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01/14/2014 23 : 07 Image# 14960018510 PAGE 1 / 9 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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Office use only refers to information or documents that are intended to be used internally within an organization and not shared with external parties.
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