Subject: Contribution: Donate to help Democrats (new abroad) / Ann Berens / 10.00 USD
From: Contribution <[email-masked]>
To: <[email-masked]>, <[email-masked]>, <[email-masked]>
Date: Mon, 23 May 2016 20:20:12 -0400

CONTRIBUTION DATA
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            Page: Donate to help Democrats (new abroad)
            Type: One-time
    Total Amount: $10.00
      First Name: Ann
       Last Name: Berens
         Address: 851 Fifth St. 2A
                  Courtenay, British Columbia V9N 1K8
                  CA
           Phone: 12506503742
           Email: [email-masked]
        Employer: N/A
Employer Address: 
                  ,  
                  US
      Occupation: retired
    Payment Type: Visa
       Account #: 2109
   Transaction #: %%TransactionId%%
       User Id #: %%UserId%%
Contribution Key: IIInsISMTAYgmdUMNJ

COMPLIANCE DATA
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Check this box to confirm that the following statements are true and accurate:  I am a United States citizen or a permanent resident alien.  This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. This contribution is not made from the treasury of an entity or person who is a federal contractor. This contribution is not made from the funds of a federally registered foreign agent. I am not a minor under the age of 16. The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.: 1

CUSTOM FIELD DATA
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(Section header: "Additional Information")
Please enter your US Passport # or Green card # below: 482392934

GENERAL INFORMATION
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      Submit Date: Mon, 23 May 2016 20:16:38 -0400
           Status: Under Review
Client IP Address: 206.116.249.161
   Client Browser: Mozilla/5.0 (Macintosh; Intel Mac OS X 10_10_5) AppleWebKit/601.6.17 (KHTML, like Gecko) Version/9.1.1 Safari/601.6.17