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& Date
 


 

Your Name:
 


 

Company Name:
 


 

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City:
 

       State:
 

Zip:
 


 

E-Mail:
 


 

Age:
 


 

Are you
experiencing:

 Apparition Sightings
 Shadow People
 Peripheral Vision Sightings
 Cold spots
Hot Spots
 Objects Disappear | Reappear
 Phantom Voices
 Ghost Lights
 Orb Lights
 Footsteps Being Heard
 Electrical Malfunctions
 Pleasant Odors
 Foul Odors
 Sulfuric Odors
 Static Shock
 Frequent Light Bulb Usage
 Nightmares
 Physically Touched
 UFO Sightings
         
( Anything else not listed here?... Please describe it below )

What type of a dwelling is the phenomena occurring in?     
 
How old is the dwelling that the phenomena is occurring in?  
 

Describe what is happening, including as much detail as possible:

 


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