zip Code*
15. Signature*
16. Date*
    Date
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