| Dog's Name: |
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| Owner's Name: |
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| SCLRR Volunteer: |
__________________________________________ |
| Date: |
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| Method of Contact: |
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Southern California Labrador Retriever Rescue, Inc. *
4654 East Ave S #108, Palmdale, CA 93552
http://www.sclrr.org * 1-888-55-4ALAB
Revised June 2005