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3500 (when amending, only re-submit if applicable). 1. Committee Information a. Full Name c. ID Number b. Mailing Address (include City, State and Zip Code) d. Date Organized e. Phone Number 2. Candidate Information Candidate's Primary Committee a. Full Name e. Candidate ID Number f. Party Affiliation (Indicate Non-partican if applicable) b. Mailing Address (include City, State, and Zip Code) g. Office Sought c . Phone Number h. Next Election Year d. Email Address i. Jurisdiction.

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