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Form 1 2019
COUNTRY
STATE
ZIP + 4
$1 You
$1 Spouse if filing jointly . . . . . Total
You 3
Spouse
3$
Primary
Spouse
You 3
Spouse
Fill in if name/address has changed since 2014
State Election Campaign Fund (this contribution will not change your tax or reduce your refund). . . . . . . . . . . . . . .
Fill in if veteran of U.S. armed forces who served in Operation Enduring Freedom, Iraqi Freedom or Noble Eagle 3
If taxpayer(s) is deceased, fill in appropriate oval(s) (see instructions) . . . . . . . . ....
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