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Liberace — Part 5
Page 13
13 / 65
| FOSi Rev. (6-24-65)
From
By
Description:
rey
To Be Returned [_] Yes
+ ee en eee oi
(NAME OF CONTRIBUTOR)
fo
(ADDRESS OF CONTRIBUTOR)
(SIT AND STATE)
(NAME OF SPECIAL AGENT)
EJ No .
_L] No
Fie Wn_82-23. 4579->
Date Received ¢- S$ -7Y
Receipt given [_] Yes
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