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FEC FORM 99

MISCELLANEOUS DOCUMENT

FILING FEC-170251

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1. American Medical Security Group Inc. PAC

    3100 AMS Boulevard
    P.O. Box 19032
    Green Bay, WI 543079032

2. Treasurer Info

    Treasurer Name: James Prochnow

4. FEC Committee ID #: C00283457

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VIEW MISCELLANEOUS DOCUMENT

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Date Signed: 04/12/2005

(End FEC FORM 99)

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