Digital copy of an Application Form relating to the Historic Abuse Redress Scheme as supplied by Lacey Advocates. [Some details redacted]. For Witness 150's statement to the Inquiry dated 27 November 2014, see C/D/AW1/B1/17/WS000484.

Reference: C/D/AW1/A3/20/WD000175

Date: September 29th 2012 - September 29th 2012

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