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if any of the fields do not apply to you, please fill out n/a.
Family's Last Name
Husband's Name
Wife's Name
Husband's Occupation
Wife's Occupation
Husband's Parents
Wife's Parents
Rav/Community
Volunteers in Organization
Address
City
Phone Number
Email Address
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Please enter the name, age, and current school of each of your children.
We are interested in joining the Lakefront Estates community when the Mosdos will be ready.
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Wife's Signature
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