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DS-DE 12 F4--09 ('j ~6 C,~ l PEE ~ ~-3 ~'A~~ a ~ 3 CA URE 'S (1) Name I TR PORT -ITEMIZED EXPENDITURES (3) Cover Period ~(~ (2) I.D. Number -~-_-~~~~ through ~~~~ nC~ (q) Page Date Full Name (6) (Last, Suffix, First, Middle) Sequence Street Address 8 Number City, State, Zip Code ~ ~ ~ ~/IM' "~S /0.1 Z•o9' ~'jb~ V~,S'Dc'~/~l ~ ~~~ ~ ~ ~- 9 D ~ Z ~L ~ 9rvk-• O. jZ A~ ~~~ D NA~rc~~ ~~ p.1~•a°1 ~t*~N Z~• Ash 1 DS-0E 14 (Re Purpose (add office sought if contribution to a Expendkure candidate) Type Ti~'uc,. G~°S M~ ~~/~ Matt ~Of•~ ~ ~vr~ ~ ~ SEE REVERSE FOR INSTRUCTIONS AND CODE VALUES Amount ~~ °~ ~~ ('A~ ~ 3 ~ 3