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Federal law requires us to use our best efforts to collect and report name, mailing address, occupation and name of employer for individuals whose contributions exceed $200 in a calendar year and in the case of candidates, election cycle.

Please do not leave blank or enter 'N/A'.
If self-employed, enter 'self'; if unemployed enter 'none' or 'retired'.
Please complete even if self-employed; enter 'none' or 'retired' if unemployed.

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Contributions to political candidates and committees are not deductible for federal income tax purposes.