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SIGNATURES OF ELECTORS SIGNATURE OF ELECTOR PRINTED NAME OF ELECTOR House No. Street or Road DATE OF SIGNING DSBE-MPP Rev. 2/17 DEPARTMENT OF STATE Page Side 1 D. A. PREAMBLE TO THE SECRETARY OF THE COMMONWEALTH We the undersigned all of whom are qualified electors of Pennsylvania of the County and of the electoral district s designated below hereby nominate the persons designated in B below as candidates representing the minor political party named herein. 1. STATEMENT OF CIRCULATOR I state...

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