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07/12/2012 14 : 13 Image# 12952317161 PAGE 1 / 22 REPORT OF RECEIPTS AND DISBURSEMENTS FEC FORM 3X For Other Than An Authorized Committee OFCE Use Only 1. TYPE OR PRINT NAME OF COMMITTEE (in full)

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Page 1 22 is a specific form used for reporting income tax information to the IRS.

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