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Please print or type your name, mailing address, agency name, and position below:LAST AME FIRST NAME MIDDLE NAME : f inf WE/53 i '.)5w 'FOR OFFICE USE ONLY:Sea/V kii2 A/MAILING ADDRESS :.../1.5 f.LA’D
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F wley - leevote is a form used by individuals to report their foreign gifts and inheritances.
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