Free FEC Form 02 - Federal

FEC FORM 2
STATEMENT OF CANDIDACY
1. (a) Name of Candidate (in full) (b) Address (number and street) (c) City, State, and ZIP Code 4. Par ty Affiliation 5. Office Sought Check if address changed 2. Candidate's FEC Identification Number 3. Is This Statement 6. State & District of Candidate New (N) Amended (A)

OR

DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE
7. I hereby designate the following named political committee as my Principal Campaign Committee for the NOTE: This designation should be filed with the appropriate office listed in the instructions. (a) Name of Committee (in full) (year of election) election(s).

(b) Address (number and street)

(c) City, State, and ZIP Code

DESIGNATION OF OTHER AUTHORIZED COMMITTEES
(Including Joint Fundraising Representatives) 8. I hereby authorize the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy. NOTE: This designation should be filed with the principal campaign committee. (a) Name of Committee (in full)

(b) Address (number and street)

(c) City, State, and ZIP Code

I certify that I have examined this Statement and to the best of my knowledge and belief it is true, correct and complete.
Signature of Candidate Date .

NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to penalties of 2 U.S.C. §437g.

FEC FORM 2 (REV. 02/2009)