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Campaign or Organization Name*
FEC ID*
State Compliance ID (If applicable)
Is your election non-partisan? (Meaning you won't have an R next to your name on the Ballot)*
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State*
Website*
What information do you need to collect on donations for compliance reporting? What disclaimers do you need to add to your pages?*
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Committee Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years old is the Committee?*
Committee Mission Statement/Purpose*
Please tell us about the Committee's budgetary process. Does the Committee have a budget? How is it designed/approved?*
Has your Committee been a respondent in any FEC Matter Under Review (MUR) or the subject of any investigation or recipient of any complaint from a state or local election authority in the last 2 years? If yes, what is/was the current status of the matter, and what is/was the subject matter?*
What percent of your Committee's income during your Committee’s current fiscal year has been used to make expenditures in support of or opposition to federal or state candidates or committees? What percent has been put toward contributions to state candidates or committees, or, if a hybrid Committee, federal contributions?*
Does your budget for this fiscal year include funds for future expenditures or contributions, and if so, what percent of your total fiscal year spending will be put toward expenditures and contributions?*
Has your Committee publicly opposed any Republican candidates? Does your PAC have a policy, written or otherwise, regarding opposition to Republican candidates?*
Treasurer/Compliance Name*
Treasurer/Compliance First Name Treasurer/Compliance Last Name
Treasurer/Compliance Email*
Legal Counsel Name*
Legal Counsel First Name Legal Counsel Last Name
Legal Counsel Email*
Please tell us about the governance of your Committee. Is there a Board of Directors? How many people, who are they, and how are they chosen? Who has decision-making authority?*

Date of IRS Determination Letter*
Date Format: MM slash DD slash YYYY
Copy of Determination Letter*
Copy of Most Recent 990 as Publicly Filed*
Mission Statement/Purpose*
Has the c3 been the subject of any enforcement matter or investigation by the IRS, any state charity regulator, or any state tax agency enforcement matters during the past three years? If so, please explain.*
Legal Counsel Name*
Legal Counsel First Name Legal Counsel Last Name
Legal Counsel Email*

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