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FORM STATEMENT OF 2000 FINANCIAL INTERESTS LAST NAME FIRST NAME MIDDLE NAVE: GAME OF REPORTING PERSON IS AGENCY:us LIC R 1 IMAIAGeMeM QF FOR Ideal 'n1 I/DI?* f(/ 4 MAILING ADDRESS. I C 7 1 k A F ;CHECK
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Form statement of is a document used to report specific information to a governing body or authority.
Certain individuals or entities, as determined by the governing body or authority, are required to file form statement of.
Form statement of can be filled out by providing the requested information in the designated fields or sections of the form.
The purpose of form statement of is to ensure that relevant information is accurately reported to the governing body or authority.
Form statement of typically requires information such as personal or business details, financial data, and other relevant information.
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