rowid,Short_Form_Termination_Date,Short_Form_Date,Short_Form_Last_Name,Short_Form_First_Name,Registration_Number,Registration_Date,Registrant_Name,Address_1,Address_2,City,State,Zip 3245,2006-01-05,2004-05-28,Tobin,Bethanie R.,5512,2002-08-01,Mullen,36 Essex Street,,Wenham,MA,01984