FORM PFR-06
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PROFESSIONAL FUND
RAISER (PFR)
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JIM RYAN
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LIST OF CHARITIES & CONTRACTS
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ATTORNEY GENERAL
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Attachment
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For Whom Fund Raising Services Are to be Provided
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PFR NAME
__________________________________________________________PFR #
02-________________
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MANAGEMENT PERSON(S) WHO
PREPARE THIS FORM. _________________________________________
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SUBMIT A COPY OF EACH
CONTRACT WITH REGISTRATION.
LIST CHARITIES FOR WHOM
FUNDRAISTNG SERVICES ARE TO BE PROVIDED.
PROVIDE the following BANK
ACCOUNT INFORMATION FOR ALL ACCOUNTS USED TO DEPOSIT FUNDS SOLICITED FOR OR
ON BEHALF OF EACH CHARITY LISTED:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01- ________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct. #
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Other describe:__________________
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct. #
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Other Describe:_________________
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct. #
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Other Describe:_________________
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct. #
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Other Describe:_________________
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct. #
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Other Describe:_________________
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COMPLETE AS MANY COPIES OF
FORM PFR-06 AS NEEDED TO LIST ALL CHARITIES FOR WHICH FUND RAISING SERVICES
ARE TO BE PROVIDED. A COMPLETED COPY OF THIS FORM MUST BE SUBMITTED WITH EACH
NEW CONTRACT FILED.
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account:
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account:
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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Contract Info:
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Charity Name, City, State:
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Contract
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Contract Date: ___/___/___
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CO#
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Terms:
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Beginning: ___/___/___
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01-________ _________
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Ending: ___/___/___
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Bank Account
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Name of Bank:
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Signatory Control of Bank
Acct:
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Information:
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Address of Bank:
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PFR Charity Escrow/Caging
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Acct #
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Other Describe:
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(Source: Added at 24 Ill. Reg. 14684, effective September 21, 2000)