Form 8872 - Political Organization Report Of Contributions And Expenditures

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8872
Political Organization
Form
OMB No. 1545-0123
Report of Contributions and Expenditures
(Rev. October 2014)
Open to Public
Information about Form 8872 and its instructions is available at
Department of the Treasury
Inspection
Do not enter social security numbers on this form or any attachments to it as they may be made public.
Internal Revenue Service
A
For the period beginning
, 20
and ending
, 20
B
Check applicable boxes:
Initial report
Change of address
Amended report
Final report
Employer identification number
1
Name of organization
Mailing address (P.O. Box or number, street, and room or suite number)
2
City or town, state or province, country, and ZIP or foreign postal code
3
Email address of organization
4 Date organization was formed
5a
Name of custodian of records
5b Custodian's address
6a
Name of contact person
6b Contact person's address
7
Business address of organization (if different from mailing address shown above). Number, street, and room or suite number
City or town, state or province, country, and ZIP or foreign postal code
8
Type of report (check only one box)
a
First quarterly report (due by April 15)
f
Monthly report for the month of:
(due by the 20th day following the month shown above, except the
December report, which is due by January 31)
b
Second quarterly report (due by July 15)
c
Third quarterly report (due by October 15)
g
Pre-election report (due by the 12th or 15th day before the
election)
d
Year-end report (due by January 31)
(1)
Type of election:
(2)
Date of election:
e
(3)
Mid-year report (Non-election year only–due by July 31)
For the state of:
h
Post-general election report (due by the 30th day after general
election)
(1)
Date of election:
(2)
For the state of:
9
Total amount of reported contributions (total from all attached Schedules A)
.
.
.
.
.
.
.
.
.
.
.
9
10
Total amount of reported expenditures (total from all attached Schedules B)
10
.
.
.
.
.
.
.
.
.
.
.
Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, correct, and complete.
Sign
Here
Signature of authorized official
Date
8872
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 30406G
Form
(Rev. 10-2014)

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