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|colspan=3 class="q4"|''{{{text|}}}
 
|colspan=3 class="q4"|''{{{text|}}}
|colspan=4 rowspan=3|{{{other|}}} {{{Choice1|}}} {{{Choice12|}}}  
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|colspan=4 rowspan=3|{{{other|}}} {{{Choice1|}}} {{{Choice2|}}}  
 
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|colspan=3 class="q4"|{{{req|}}}
 
|colspan=3 class="q4"|{{{req|}}}
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