This government document is issued by Department of Conservation and Natural Resources for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=016351591786576881989:rc4cp9drohe&q=https://www.snowatvreg.dcnr.pa.gov/Publications/public-replacement-form.pdf&sa=U&ved=2ahUKEwjBkajMuvP8AhU3g_0HHdO7CTk4ChAWegQIARAB&usg=AOvVaw3vJyCWET6uA0SJJ5WbVQdD