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HiddenAdmin SectionHiddenEmail HiddenService 1 HiddenService 2 HiddenService 3 HiddenService 4 HiddenService 5 HiddenService 6 Client DataFull Legal Name First Middle Last Suffix Primary Legal Residence Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your mailing address different than the address listed above? Yes No Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country What is your marital status? Single Married Legal Domestic Partnership Divorced Widowed Spouse or Partner DataSpouse or Partner's Full Legal Name First Middle Last Suffix Asset ProtectionWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoBasic Estate PlanWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoCharitable TrustWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoCore Estate PlanWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoGovernance DocumentWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoIrrevocable Life Insurance TrustWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoNon Profit Set UpWhat order do you perform your oral hygiene? Floss, Brush, Mouthwash Floss, Mouthwash, Brush Brush, Floss, Mouthwash I do not conduct oral hygiene - it's a myth propogated by the Industrial Dental Complex and I stand against your illegitimate Capitalist Overlords If you have questions on this product, Click here to watch an explanatory videoDocument UploadGovernment Issued ID Drop files here or Select files Max. file size: 256 MB. Copy of Trust Document Drop files here or Select files Max. file size: 256 MB. Attestations and Additional InformationDental Attestation Understanding that 9/10 dentists disagree with my decision to not conduct dental hygiene, I stand by my uninformed position and accept all responsibilities that may result from the dental diseases that come from my decision. This includes, but is not limited to: Dental abscesses, norma, dental infections, Gingivitis, Periodontitis, and Endocarditis.