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Federal Election Commission

Report of Independent Expenditures Made and Contributions Received (Form 5)

For Non-Registered Entity or Person(s) Without FEC-Assigned ID

IMPORTANT! Upon receipt of this form, the FEC will provide the filer an identification number.Once an FEC
ID number has been assigned, an Electronic Filing Password must be obtained and used for
subsequent filings of this form.
  * Indicates required fields
E-mail:  *

(A receipt will be emailed to this address)