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  • HIDDEN_WEBSITE_VARIABLES

     

    How to use: Insert <span class="EXACT_VALUE_LABEL_AS_ENTERED_BELOW">&nbsp;</span> where you'd like the value to be populated.

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    repName John Smith  
    helpWithFedAgencyAddress Haverhill District Office
    1234 S. Courthouse
    Haverhill, CA 35602
     
    district 21st District of California  
    academyUSCitizenDate July 1, 2012  
    academyAgeDate July 1, 2012  
    academyApplicationDueDate October 20, 2012  
    repStateABBR AZ  
    repDistrict 1  
    repState Arizona  
    repDistrictText 1st  
    repPhoto  
    SponsoredBills Sponsored Bills  
    CoSponsoredBills Co-Sponsored Bills  
         
         
         
         
         
  • Office Locations

    Office Name Location Image Map URL
    Washington DC 1124 Longworth HOB
    Washington, DC 20515
    Phone: (202) 225-5731
    Fax: (202) 225-3307
      https://goo.gl/maps/kVjDNPYhXAA2
    Twinsburg Office



    Twinsburg Gov. Center
    10075 Ravenna Road
    Twinsburg, OH 44077
    Phone: (202) 333-4455
    Fax: (202) 333-5522

      https://goo.gl/maps/5tvuVcMrCME2
    Mentor Office 8500 Station Street
    Suite 390
    Mentor, OH 44060
      https://goo.gl/maps/u2KFSgrQvR72
           
           

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