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U : LEGAL FOUNDATION OF WASHINGTONPRIVATE
2010 GRANTEE INFORMATION FORM
_________________________________________________________________
Organization Name
_________________________________________________________________
Program Director/Coordinator
Make grant checks payable to:
Name: ___________________________________
Mail checks to:
Name: ___________________________________
Address: ___________________________________
___________________________________
Board Chair as of 1/1/2010:
Name: ___________________________________
Term of Service: ____________________________________
Address: ____________________________________
____________________________________
Phone/e-mail: ____________________________________
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