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FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the

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Page 1: FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the
Page 2: FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the
Page 3: FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the
Page 4: FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the
Page 5: FS Form 3858.WM.RDFOR COMPLETING CLAIM FORM FS 1133, CLAIM AGAINST THE UNITED STATES FOR THE PROCEEDS OF A U.S. TREASURY CHECK. B Sign your name personally where indicated. If the