Mail-In

Walk-In

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Provide specific purpose for which the Political Committee was organized.

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Name	Address	Relationship	Action
{{value.Organization.OrganizationName}}	{{value.Address.CompleteAddress}}	{{value.Organization.Relationship}}	Update Remove

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Name	Address	Relationship	Action
{{value.Organization.OrganizationName}}	{{value.Address.CompleteAddress}}	{{value.Organization.Relationship}}	Update Remove

I hereby swear or affirm under penalty of law that all information on this form is true, correct, and complete to the best of my knowledge.

Electronic Signature of Treasurer or Appointed Officer

Date

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