\documentclass[12pt]{article}
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\begin{document}
\tt
\pagestyle{empty}
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\noindent {\large\bf 2280-2 S2019}
\\
\begin{tabular}{ll}
000 Name 2280-1 S2019\\
022 ~~~~~~~~~~~~~~~~~~~~~~~& \AA\\
023 ~~~~~~~~~~~~~~~~~~~~~~~& \AA\\
024 ~~~~~~~~~~~~~~~~~~~~~~~& \AA\\
025 ~~~~~~~~~~~~~~~~~~~~~~~& \AA\\
\end{tabular}
\end{document}
