Organization Information

Lines 1-7 of Form 8872

1. Name of Organization *

2. Mailing Address *

Street Address

City

State--ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

ZIP Code

3. Employer Identification Number (EIN) *

4. Email Address

5. Date Established

6. Custodian of Records

Custodian Address

Street Address

City

State--ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

ZIP Code

7. Contact Person

Contact Address

Street Address

City

State--ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

ZIP Code

Phone

Report Information

Line 8 of Form 8872

Type of Report *(a) First Quarterly Report (due April 15)(b) Second Quarterly Report (due July 15)(c) Third Quarterly Report (due October 15)(d) Year-End Report (due January 31)(e) Mid-Year Report (non-election year, due July 31)(f) Monthly Report(g) Pre-Election Report(h) Post-General Election Report

Initial or AmendedInitial ReportAmended Report

Period Beginning *

Period Ending *

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