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09/29/2014 23 : 33 Image# 14978041920PAGE 1 / 126REPORT OF RECEIPTS AND DISBURSEMENTS FEC FORM 3 1. For An Authorized Committeeman OF COMMITTEE (in full)Office Use OnlyExample: If typing, type over

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Page 1 126 is a specific form used for reporting certain information to the relevant tax authorities.

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