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Continuation Page <br />C. 271 POLITICAL CONTRIBUTION DISCLOSURE FORM <br />Required Pursuant To N.J.S.A. 19:44A-20.26 <br />Page ___ of ______ <br />Vendor Name: <br />Contributor NameRecipient NameDateDollar Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor NameRecipient NameDateAmount <br />Contributor Name Recipient Name Date Amount <br />Contributor NameRecipient NameDateAmount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date Amount <br />Contributor Name Recipient Name Date $Amount <br />Contributor Name Recipient Name Date $Amount <br />Contributor Name Recipient Name Date $Amount <br />Contributor Name Recipient Name Date $Amount <br />Contributor Name Recipient Name Date $Amount <br />Check here if the information is continued on subsequent page(s) <br />Page | 41 <br /> <br /> <br />