Base

First Name

Rusty Talbert
First Name

TF
Last Name

DK
First Name

XE
Last Name

AQ
First Name

UG
Last Name

ER
First Name

UO
Last Name

DW
First Name

ES
Last Name

EW
First Name

FW
Last Name

RE
First Name

LJ
Last Name

WD
Last Name

YM
First Name

GA
Last Name

OG
First Name

IA
Last Name

TN
City

Minneapolis
State

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Zip Code

55410
Bar Number (required only for attorneys)

75