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REPORT OF RECEIPTS FEC AND DISBURSEMENTS FORM 3 For An Authorized Committee Office Use Only
1. NAME OF TYPE OR PRINT Example: If typing, type 12FE4M5 COMMITTEE (in full) over the lines. Dr. Raul Ruiz for Congress
PO Box 3433 ADDRESS (number and street)
Check if different than previously Palm Desert CA 92261
reported. (ACC)