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Address:

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Additional Information:
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If self-employed, please enter the name of your business.
 
City and State of Employer:
We are required to request this information by state law if your aggregate contributions for this election cycle will exceed $100.

If you are retired or a homemaker, please indicate that in the Occupation box.

Contribution limits: $800 per person per election/$1600 for the election cycle, or $1600/3200 for a joint contribution.
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