Unified Registration Statement Supplement

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STATE OF WEST VIRGINIA
UNIFIED REGISTRATION STATEMENT SUPPLEMENT
This supplement must be completed in its entirety, attached to the Unified Registration
Statement and filed with the Secretary of State.
1. Actual amount of funds received in the West Virginia during the last fiscal reporting year [see
§29-19-5(a)(6)]: $_______________________________________________________________
2. Amount disbursed for program services in West Virginia during the period covered in this
report [see §29-19-5(a)(6)]:$______________________________________________________
3. Amount disbursed for program services outside West Virginia during the same
period:$_______________________________________________________________________
Explain: _______________________________________________________________________

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