Free FEC FORM 1M.pm65 - Federal

NOTIFICATION OF MULTICANDIDATE STATUS
(See reverse side for instructions)

This form should be filed after the Committee qualifies as a multicandidate committee.
1. (a) NAME OF COMMITTEE IN FULL

(b) Number and Street Address 2. FEC IDENTIFICATION NUMBER (c) City, State and ZIP Code

3. TYPE OF COMMITTEE (check one) STATE PARTY OTHER

I certify that one of the following situations is correct (complete line 4 or 5): 4. STATUS BY AFFILIATION: The committee submitted its Statement of Organization (FEC FORM 1) on __________________ and simultaneously qualified as a multicandidate committee through its affiliation with: Committee Name: ____________________________________ FEC Identification Number: ____________________________________. 5. STATUS BY QUALIFICATION: (a) Candidates: The committee has made contributions to the five (5) federal candidates listed below (ONLY State party committees may leave this blank.):

Name (i) (ii) (iii) (iv) (v)

Office Sought

State/District

Date

(b) Contributors: The committee received a contribution from its 51st contributor on:__________________. (c) Registration: The committee has been registered for at least 6 months. FEC FORM 1 was submitted on: __________________. (d) Qualification: The committee met the above requirements on: __________________.
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 TREASURER TYPE OR PRINT NAME OF TREASURER
DATE

NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Statement to the penalties of 2 U.S.C. §437g. ANY CHANGE IN INFORMATION SHOULD BE REPORTED WITHIN 10 DAYS. For further information contact: Federal Election Commission, Washington, DC 20463 Toll-free 800-424-9530 Local 202-694-1100

FEC FORM 1M
(Revised 1/2001)

FE1AN048.PDF