State Elected Officials Financial Disclosure Page 2

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State Elected Official Financial Disclosure Form
Name of Official:
_______________________________________________________________
Office Held:
_______________________________________________________________
Senate District (if applicable):
___________
House District (if applicable): ___________
Business Address:
_________________________________________________________
Business City, State and Zip: _________________________________________________________
Business Phone:
(______)______________________
Home Address:
_________________________________________________________
Home City, State and Zip:
_________________________________________________________
Home Phone:
(______)______________________
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