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Illinois Disclosure Living Form
(fax)
www.cyberdriveillinois.com
Name and type of organization for which this disclosure is being filed:
_____________________________________________________________________________________
❑
❑
❑
❑
Board
Commission
Authority
Task Force
Date of Appointment:
_____________________________
(This date must be completed.)
GENERAL DIRECTIONS
Pursuant to 5 ILCS 420/3A.30, upon appointment to a board, commission, authority or task force authorized or created by State law,
a person must file with...
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