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05/22/2014 17 : 09 Image# 14961203525 PAGE 1 / 5 REPORT OF RECEIPTS AND DISBURSEMENTS FEC FORM 3 1. For An Authorized Committee NAME OF COMMITTEE (in full) OFCE Use Only Example: If typing, type over
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Dan Levine for Congress is a campaign for Dan Levine to run for a seat in the United States Congress.
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