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RECIPIENT INFORMATION

Needed for each recipient.  Attach the list of recipients to the information for each purchaser/donor and add additional pages as necessary.

Name___________________________________________________________________

Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________

Name___________________________________________________________________
Name 2_________________________________________________________________ Address_________________________________________________________________

Address 2_______________________________________________________________

Email address (optional) ___________________________________________________