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ELECTION DATE INITIAL AMENDED 2. OFFICE OR POSITION SOUGHT mm/dd/yyyy Nov 2012 3. DISTRICT NUMBER if applicable State Senator 4. Go to Form 1A and complete Candidate Registration Statement 10b. I am exempt from forming a candidate committee and I am filing a Certification of Exemption from Forming a Candidate Committee. CANDIDATE NAME Prefix First MI Daniel Suffix Last DeFazio J 5. CANDIDATE RESIDENCE ADDRESS 6. CANDIDATE MAILING ADDRESS if different Street Address Address 651 State St City...
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