Subject: Contribution: Donate to help Democrats (new abroad) / Carl Ellsworth / 25.00 USD
From: Contribution <[email-masked]>
To: <[email-masked]>, <[email-masked]>, <[email-masked]>
Date: Wed, 27 Apr 2016 01:19:52 -0400

CONTRIBUTION DATA
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            Page: Donate to help Democrats (new abroad)
            Type: One-time
    Total Amount: $25.00
      First Name: Carl
       Last Name: Ellsworth
         Address: Onarimachi 17-15 Takanuki Apt. 2F
                  Kamakura, Japan, CA 00248
                  US
           Phone: 0467-50-0472
           Email: [email-masked]
        Employer: US Civil Service
Employer Address: 
                  ,  
                  US
      Occupation: retired
    Payment Type: Visa
       Account #: 3431
   Transaction #: %%TransactionId%%
       User Id #: %%UserId%%
Contribution Key: IHT_fjriqsTUf5Tcet

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: 531082620

GENERAL INFORMATION
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      Submit Date: Wed, 27 Apr 2016 01:19:51 -0400
           Status: Under Review
Client IP Address: 110.4.230.188
   Client Browser: Mozilla/5.0 (Macintosh; Intel Mac OS X 10.10; rv:45.0) Gecko/20100101 Firefox/45.0