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Please be advised that the undersigned hereby recommends the following disbursement(s) from the:

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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.

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Download Disbursement Form

3211 North Front Street, Harrisburg, PA 17110
phone: 1-717-409-8220 fax: 717-236-0965
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