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![Application form [Department of Social Welfare Application For Television Licence Fee Concession]; Department of Social Welfare; 1974; XOPO.150](https://images.ehive.com/accounts/3059/objects/images/jg9lgp_13or_t.jpg "Application form [Department of Social Welfare Application For Television Licence Fee Concession]; Department of Social Welfare; 1974; XOPO.150")
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