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Submitted by Jburke on May 16, 2016

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MUNICIPALITY/ MEMBER INFORMATION

LOSS INFORMATION

If Other, Please Describe Below in Other Information
Select One or More
Select One or More of the Following
Such as an image or document for evidence Multiple files or files larger than 16 MB can be emailed to: vlct.claims@vlct.org.
Files must be less than 16 MB.
Allowed file types: gif jpg jpeg png txt pdf doc docx zip.