J. MILLARD TAWES, Governor                       1129

2.—Organization               5.—30 days post election

day                                 (—P.—G.)
3.—Individual 6.—60 days post election (if

(mark one only)                  necessary)                       (—P.—G.)

7.—6 month post election (if

necessary)                       (—P.—G.)
8.—1 year post election (if

necessary)                       (—P.—G.)

C.    Date of this Report: ............................................................................

day             month             year

D.    Candidate, organization, group, individual, or for whom this re-
port is filed:

Name: ....................................................................................................

Address: ................................................................................................

No., Street, City or Post Office, State, Zip Code.

Phone No.: ................................................

Area Code          Number

E.    Party Affiliation:

9. Name of Party: ..........................................................................

(e.g., Democrat, Republican)

10. If non-party, specify: ................................................................

(e.g., Independent, COPE, Bar Assn., LWV, PTA)

F.    If organization or group, activities of organization filing report
are:

11.—National

12.—Statewide

13.—Congressional District

14.—City (specify)........................................................

15.—County (specify) ..................................................

16.—Other (specify) ....................................................

G.    If organization or group, candidates and/or referenda supported:
17.—Party ticket.

18.—Individually. If individually, list: ............................................

19.—President and Vice President ...................................

(names)

20.—U. S. Senators                         ...................................

(names)

21.—U. S. Representatives               ...................................

(name(s))

22.—Governor                                ...................................

(name)