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Recipient Committee Campaign Statement Cover Palette or print in ink. Statement covers periods INSTRUCTIONS ON REVERSEbZIfrom9/20/09through10/17/09Committees Complete PartsOfficeholder, Candidate

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Fill out the personal information section of the form, including your full name, address, and contact information.

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The Belmont Police Department is the local law enforcement agency responsible for serving and protecting the Belmont community.

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