Why you would even consider putting your name and their address is beyond me. That's just asking for legal trouble. Use their custodian information as provided, or use yourself if you want to take it upon yourself to be the custodian of records. I will advise you it is better to go with their custodian, as that is their job and they know the requirements.
You should really ocnsider a consultation with a lawyer regarding this matter, have a look at
http://www.xxxlaw.net/ I'm sure they'd be more then willing to help you with your needs.
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