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FEC FORM 99

MISCELLANEOUS DOCUMENT

FILING FEC-112688

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1. BROOKE HOLDINGS INC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SEPARATE SEGREGATED FUND

    1 Corporate Way
    LANSING, MI 48951

2. Treasurer Info

    Treasurer Name: Cynthia Dolan

4. FEC Committee ID #: C00254953

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VIEW MISCELLANEOUS DOCUMENT

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Date Signed: 03/22/2004

(End FEC FORM 99)

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