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08/23/2012 16 : 24 Image# 12952836282 PAGE 1 / 23 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
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Office use only refers to information or documents that are intended for internal use within a company or organization and should not be shared externally.
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