Committee Registration

Statement of Organization of Political Action Committee

Filing Date

Time(hh:mm)

Committee Name *

Address *

City/Town *

State *

Zip Code *

Phone Number *

Email *

PAC Acronym

Date PAC Established *

PAC Type

Duration of PAC *

Continuing

Short Term

Termination Date

(Short-term committees only)

Purpose of PAC *

Manner in which residual funds will be disposed *

Identify principal officers of the political action committee pursuant to Code of Alabama 1975, §17-5-5(b)(5).

Affiliated Organizations

To add an organization, fill out the fields below.

Organization Name

Address

City/Town

State

Zip Code

Chairperson

To add a chairperson, fill out the fields below. Only one chairperson may be designated.

First Name

Middle Name

Last Name

Suffix

Address

City/Town

State

Zip Code

Phone Number

Treasurer

Designate Chairperson as Treasurer

To add a treasurer, fill out the fields below. Only one treasurer may be designated.

First Name

Middle Name

Last Name

Suffix

Address

City/Town

State

Zip Code

Phone Number

Designated Filing Agent

You may authorize an individual other than the chairperson or treasurer to enter data and file reports on the committee's behalf.

First Name

Middle Name

Last Name

Suffix

Address

City/Town

State

Zip Code

Phone Number

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