BYS
Youth Community Promotional Fund Policy
Youth Community Promotional Fund Check List:
Listed below is a check list of all required documents to submit an application for the Youth Community Promotional Funds. Please refer to this list as a guideline to ensure a complete application.
Document Check List
Date Submitted
| Document Details
Current Non-Profit Status (501c) 1. Documentation showing current status
2. Latest 990 Fom.
1. Provide a detailed breakdown of /
Breakdown of Services and Cost what services are being provided
2. Provide a detailed breakdown of
the cost to the Residents of
Barstow
1. Provide a detailed explanation of /
Two Year Plan goals for the organization for the
next two years
2. Provide a detailed explanation of
operations for the next two years
1. Detailed explanation of how the /
Donation Benefit donation will benefit organization.
2. Detailed explanation of how this
donation will cut down the cost to
the Residents of Barstow
1 -
Certificate of Liabilty Insurance Include a copy of a certificate of liability insurance. Policy must be a $1,000,000
policy listing the City of Barstow as
additionally insured.
Background Checks Procedures Provide a detailed explanation of what procedures are being used to conduct
backarounds checks for individuals
Evidence or Proof of Funds Provide evidence and proof of funds showing that the City is not the sole sourc
of funding.
HE NON OF THE G CITY OF BARSTOW
BARSTOW
YOUTH COMMUNITY PROMOTIONAL FUND
IN-KIND DONATION APPLICATION
APPLICANT INFORMATION
Name of Applicant: Name of Organization:
Destet Youth SocceR BARstow Youth Socce
Mailing Address: P.o. Box 1815
State: CA Zip: 92311
City:
Telephone: (1 740-963-4855 Email [email protected]
760-221-8724
No D If No, are you planning on partnering with a non-
Non-Profit: Yes 8
profit? Yes O No D
501(c)(3) #: 33-00505Ile
EVENT DESCRIPTION
Name of Event:
BOYS SOCCER GAMES/PRACT a 2024/2027
Date(s) of Event: Location:
BARstoW SpoRtspReK
7/15/24-2/1/27 #stsocue Folds
# of Participants: 150 Kids
WAIVER OF FEES DESCRIPTION
Park/Facility: Date(s):
Robust Sessions sport Park 1/15/26-2/1/27
Total:
Fees:
$
Rental Fee: $ /hr x hrs
$
Lights: $ /hr x hars
Total Fees Waived: $ 3
IN-KIND DONATION DESCRIPTION
Quantity Unit Cost Total
Items):
Sset of CorneR Flass #948 5 51.95 259.75
Frol E Practica LISAGE 343604
Total: 6 34,120
Youth Community Promotional Fund Application Page 1
1. Why is your organization requesting an in-kind donation? This will support 150° local Kids in the Barsia Area.
Give BARsta Youth Soccer mplace For games and practics in Asafe wall It coutomat.
How will this in-kind donation benefit your organization and the youth population of Barstow?
Thes will suppet autober Achines mad have is palt agent oN BaRst Youth. Ponding A pher of team buckling raw hoot of b keep sure registration cast lowne thom the rest of the tach besut, so more of the chulden of Basstew can With this application, please attach the following:
1. A detailed description stating the total cost of the activity or event, all sources and amounts of funding, and all expenses;
2. A description of the organization's or group's purpose or objective;
3. A five-year operating plan outlining the goals and objectives for their organization;
4. A copy of the organization's non-profit determination.
By signing below, I declare that I have read the Youth Community Promotional Fund Policy and agree to all its terms and conditions. I agree that there is a formal process in place to conduct background checks on all employees and volunteers who work with persons under the age of 18 years and senior citizens. I understand that an incomplete application will not be accepted and that the ørganization or applicant will not be considered for funding. (If the application is being even kichaRden
Applicant Signatur Applicant Name (printed)
12/15/2025
Organization President/Director Signature Date
(if applicable)
Youth Community Promotional Fund Application Page 2
Desert Communities Soccer League
DBA Barstow Youth Soccer
• Our 501 (c) was started in July 1985. We renew it each year in May when we do our taxes. We have attached a copy of 990 form.
• We are the largest youth sport organization in Barstow. Our league runs from August to January.
We utilize the H St Soccer fields for our lower divisions and the sportspark for our upper divisions.
We have over 745 kids within Barstow and the surrounding areas that play youth soccer. With the help of Measure Q and our sponsorships we have been able to keep our registration fees to $90.00 for u18 age group players and $85.00 for all other players. We have the lowest fees in the high desert, with Victorville being over $165.00 - $200.00 • We are hoping to maintain our league fees as we currently have them and encourage more players to come out and play. With keeping the fees as low as they are more players may be able to play.
• We are asking for Measure Q funds to cover the fees of the sportspark for our practice times and game times. Being our league starts in August we lose the sunlight early and our teams need to practice under the lights. If our coaches have to pay $20.00 dollars a practice it will become very expensive for our coaches and we will lose coaches. The last time we paid for the use of the sportspark for games alone it was over $6000.00. That was several years ago. If we don't receive Measure Q funds our fees will have to go up to offset the sportspark fees. • Our Certificate of Liability runs May 1, 2025 to May 1, 2026. • Per California Soccer Association - South (Calsouth) which is our governing body all our coaches as well as parents (admin) over the age of 18 that will be alone or on the field must go through a DOJ and FBI Live Scan background check. Calsouth receives the information and update the profile of each admin. We as a league do not have the ability to adjust the admin profile for risk management. Our admin also must go through a Safesport computerized train to review for bullying and sexual assault, and how it needs to be reported each year. They also have to get a Concussion Certification to learn the protocol and procedure when a player has a possible concussion. Each admin also does a computerized course on Cardiac Arrest. • We took in $61,000 dollars in registration and local sponsorships. Our sponsors get their logos put on the jerseys of the players. We paid $29,300.00 dollars in uniforms and equipment that the players and coaches keep. $7227.00 for insurance, $2526.45 for trophies, $400.00 for fingerprinting of the admins. $2850.00 in tournament fees, and $19,000.00 in referee fees.
Barstow Youth Soccer Supports over 745 local kids in the Barstow area and gives them a place to interact, play games and practice in a safe well-lit environment when we use the City Sportspark and H St. soccer field during daylight hours. Our operational cost goes towards Uniforms, Insurance, Referees, Awards, Regional tournaments, Calsouth Sanctioning fees and other day to day operations.
Barstow Youth Soccer also support outdoor activities and have a positive impact on Barstow's youth.
Providing a place for team building and healthy exercise. We have been able to keep our registration cost lower than the rest of the High Desert, so more of the children of Barstow can afford to play and be involved. Our sign ups normally begin in late May/early June and games will start mid-August and go until the end of January (8/1/26-2/1/27). We have local games and also compete with the surrounding High Desert teams and the Inland Empire.
Our plan is to keep our registration fee where they currently are going forward. We want to encourage more kids to get involved and be outside being active. Soccer is a great healthy exercise and promotes teamwork.
We currently have a 501 (c) nonprofit under Desert Communities Youth Soccer (DBA Barstow Youth Soccer)
Our coaches and volunteers are fingerprinted and verified through the DOJ and FBI.
We are requesting mainly the fee waivers for the use of the Sportspark and H St. fields to have games and coaches can hold their practices. Schedules are and will be forwarded to the Sportpark Director for the City Of Barstow at the beginning of the season, bi-weekly practice schedule and when any changes might need to be made.
If you have any questions please contact the following:
Ray Winston - President 760-963-4855
Steven Richardson - Vice President 760-221-8724
Barstow Youth Soccer request the usage of the Robert A. Sessions Sportspark for team practices and games from mid July 2026 to January 2027.
1. July it is split half with lights and half without Blue Field 2hr - 4 day × 15 = 120 x 2 weeks = $240.00
2hr - 4 day × 20 = 160 x 2 weeks =$320.00
2. August all lower fields are used 3 field (Red White Blue) 2hr - 4 days × 15 = 120 x 5 field = 600 × 4 weeks = $2400 2hr - 4 days × 20 = 160 x 5 fields = 800 x 4 weeks = $3200
3. September, October and November (Red White Blue)
4 hr - 4 days × 20=320 x 5 fields = 1600 x 12 weeks = $19200
4. November, December, January (Red White Blue)
Commissioner's Cup / Presidents Cup / Tournament of Champions practice 3 hr x 3 days × 20 = 180 x 5 fields = 900 × 10 weeks = $9000 1 560
2 5600
3 19200
4 9000
Total 34360
Thank you,
S Richardson
Oct 2025 for 26/27 Season
Barstow Youth Soccer supports over 700 local kids in the Barstow area and gives them a place to interact, play games and practice in a safe well-lit environment when we use the City Sportspark and H st soccer fields during daylight hours. Our operational cost goes towards Uniforms, Insurance, Referees, Awards, Regional tournaments, Cal- South sanctioning fees and other day to day operations.
youths. Providing a place for team building and healthy exercise. We have been able to keep Barstow Youth Soccer also support outdoor activities and have a positive impact on Barstow our registration cost lower than the rest of the High Desert, so more of the children of Barstow can afford to play and be involved. Our Sign ups normally begin in late May / early June and Games will start mid-August and go until the end of January (8/1/25-2/1/26) We have local games and also compete with the surrounding High Desert teams and the Inland Empire. encourage more kids to get involved and be outside being activity. Soccer is a great healthy Our plan is to keep our registration fee where they currently are going forward, We want to exercise and promotes teamwork.
We currently have a 501C nonprofit under Desert Communities Youth Soccer (Dba Barstow Youth Soccer)
Our coaches and volunteers are fingerprinted and vetted through the DOJ. games and coaches can hold their practices. Schedules are and will be forward to the Sports We are requesting mainly the Fee waivers for the use of the Sportspark and Hst fields to have Director for City of Barstow at the beginning of the season and bi-weekly practice schedules.
If you have any questions please contact the following:
760-963-4855
Ray Winston President
Steven Richardson Vice President 760-221-8724
DATE (MM/DD/YYYY)
ACORD® CERTIFICATE OF LIABILITY INSURANCE
7/10/2026
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INSURERS) AFFORDING COVERAGE NAIC#
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ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 91421014 | 26-27 Master Certificate Incl Auto | Raul Aguayo | 7/10/2026 10:29:28 AM (PDT) | Page 1 of 3 Barstow Youth Soccer League
(Cal South)
POLICY NUMBER: CZ26CAGL001703 COMMERCIAL GENERAL LIABILITY CG 20 11 12 19
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - MANAGERS OR
LESSORS OF PREMISES
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Designation Of Premises (Part Leased To You):
20 East Mountain View Street, Suite f
Barstow CA 9231-
Name Of Person(s) Or Organization(s) (Additional Insured):
ANY CERTIFICATE HOLDER IDENTIFIED AS AN ADDITIONAL INSURED ON A
CERTIFICATE ON FILE WITH THE COMPANY
City of Barsto East Mountain View Street, Suite A
Barstow CA 92311
Additional Premium: INCL.
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section Il - Who Is An Insured is amended to 2. If coverage provided to the additional insured is include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property or "personal and advertising injury"
caused, in whole or in part, by you or those acting
on your behalf in connection with the ownership,
maintenance or use of that part of the premises additional insureds, the following is added to leased to you and shown in the Schedule and Section III - Limits Of Insurance:
subject to the following additional exclusions: If coverage provided to the additional insured is This insurance does not apply to: required by a contract or agreement, the most we
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However: This endorsement shall not increase the
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CG 20 11 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 91421044 | 26-27 Master Certificate Incl Auto | Raul Aguayo | 7/10/2026 10 INSURER COPS) | Page 2 of 3
COMMERCIAL GENERAL LIABILITY
ECG 24 520 04 02
Policy # CZ26CAGL001703
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - OTHER INSURANCE
(PRIMARY NONCONTRIBUTORY)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
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ECG 24 520 04 02 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.
91121044 | 26-27 Master Certificate Incl Auto | Raul Aguayo | 7/10/2026 10:29:28 AM (PDT) | Page 3 of 3 Train
A IRS me rande Service In reply refer to: 0248219454
ALp- G1, 2019 LIR 416BC
CINEINNATI DH 45999-0036 35-0050516 000000 DO
0001238
BODCS TE
DESERT COMKUNITIES YOUTH SOCCER
ASSOGIATIDN
1865
BARSTOW CA 92512-3865
027845
Employer 10 number: 35-0950516
Fore 950 regured: Yes
Dear Taxpayer!
responding to your request dated July 25, 2019, about your we're
tax -exempt status.
you a deterination letter in July 1985, recognizing
Me issued Code (IRC) Section 501(c)
tax-exempt under internal Revenue
you as
(3.-
not à private foundation as defined under IRC
also shOw you're
We you're described in IRC Section 509(a)(2).
Section 509C =) because
deduct contribution: they make to you as provided in IRC Sonors qualified to receive tax deductible bequests,
Section 170 You're al50
devises, transfers, or gifts under IRC Sections 2055, 2106; Jagacies,
and 2522.
letter, we indicated whether you must file an
in the heading of this required to file a return, you
annual infornation return. If you're
15th day of the 5th month after
must file one of the following by tha
the end of your annual accounting poried:
of OrganiZation Exempt From Incone Tax
Farm 990, Return
Short Form Return of Organization Exempt Froe Incone
Form 990E2
Tax
Fore 990-N, Electronic Notice (o-Postcard) for Tax-Exempt Form 990 or Form 990-E2
- Form 990-PF, Return of Private Foundation or Section 4947(a) (1) Organizations Not Required to File Trust Treated as Private Founcation
Accordino to IRC Section 6035(3), If you don"t file a required annual 3 consecutive years, we'll revoke infornation return or notice for tax-exempt status on the due date of the 3rd raquired return or your
notice.
www.irs.g0v/forms-pubs on by calling B00-TAX-FORM (800-829-3676) You can pet IRS fores or publicellons you need from our website 8t It you have cuestions, call 877 829-5500 between E a e. and 5 p.m., through Friday CAlaska anu Hawald follow Paclr1= ¿acal time: Montas
0246219454
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35-0050510 CLONER
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DESE : COMMUNITE OUTH SOCCER
ASSOC: &TIC
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Sircerely yours;
Billups Operations Manager
Asrevnta Manacement Operatsons
Administrator Information Report
First Name Last Name Risk Status Risk Expire Date
Season League 2/11/2099
Ruben Aguilar-Medina Approved
2025-26 Fall (Aug 1st Barstow Youth Soccer League
School Year) Arredondo Approved 12/26/2099
Barstow Youth Soccer League Jesus
2025-26 Fall (Aug 1st
School Year Ayala Navarro Approved 11/14/2099
Barstow Youth Soccer League Ramon
2025-26 Fall (Aug 1st
School Year) Camacho Alonso Approved 5/14/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Arturo School Year) Cervantes Approved 4/16/2099
Barstow Youth Soccer League Andres
2025-26 Fall (Aug 1st
School Year Coley Approved 7/11/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Lon
School Year) Craig Approved 11/26/2099
Barstow Youth Soccer League Paul
2025-26 Fall (Aug 1st
School Year Dokie Approved 5/12/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jason School Year Enaligo Approved 9/24/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jerry School Year) Espinoza Approved 12/14/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League •Nancy School Year) Gilmore Approved 6/14/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Johnathan School Year) Gonzales Approved 1/1/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Domingo School Year) Hernandez-Ayala Approved 5/25/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Celina School Year) Hobbs Approved 5/20/2099
Barstow Youth Soccer League Jacee
2025-26 Fall (Aug 1st
School Year) Holland Approved 7/9/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Tyler School Year) Hunt Approved 2/16/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jeane School Year) Lee Approved 8/5/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Kimberly School Year) Machuca Approved [01/23/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Veronica School Year) Mendez Pacheco Approved 9/2/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Joseph School Year) Molina Approved 5/3/2099
Barstow Youth Soccer League Ivan
2025-26 Fall (Aug 1st
School Year) Cesar Morales Approved 12/14/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League
School Year) Approved 1/1/2099
Barstow Youth Soccer League Jesus Ortega
2025-26 Fall (Aug 1st
School Year) Approved 12/6/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jerry School Year) Approved 10/1/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Anthony School Year) Jennifer Approved 7/22/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League
School Year Approved 9/16/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jason School Year) Approved [12/9/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Steven School Year Approved 01/12/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Ricardo School Year) Approved 4/30/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jun
School Year) Approved 2/12/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jasmine School Year Approved 10/23/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League John
School Year) Approved 5/18/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jesse School Year) Approved 1/17/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jessica School Year) Approved 7/31/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jasmine School Year)
Report Run Time: 10/14/2025 10:58
Approved [9/10/2099
Barstow Youth Soccer League Nathan
2025-26 Fall (Aug 1st
School Year) Approved 1/30/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Lorraine School Year) Approved 10/20/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Michael School Year) Approved 04/13/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Jared School Year) Approved 6/13/2099
Barstow Youth Soccer League Jose De Jesus
2025-26 Fali (Aug 1st
School Year) Approved 5/8/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Alison School Year) Approved 1/1/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Paul
School Year) Approved 12/16/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Marcus School Year) Review 1219/2099
2025-26 Fall (Aug 1st Barstow Youth Soccer League Deklan Rucc Committee
School Year)
Report Run Time: 10/14/2025 10:58
* CalSouth.
Risk Management Instructions
Risk Management is our California Department of Justice background check. This is only required of individuals 18 years of age and older. This can only be done anywhere in the State of California.
To complete this, you will need to print out our live scan form on the second page. Fill out the middle portion with your contact information. That form can then be taken to any servicer. You can do a quick google search for "local live scan locations" and take your form to them. The cost will range anywhere from $15-$30. Keep your copy of the live scan form after the service is done until you have confirmation that we have received your results. On average it takes from 1-14 days to receive the electronic results back from the Department of Justice. We will update your Cal South profile as soon as that clearance comes in.
Once you complete the service, please do the following:
1) With dark marker, cover up your social on the form. The servicer only needed to see this, not everyone else.
2) Email [email protected] to provide us the ATl code you were assigned.
This is located in the bottom portion of the form copy they give back to you.
CALIFORNIA STATE SOCCER ASSOCIATION - SOUTH
Request For Live Scan Service
CalSouth. REQUEST FOR LIVE SCAN SERVICE
APPLICANT SUBMISSION
Non-Profit Organization
A2094 Authorized Applicant Type
ORI (code assigned by DOl)
Volunteer
Type of License/Certification/Permit OR Working Title (Maximum 30 characters- if assigned by DOJ, use exact title assigned) Contributing Agency Information
09380
Cal South Mail Code (five-digit code assigned by DO)
Agency Authorized to Receive Criminal Record Information Risk Management Dept. [email protected] 1029 South Placentia Avenue Contact Name Contact Email
Street Address or P.O. Box (714) 451-1017
92831 (714) 451-1518 Contact Fax Number
Fullerton CA
ZIP Code Contact Telephone Number
State
City
Applicant Information
Middle Name Suffix
First Name
Last Name
Other Name Middle Suffix
Other Name First
Other Name (AKA or Alias) Last
Driver's License Number State
Sex Male Female
Date of Birth
Mobile Phone Number Home Phone Number
Eye Color Hair Color
Height Weight
Social Security Number Email Address
Place of Birth (State or Country)
State ZIP Code
City
Home Address or P.O. Box
Live Scan Service
Level of Service: X DOJ (FBl not required)
If re-submission, list original ATI number (must provide proof of rejection): Original ATI Number Applicant Role(s)
Choose all that apply:
Г Referee:
Г Administrator: Referee Association or "New Referee"
Club/League Name
OFFICIAL USE ONLY
Live Scan Transaction Completed By:
Date
Name of Operator
ATI Number Amount Collected/Billed
ISID
Transmitting Agency
PRINT TWO COPIES SECOND COPY - Applicant (please keep for your records) Please allow at least seven (7) business days for processing.
ORIGINAL - Live Scan Operator
DEPARTMENT OF JUSTICE
STATE OF CALIFORNIA PAGE 1 of 4
BCIA 8016VECHS
(Rev. 12/2023)
CalSouth. REQUEST FOR LIVE SCAN SERVICE
(California Volunteer and Employee Criminal History Service) Applicant Submission
VECHS / Volunteer 11105.3PC
A2094 Authorized Applicant Type
ORI (Code assigned by DOJ
VOLUNTEER 92072 Volunteer
CJIS Code
Type of License/Certification/Permit OR Working Title
Contributing Agency Information:
09380
Agency Authorized to Receive Criminal Record Information Mail Code (five-digit code assigned by DO) 1029 S Placentia Ave on anamen neatory for al schol submissions) Street Address or P.O. Bo>
CA 92831 714-778-2972 [email protected]
Fullerton State ZIP Code Contact Telephone Number & Email City
Applicant Information:
First Name Middle Initial Suffix
Last Name
Other Name: (AKA or Alias)
Suffix
First Name
Last Name
Sex • Male Female
Driver's License Number
Date of Birth
Billing
Hair Color Number
Weight Weight Eye Color (Agency Billing Number)
Misc.
Place of Birth (State or Country) Social Security Number Number (Other Identification Number)
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