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I certify that no individual will receive goods, services or other items of value as a result of the Foundation making the recommended disbursement(s). I further certify that the recommended disbursement(s), if made, will not satisfy any legal obligations that I have incurred.
3211 North Front Street, Harrisburg, PA 17110
phone: 1-717-409-8220 fax: 717-236-0965