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complete the following information to comply with **election laws. |
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Name ____________________________________________________ |
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Street Address
_____________________________________________________________ |
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City, State & Zip _________________________________________________ |
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Home Telephone ________________________ Work Telephone
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E-mail Address
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I want
to Support Bruce! |
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Please accept my contribution of: |
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$500, ( ) $1000, ( ) Other
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Occupation **________________________________ Employer **
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for occupation.
If self-employed, provide name of business. |
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_____ Check here if it is O.K. to use
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