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

Please be advised that knowingly and willfully making any materially false, fictitious, or fraudulent statement or representation to a federal government agency, including the Federal Election Commission, is punishable under the provisions of 18 U.S.C. § 1001. The Commission may report apparent violations to the appropriate law enforcement authorities. 52 U.S.C. § 30107(a)(9).

 

I have read, and understand fully, the above declaration.