State Form 4604 PDF Details

The State 4604 form, formally titled "Candidate's Statement of Organization and (CFA-1) Designation of Principal Committee or Exploratory Committee," is a crucial document for candidates in Indiana planning to participate in election processes. This form serves a dual purpose: it is utilized not only for designating a candidate's principal committee, where the candidate may act as both chairperson and treasurer, but also for establishing an exploratory committee for individuals considering a run for political office but who have not yet made a definitive decision. It demands detailed candidate and committee information, including names, addresses, affiliations, and roles within the organization, aiming for transparency and compliance with Indiana Election Commission regulations. Amendments to the form must be reported within ten days, highlighting the document's dynamic nature in reflecting the evolving nature of campaign organizations. Furthermore, it outlines the legal implications for misreporting or failing to file accurately, emphasizing the seriousness of campaign finance laws in Indiana. By mandating legible typing or printing in black ink and specifying the conditions under which additional sheets may be attached, it underscores the importance of clarity and completeness in campaign finance documentation. The form exemplifies the structured approach required to ensure candidates and their committees adhere to the Indiana Campaign Finance Law, serving as an essential tool for maintaining integrity within the state's electoral system.

QuestionAnswer
Form NameState Form 4604
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesweclick 4pdf, E-mail, indiana cfa 4 pdf fill in, indiana state form 4604

Form Preview Example

CANDIDATE’S STATEMENT OF ORGANIZATION AND

(CFA-1)

DESIGNATION OF PRINCIPAL COMMITTEE OR EXPLORATORY COMMITTEE

 

State Form 4604 (R13/9-10)

Indiana Election Commission (IC 3-9-1-3; IC 3-9-1-4; IC 3-9-1-5)

PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. SEE INSTRUCTIONS ON REVERSE SIDE.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. IS THIS AN AMENDMENT?

No

 

Yes

If Yes, please enter the file number in this box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION A . CANDIDATE INFORMATION: Fill in all applicable boxes as fully and accurately as possible.

 

2. Last Name

 

 

First Name

 

 

Middle Name

 

 

Nickname

 

 

 

3. Type of Committee (Check one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Candidate’s Principal Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Exploratory Committee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Mailing Address

 

 

 

 

 

 

 

 

 

5. FAX (Optional)

 

6. E-mail Address (Optional)

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

7. City

 

State

ZIP Code

8. County

 

9. Telephone (Day)

 

 

10. Telephone (Evening)

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Party Affiliation

 

 

 

 

 

 

 

 

12. Office Sought (Include district number, if any. Not required for an exploratory committee.)

 

Democratic Libertarian

Republican

Other

_______________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION B. COMMITTEE INFORMATION: Fill in all applicable boxes as fully and accurately as possible.

13. Full Name of Committee (Do not abbreviate)

Check if this is a new name

14.

Mailing Address

Check if this is a new address

 

15. FAX (Optional)

 

16. E-mail Address (Optional)

 

 

 

 

 

 

 

(

)

 

 

 

17.

City

 

State

ZIP Code

18. County

19. Telephone

 

20. Committee Organization Date

 

 

 

 

 

 

 

 

 

 

 

(MM-DD-YY)

 

 

 

 

 

 

 

 

(

)

 

 

21. Chairperson’s Full Name

Designate Candidate as Chairperson

Check if this is a new chairperson

22.

Mailing Address

Check if this is a new address

 

23. FAX (Optional)

24. E-mail Address (Optional)

 

 

 

 

 

(

)

 

25.

City

State

ZIP Code

26. County

 

27. Telephone (Day)

28. Telephone (Evening)

()

()

29.Bank or Other Depositories (List all banks or other depositories in which the committee deposits funds, holds accounts, rents safety deposit boxes or maintains funds.)

30.Exploratory Committee

31.Salaries and Reimbursements (Will the committee pay the candidate a salary or

reimbursement for lost wages? If Yes, attach a copy of the contract.)

No

Yes

SECTION C. APPOINTMENT OF TREASURER (IC 3-9-1-14)

32.I, as Chairperson of the foregoing committee, appoint the following person as Treasurer of the Committee.

Person Appointed Treasurer

Signature of the Committee Chairperson

33. Treasurer’s Full Name

Designate candidate as treasurer

Check if this is a new treasurer

34.

Mailing Address

Check if this is a new address

 

35. FAX (Optional)

36. E-mail Address (Optional)

 

 

 

 

 

(

)

 

37.

City

State

ZIP Code

38. County

 

39. Telephone (Day)

40. Telephone (Evening)

()

()

SECTION D. ACCEPTANCE OF APPOINTMENT (IC 3-9-1-15)

41.I give notice that I accept the duties and responsibilities of Treasurer of this Signature of Person Accepting Appointment Committee. I am not the chairperson of a campaign finance committee (except as

permitted for a candidate committee under IC 3-9-1-7).

SECTION E. CERTIFICATION OF STATEMENT

We certify as the candidate and the duly appointed Chairperson of the Committee and that we have examined this statement. To the best of our knowledge and belief it is true, correct and complete.

42.

Typed or Printed Name of Chairperson

Signature of Chairperson

Date

 

 

 

 

43.

Typed or Printed Name of Candidate

Signature of Candidate

Date

 

 

 

 

Warning: State law requires that any change in this information be reported within 10 days of the change (IC 3-9-1-10). A person who knowingly files a fraudulent report commits a Class D felony (IC 3-14-1-13). A person who fails to file a complete or accurate report as required by the Indiana Campaign Finance Law commits a Class B misdemeanor (IC 3-14-1-14), and may be subject to civil penalties (IC 3-9-4-16, IC 3-9-4-17, and IC 3-9-4-18).

FOR OFFICE USE ONLY

INSTRUCTIONS FOR

COMPLETING THIS FORM

This is a dual purpose form. The most common use of this form is to designate a candidate’s principal committee in which the candidate is both the chairperson and treasurer. The form enables the candidate to organize and at the same time designate the candidate’s principal committee as required by IC 3-9-1-3, IC 3-9-1-4 & IC 3-9-1-5.

The form also allows a person exploring opportunities for seeking a political office but who has not definitely decided to be a candidate for a particular office to organize an exploratory committee. If the candidate is not yet a candidate for a specific office, check “exploratory committee” under Section A 3. When the candidate does become a candidate for a specific office, an amended CFA-1 must be filed.

The preparer should type or print legibly in black ink all information on this form. If more space is needed please attach additional sheets. All versions of State Form 4604 prior to revision (R10/10-01) are obsolete and cannot be used (IC 3-5-4-8). State law requires that any changes on this form must be reported WITHIN 10 DAYS OF THE CHANGE.

ITEM 1. IS THIS AN AMENDMENT? Check the appropriate box. If “YES” is checked, enter the file number in the file number box and go on to Section A. If “NO” is checked, proceed directly to Section A.

SECTION A. CANDIDATE INFORMATION: Enter the name of the candidate, as set forth in the candidate’s voter registration record and any nickname the candidate uses.

TYPE OF COMMITTEE. See second paragraph above. Be sure to enter the full and current address and the ZIP Code+4, if known. Under party affiliation, enter the party the candidate supports. If no party is supported, enter “Independent.” A “Write-In” candidate should follow the same procedure; do not write “Write-In.”

OFFICE BEING SOUGHT. Enter the full name of that office. For example, “Indiana State Senator, District ____.” This box

is not required to be completed by an exploratory committee.

SECTION B. COMMITTEE INFORMATION: Do not use any abbreviations in the committee name. Check the new name box if this is a new name. Be sure to enter the full and current mailing address. All correspondence with the committee relative to filings under the Campaign Finance Act will be mailed to this address, unless specified otherwise.

Check the new address if appropriate. Enter the ZIP Code+4, if known, in all boxes calling for the ZIP Code. The date the committee was organized may be the date the candidate publicly announced, filed a declaration of candidacy, solicited or accepted contributions, or made an expenditure.

ITEM 16. COMMITTEES FILING WITH THE INDIANA ELECTION DIVISION ONLY: Committees that file campaign finance reports with the Indiana Election Division and wish to file these reports electronically may contact the Election Division at (800) 622-4941 or at the e-mail address campaignfinance@iec.in.gov for further information.

ITEM 21. Chairperson. This may be the candidate. However, the chairperson may not be the treasurer of any other campaign finance committee except in the case of the candidate’s committee. Check if this is a new chairperson or new information.

ITEM 29. Bank or Other Depositories. If a candidate’s committee accepts contributions or makes expenditures on an aggregate amount of more than two hundred dollars ($200) in a year, all funds of a committee must be segregated from, and may not be commingled with, the personal funds of officers, members or associates of the committee. (IC 3-9-2-9)

ITEM 30. Exploratory Committee. Enter a brief statement explaining the purpose of this committee. Example: “To receive and expend funds to explore the opportunities for elected office.”

ITEM 31. Salaries and Reimbursements. Pursuant to Indiana Election Commission Advisory Opinion 2001-01, attach a copy of any contract between the committee and the candidate permitting salary and reimbursement payments.

SECTION C. APPOINTMENT OF TREASURER:

ITEM 32. Treasurer. The treasurer must be a U.S. citizen and may not be the chairperson of any other campaign finance committee except in the case of a candidate’s committee. The treasurer’s duties and responsibilities are discussed in detail in the Instruction Manual for the Indiana Campaign Finance Act (current edition). Check if this is a new treasurer or new information. This section must be completed in its entirety by the committee chairperson.

SECTION D. ACCEPTANCE OF APPOINTMENT: The treasurer must provide the treasurer’s written signature verifying acceptance of the duties and responsibilities as committee treasurer.

SECTION E. CERTIFICATION OF STATEMENT: The chairperson and candidate must enter their typed or printed names, written signatures and date signed in this section. Note: If the candidate and the chairperson are the same only one signature is necessary.

SPECIAL INSTRUCTIONS FOR

STATEWIDE CANDIDATES

This form must be filed electronically with the Election Division. Contact 1-800-622-4941 for more information.

WARNING: Any information contained in this statement may not be copied for sale or used for any commercial purpose. (IC 3-9-4-5) Using campaign funds for primarily personal purposes is prohibited. (IC 3-9-3-4 and IC 3-9-1-12)