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Visitor Reimbursement Form Name: Country of Citizenship: Type of Visa: H₁ J1 F1 B1 B2 Permanent US Resident? Salary Paid by Federal Funds at Time of Visit? Current Mailing Address: Other: YES YES

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What is attached is a list?

A list of relevant information or items that are connected to the document.

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The person or party specified in the document or filing requirements.

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