Blank Utility Bill PDF Form

Blank Utility Bill PDF Form

The Utility Bill form is a document used to provide proof of residence and utility service, often required for various applications and services. This form typically includes details such as the account holder's name, address, and utility service provider information. To ensure timely processing of your requests, it is important to complete the form accurately.

Fill out the form by clicking the button below.

Understanding your utility bill is essential for managing your household expenses effectively. A utility bill form typically encompasses various key components that provide a clear overview of your energy, water, or gas usage and the corresponding charges. Each bill includes details such as the billing period, account number, and due date, ensuring that you stay informed about when payments are expected. Additionally, you will find a breakdown of your consumption, which can help you track usage patterns and identify opportunities for savings. Charges often include not only the base rate for services but also taxes and fees, which can vary depending on your location and the utility provider. Many forms also feature graphs or charts that visually represent your usage over time, making it easier to understand fluctuations in your consumption. By familiarizing yourself with the utility bill form, you empower yourself to make informed decisions about your energy use and budgeting, ultimately leading to more sustainable living practices.

Document Sample

ENERGY STATEMENT

Account No:

1234567890-1

Statement Date:

09/07/2019

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

 

Service For:

SPARKY JOULE 12345 ENERG'( CT

Questions about your bill?

Monday-Friday 7 a.m.-9 p.m. Saturday 8 a.m.-6 p.m. Phone: 1-800-743-5000 www.pge.com/MyEnergy

Ways To Pay

www.pge.com/waystopay

Your Account Summary

Amount Due on Previous Statement

$91.57

Payment(s) Received Since Last Statement

-91.57

Previous Unpaid Balance

$0.00

Current PG&E Electric Delivery Charges

$55.66

Silicon Valley Clean Energy Electric Generation Charges

$32.48

I Total Amount Due by 08/28/2019

$88.14

Monthly Billing History

 

 

 

 

Daily Usage Comparison

$200

 

 

 

 

 

 

 

1 Year

Last

Current

 

 

 

 

 

 

 

Ago

Period

Period

$150

 

 

 

 

 

 

 

12.50

12.16

12.67

$100

 

 

 

 

 

 

 

■ ■ ■

$50

 

 

 

 

 

 

 

Electric kWh / Day

 

 

 

 

 

 

 

 

 

 

$0

-+-----'-r-"-------

"'r�---

'-r"-----'-r-"

-----'-r�---

'-r"-----'-r"----'-r�---

'--r"------'-r"------i

0.12

0.16

0.17

2018 8/07

9/06 10/04 11/06 12/06 1/08 2/06

3/07 4/08

5/09 6/06

7/10 8/07 2019-�c____<=----

=::,__---l

 

 

 

Electric

D

Gas

 

Gas Therms/ Day

Visit www.pge.com/MyEnergy for a detailed bill comparison

Important Messages

The Family Electric Rate Assistance (FERA) Program provides a monthly discount on electric bills for income-qualified households of three or more persons. To see if you qualify, please call 1-800-PGE-5000 or apply online at www.pge.com/fera.

El Programa FERA ofrece ahorros mensuales solo en las facturas de electricidad a hogares de ingresos econ6micos bajos y medianos con tres o mas personas. Para determinar si califica, por favor llame al 1-800-PGE-5000 o puede aplicar a traves de nuestra pagina web www.pge.com/fera.

Continued on page 6

Please return this portion with your payment. No staples or paper clips. Do not fold. Thank you.

®

Account Number:

Due Date:

Total Amount Due:

Amount Enclosed:

123456789-1

09/28/2019

$88.14

$

PG&E

BOX 997300

SACRAMENTO, CA 95899-7300

Page 1 of 6

ENERGY STATEMENT

Account No:

1234567890-1

Statement Date:

09/07/2019

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

 

Important Phone Numbers - Monday-Friday 7 a.m.-9 p.m., Saturday 8 a.m.-6 p.m. Customer Service (All Languages; Relay Calls Accepted) 1-800-743-5000

TTY 7-1-1

Servicio al Cliente en Espanol (Spanish) -��.P�IHf (Chinese)

1-800-660-6789

Djch VI) khach tieng Vi�t (Vietnamese)

1-800-298-8438

1-800-893-9555

Business Customer Service

1-800-468-4743

Rules and rates

You may be eligible for a lower rate. To learn more about optional rates or view a complete list of rules and rates, visit www.pge.com or call 1-800-743-5000.

If you believe there is an error on your bill, please call 1-800-743-5000 to speak with a representative. If you are not satisfied with our response, contact the California Public Utilities Commission (CPUC), Consumer Affairs Branch (CAB), 505 Van Ness Avenue, Room 2003, San Francisco, CA 94102, 1-800-649-7570 or 7-1-1 (8:30 AM to 4:30 PM, Monday through Friday) or by visiting www.cpuc.ca.gov/complaints/.

To avoid having service turned off while you wait for the outcome of a complaint to the CPUC specifically regarding the accuracy of your bill, please contact CAB for assistance. If your case meets the eligibility criteria, CAB will provide you with instructions on how to mail a check or money order to be impounded pending resolution of your case. You must continue to pay your current charges while your complaint is under review to keep your service turned on.

If you are not able to pay your bill, call PG&E to discuss how we can help. You may qualify for reduced rates under PG&E's CARE program or other special programs and agencies may be available to assist you. You may qualify for PG&E's Energy Savings Assistance Program which is an energy efficiency program for income-qualified residential customers.

Important definitions

Rotating outage blocks are subject to change without advance notice due to operational conditions.

Tier 1/Baseline allowance: Some residential rates are given a Tier 1/Baseline allowance - a CPUC approved percentage of average customer usage during summer and winter months. Your Tier 1/Baseline allowance provides for basic needs at an affordable price and encourages conservation. Your allowance is assigned based on the climate where you live, the season and your heat source. As you use more energy, you pay more for usage. Any usage over your baseline allowance will be charged at a higher price.

High Usage: An increased price per kWh whenever electricity usage exceeds four times the Baseline Allowance (Tier 1) in a billing period. This charge does not apply to Time-of-Use rate plans.

DWR bond charge: Recovers the cost of bonds issued by the Department of Water Resources (DWR) to purchase power to serve electric customers during the California energy crisis. DWR bond charges are collected on behalf of DWR and do not belong to PG&E.

Power Charge Indifference Adjustment (PCIA): Ensures that non-exempt customers under PG&E's GT and ECR rate schedules or who purchase electricity (generation) from non-PG&E suppliers pay their share of generation costs.

Gas Public Purpose Program (PPP) Surcharge. Used to fund state-mandated gas assistance programs for low-income customers, energy efficiency programs, and public-interest research and development.

Visit www.pge.com/billexplanation for more definitions. To view most recent bill inserts including legal or mandated notices, visit www.pge.com/billinserts.

Your Electric Charges Breakdown

Conservation Incentive

-$9.50

Transmission

12.42

Distribution

35.08

Electric Public Purpose Programs

4.71

Nuclear Decommissioning

0.33

DWR Bond Charge

1.91

Competition Transition Charges (CTC)

0.42

Energy Cost Recovery Amount

-0.22

PCIA

10.26

Taxes and Other

0.25

Total Electric Charges

$55.66

"PG&E" refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation. © 2019 Pacific Gas and Electric Company. All rights reserved. Please do not mark in box. For system use only.

Update My Information (English Only)

Please allow 1-2 billing cycles for changes to take effect

Account Number: 1234567890-1

Change my mailing address to: ________________

City _____________ State

ZIP code ____

Primary

Primary

 

Phone#--------- Email --------------

Ways To Pay

Online via web or mobile at www.pge.com/waystopay

By mail: Send your payment along with this payment stub in the envelope provided.

By debit card, Visa, MasterCard, American Express, or Discover: Call

877-704-8470 at any time. (Our independent service provider charges a fee per transaction.)

At a PG&E payment center or local office: To find a payment center or local office near you, please visit www.pge.com or call 800-743-5000. Please bring a copy of your bill with you.

Page 2 of 6

ENERGY STATEMENT

Details of PG&E Electric Delivery Charges

Service For: 12345 ENERGY CT

Service Agreement ID: 111111111

Rate Schedule: E1 X Residential Service

07/02/2019 - 07/31/2019 Your Tier Usagel�-1��-2

Tier 1 Allowance

297.00

kWh

(30 days x 9.9 kWh/day)

Tier 1 Usage

297.000000

kWh

@$0.22376

$66.46

Tier 2 Usage

83.000000

kWh

@$0.28159

23.37

Generation Credit

 

 

 

-44.68

Power Charge Indifference Adjustment

 

 

10.26

Franchise Fee Surcharge

 

 

 

0.25

Total PG&E Electric Delivery Charges

$55.66

Electric Usage This Period: 380.000000 kWh, 30 billing days

30kWh

 

 

 

 

----- =

Average Daily Usage 12.67 I

24

 

 

 

 

 

 

 

 

 

 

18

 

 

 

 

 

 

 

 

 

 

12

---------

------------�•--·--- - ------

----

--

- -

6

 

 

 

 

 

 

 

 

 

 

0

--+------"P.__.,.___.,._.,.__.,.___.,._.,.__.,.___.,._.,.__.,.__.,._.,.__.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.__.,._.,._.,.____.,.___,

 

7/2

7/5

7/8

7/11

7/14

7/17

7/20

7/23

7/26

7/29

Due Date:

09/28/2019

Service Information

1111111111

Meter#

Current Meter Reading

37,710

Prior Meter Reading

37,330

Total Usage

380.000000 kWh

Baseline Territory

X

Heat Source

B - Not Electric

Serial

G

Rotating Outage Block

50

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 3 of 6

 

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Silicon Valley Clean Energy Electric Generation Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 11111111

07/02/2019 - 07/31/2019

Rate Schedule:

E-1

$32.37

Generation - Total

380.000000 kWh @$0.08519

 

Net Charges 32.37

0. 11

Energy Commission Surcharge

Customers receive clean electricity and save money with SVCE. Please see updated

SVCE electric rates and comparisons to PG&E at www.svcleanenergy.com/rates

Total Silicon Valley Clean Energy

$32.48

Electric Generation Charges

Account No:

1234567890-1

Statement Date:

09/07/2019

Due Date:

09/28/2019

Service Information

 

Total Usage

380.000000 kWh

For questions regarding charges on this page, please contact:

SILICON VALLEY CLEAN ENERGY 1-844-474-7823 [email protected]

Additional Messages

About Silicon Valley Clean Energy (SVCE) Serving 13 Santa Clara County communities, SVCE is a locally-controlled, public agency providing residents and businesses with electricity from renewable and hydroelectric sources.

Understanding SVCE Charges

PG&E continues to provide and bill for electric delivery. SVCE replaces PG&E generation charges. Under PG&E Electric Delivery Charges, note the Generation Credit. This is what PG&E would have charged for power, and now credits back to you. The Power Charge Indifference Adjustment and Franchise Fee are factored into SVCE rates. Learn more:

https://www.svcleanenergy.orgies/your-bi11/.

SVCE is committed to protecting customer privacy.

Learn about our privacy policy at www.svcleanenergy.org/customer-confidenti ality

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 4 of 6

 

ENERGY STATEMENT

www.pge.com/MyEnergy

Details of Gas Charges

08/02/2019 - 08/31/2019 (30 billing days)

Service For: 12345 ENERGY CT

Service Agreement ID: 1111111111

Rate Schedule: G1 X Residential Service

07/02/2019 - 07/31/2019

Your Tier Usagel�-1��-2

 

 

 

 

 

Tier 1 Allowance

17.70 Therms (30 days x

0.59 Therms/day)

 

 

Tier 1 Usage

5.000000Therms @$ 1.28395

$6.42

Gas PPP Surcharge ($0.09047 /Therm)

0.45

Total Gas Charges

 

 

$6.87

Account No: 1234567890-1

Statement Date: 09/07/2019

Due Date: 09/28/2019

Service Information

Meter#

11111111

Current Meter Reading

2,588

Prior Meter Reading

2,583

Difference

5

Multiplier

1.031647

Total Usage

5.000000 Therms

Baseline Territory

X

Serial

G

Gas Procurement Costs ($/Therm)

07/02/2019 - 07/31/2019$0.28462

Gas Usage This Period: 5.000000 Therms, 30 billing days

Therms

 

 

 

 

 

= Average Daily Usage 0. 17 I

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

7/2

7/5

7/8

7/11

7/14

7/17

7/20

7/23

7/26

7/29

 

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 5 of 6

 

ENERGY STATEMENT

Statement Date:

 

09/07/2019

 

Account No:

1234567890-1

www.pge.com/MyEnergy

Due Date:

09/28/2019

 

Important Messages (continued from page 1)

CARE Program. You may qualify for a monthly discount with the California Alternate Rates for Energy (CARE) Program. To find out more and apply online, visit www.pge.com/care.

Usted podría reunir los requisitos de un descuento mensual con el California Alternate Rates for Energy Program (CARE). Para obtener más información y hacer su solicitud en Internet, visite www.pge.com/espanol/care.

Electric power line safety PG&E cares about your safety. Be aware of your surroundings and keep yourself, tools, equipment and antennas at least 10 feet away from overhead power lines. If you see an electric power line fall to the ground, keep yourself and others away. Call 9-1-1.

Call 811 before you dig. A common cause of pipeline accidents is damage from digging. If you plan on doing any digging, such as planting a tree or installing a fence, please call 811 at least two working days before you dig. One free call will notify underground utilities to mark the location of underground lines, helping you to plan a safe project.

Visit www.pge.com/MyEnergy for a detailed bill comparison.

Page 6 of 6

File Specifics

Fact Name Description
Purpose The Utility Bill form is used to document and verify utility expenses for various purposes, including financial assistance and legal matters.
Required Information This form typically requires details such as the account holder's name, account number, utility provider, and billing period.
Governing Laws In some states, the use of this form is governed by laws related to consumer protection and financial assistance programs.
Submission Process Individuals must submit the completed form to the relevant authority or organization, often alongside supporting documents.
Importance Accurate completion of the Utility Bill form is crucial for ensuring eligibility for assistance programs and maintaining good standing with utility providers.

How to Use Utility Bill

Filling out the Utility Bill form is an important step in managing your household expenses. By providing accurate information, you ensure that your utility services remain uninterrupted. Follow these steps carefully to complete the form correctly.

  1. Begin by entering your personal information, including your full name, address, and contact number.
  2. Next, indicate the type of utility service you are applying for, such as electricity, water, or gas.
  3. Provide your account number, if applicable, to help the utility company identify your account.
  4. Fill in the date of your last bill to establish a reference point for your application.
  5. Include the total amount due from your last bill to give a clear picture of your current standing.
  6. Sign and date the form at the bottom to confirm that all information provided is accurate and complete.
  7. Finally, submit the form according to the instructions provided, either online or by mailing it to the appropriate address.

Your Questions, Answered

What is the Utility Bill form?

The Utility Bill form is a document used to verify a person's residency or address. It typically includes information such as the name of the utility provider, the account holder's name, and the service address. This form is often required for various applications, such as opening a bank account, applying for government assistance, or enrolling in school.

Who needs to fill out the Utility Bill form?

Individuals who need to prove their residency may be required to fill out the Utility Bill form. This includes renters, homeowners, and students. If you are applying for services or benefits that require proof of address, you may need to submit this form.

What information is typically required on the Utility Bill form?

When filling out the Utility Bill form, you will generally need to provide:

  1. Your full name
  2. Your current address
  3. The name of the utility provider
  4. Your account number
  5. The billing period

Some forms may also ask for additional information, such as your contact details or the type of utility service (e.g., electricity, water, gas).

How do I obtain a Utility Bill?

You can usually obtain a utility bill from your utility provider. Most companies offer online access to your account, where you can view and print your current and past bills. Alternatively, you can contact customer service to request a paper copy be mailed to you.

Is there a specific format for the Utility Bill form?

While there is no universally mandated format for the Utility Bill form, it should clearly present the necessary information. Different organizations may have their own versions or requirements, so it is advisable to check with the requesting party for any specific guidelines.

Can I use a digital copy of my Utility Bill?

Many institutions accept digital copies of utility bills, especially if they include all necessary information and are clear and legible. However, some may require a physical copy or a notarized document. Always verify with the organization requesting the bill to ensure compliance with their requirements.

What if my name is not on the Utility Bill?

If your name does not appear on the utility bill, you may still be able to provide proof of residency. You can do this by obtaining a letter from the account holder, along with a copy of their bill. This letter should state that you reside at the address listed and include both parties' signatures.

How recent does the Utility Bill need to be?

Most organizations require that the utility bill be recent, typically within the last 30 to 90 days. This ensures that the information reflects your current residency. Always check the specific requirements of the organization requesting the form to avoid any issues.

What should I do if I do not have a Utility Bill?

If you do not have a utility bill, consider alternative forms of proof of residency. Options may include a lease agreement, bank statement, or government document that includes your name and address. Each organization may have different policies regarding acceptable documents, so it’s best to inquire beforehand.

Where can I submit the completed Utility Bill form?

Once you have filled out the Utility Bill form, submission methods will vary based on the organization requesting it. Common options include:

  • In-person delivery
  • Email submission
  • Online upload through a designated portal
  • Mailing a physical copy

Always follow the instructions provided by the requesting organization to ensure proper processing.

Common mistakes

Filling out a Utility Bill form can seem straightforward, but many people make common mistakes that can delay processing or cause issues with their account. Here’s a list of eight mistakes to watch out for:

  1. Incomplete Information: Many individuals forget to fill in all required fields. Leaving out essential details like your name, address, or account number can lead to delays.
  2. Incorrect Account Number: Double-checking the account number is crucial. An incorrect number can result in payments being applied to the wrong account.
  3. Missing Signature: Some forms require a signature to validate the information. Forgetting to sign the form can result in it being rejected.
  4. Wrong Payment Amount: Entering the wrong payment amount can cause confusion. Always verify the total due before submitting your form.
  5. Failure to Update Personal Information: If you’ve moved or changed your name, it’s important to update this information on the form. Outdated details can lead to service interruptions.
  6. Not Reviewing the Form: Skimming through the form before submission can lead to overlooked errors. Taking a moment to review can save time and hassle.
  7. Ignoring Instructions: Each Utility Bill form may have specific instructions. Not following these can lead to mistakes that could have been easily avoided.
  8. Submitting Late: Timeliness is key. Missing the deadline for submission can incur late fees or service disruptions.

By being aware of these common pitfalls, individuals can ensure that their Utility Bill forms are filled out correctly, leading to a smoother process and uninterrupted service.

Documents used along the form

When submitting a Utility Bill form, several other documents may be required to support your application or request. Each of these documents serves a specific purpose and helps to provide additional information or verification. Below is a list of commonly used forms and documents that may accompany the Utility Bill form.

  • Proof of Identity: This document verifies your identity and may include a driver's license, passport, or state-issued ID.
  • Proof of Residency: This document confirms your current address, which can be established through a lease agreement, mortgage statement, or official government correspondence.
  • Income Verification: Pay stubs, tax returns, or bank statements may be required to demonstrate your financial situation.
  • Application for Assistance: This form outlines the type of assistance you are seeking and may require details about your household and income.
  • Service Agreement: A document that outlines the terms of service between you and the utility provider, confirming your account status.
  • Authorization Form: This allows a third party to access your account information or act on your behalf in utility matters.
  • Dispute Resolution Form: If there are issues with your utility service or bill, this form can be used to formally address your concerns.
  • Payment Plan Agreement: This outlines the terms of any payment arrangements made with the utility provider to manage outstanding bills.
  • Emergency Contact Form: This document provides a contact person in case of emergencies related to your utility service.

Having these documents prepared can streamline the process and ensure that your Utility Bill form is processed efficiently. Always check with the relevant authority to confirm which documents are necessary for your specific situation.

Similar forms

A lease agreement is a document that outlines the terms under which one party agrees to rent property from another party. Similar to a utility bill, a lease agreement provides essential information about the rental property, including the address, the names of the parties involved, and the duration of the lease. Both documents serve as proof of residence and can be used to establish a person's address for various purposes, such as applying for a loan or enrolling in school.

A bank statement is another document that shares similarities with a utility bill. It reflects the financial activity of an account holder over a specific period. Like a utility bill, a bank statement includes the account holder's name and address, making it useful for verifying identity and residence. Both documents can be used to demonstrate financial responsibility, which may be required for applications like credit cards or mortgages.

An insurance policy document provides details about coverage, premiums, and the insured party. It is similar to a utility bill in that it confirms the identity and address of the policyholder. Both documents may be required when applying for certain services or benefits, as they help establish a person's identity and residence. Insurance policies often need to be current, just as utility bills should reflect recent payment history.

A tax return is a comprehensive document that reports an individual's income and tax obligations to the government. Like a utility bill, it includes the taxpayer's name and address. Tax returns can serve as proof of income and residency, which may be necessary for loan applications or government assistance programs. Both documents provide a snapshot of a person's financial situation, albeit from different perspectives.

A pay stub is a document provided by an employer that outlines an employee's earnings for a specific pay period. It shares commonalities with a utility bill in that it includes the employee's name and address. Pay stubs can be used to verify income and residency, which may be required for various applications, such as renting an apartment or applying for a loan. Both documents help establish financial stability.

A government-issued ID, such as a driver's license or state ID, serves as a primary form of identification. Similar to a utility bill, it contains the individual's name and address. Government-issued IDs are often required for identification verification in various situations, including opening bank accounts or applying for jobs. Both documents are essential for confirming identity and residency.

A voter registration card is a document that confirms an individual's registration to vote in elections. It includes the voter’s name and address, making it similar to a utility bill. Both documents can be used to establish residency, which may be necessary for various legal and administrative processes. Voter registration cards help ensure that individuals are eligible to participate in civic duties, while utility bills confirm their residence.

Dos and Don'ts

When filling out a Utility Bill form, it’s important to ensure accuracy and completeness. Here’s a list of things you should and shouldn’t do to make the process smoother.

  • Do read the instructions carefully before starting.
  • Do provide accurate information, including your name and address.
  • Do double-check the account number to avoid errors.
  • Do keep a copy of the completed form for your records.
  • Don’t leave any required fields blank.
  • Don’t use abbreviations that could cause confusion.
  • Don’t forget to sign and date the form before submission.

By following these guidelines, you can help ensure that your Utility Bill form is processed without delays or issues.

Misconceptions

Understanding the Utility Bill form is essential for both consumers and service providers. However, several misconceptions often arise, leading to confusion and potential errors. Here are four common misconceptions:

  • The Utility Bill form is only for residential customers. Many people believe that this form is exclusively for households. In reality, both residential and commercial customers are required to complete it to ensure accurate billing and service provision.
  • Submitting the Utility Bill form is optional. Some individuals think that filling out this form is merely a suggestion. However, it is a mandatory requirement for establishing or maintaining utility services. Without it, service providers may not process requests or accurately bill customers.
  • Once submitted, the information on the Utility Bill form cannot be changed. There is a common fear that any submitted information is final. In fact, customers can update their details if there are changes in ownership, contact information, or service requirements. It is important to communicate these changes promptly.
  • The Utility Bill form is only needed when starting service. Many believe that the form is only necessary at the beginning of service. In truth, it may also be required during changes in service, such as moving to a new location or switching providers. Keeping the information current is crucial for uninterrupted service.

Key takeaways

When filling out and using the Utility Bill form, it’s important to keep several key points in mind. Here are some essential takeaways:

  • Ensure all personal information is accurate. This includes your name, address, and account number.
  • Double-check the utility provider's name and contact information to avoid confusion.
  • Include the correct billing period. This helps in aligning your payment with the correct usage timeframe.
  • Attach any required documentation, such as proof of identity or residency, if necessary.
  • Keep a copy of the completed form for your records. This can be useful for future reference.
  • Submit the form through the designated method, whether online, by mail, or in person.
  • Follow up with the utility company to confirm receipt and ensure your request is being processed.

By following these steps, you can navigate the Utility Bill form process more smoothly and efficiently.

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