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.
Question | Answer |
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Form Name | State Form 4604 |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | weclick 4pdf, E-mail, indiana cfa 4 pdf fill in, indiana state form 4604 |
CANDIDATE’S STATEMENT OF ORGANIZATION AND |
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DESIGNATION OF PRINCIPAL COMMITTEE OR EXPLORATORY COMMITTEE |
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State Form 4604
Indiana Election Commission (IC
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK. SEE INSTRUCTIONS ON REVERSE SIDE.
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1. IS THIS AN AMENDMENT? |
No |
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Yes |
If Yes, please enter the file number in this box → |
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SECTION A . CANDIDATE INFORMATION: Fill in all applicable boxes as fully and accurately as possible. |
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2. Last Name |
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First Name |
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Middle Name |
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Nickname |
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3. Type of Committee (Check one) |
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Candidate’s Principal Committee |
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Exploratory Committee |
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4. Mailing Address |
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5. FAX (Optional) |
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7. City |
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ZIP Code |
8. County |
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9. Telephone (Day) |
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10. Telephone (Evening) |
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11. Party Affiliation |
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12. Office Sought (Include district number, if any. Not required for an exploratory committee.) |
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Democratic Libertarian |
Republican |
Other |
_______________ |
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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 |
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15. FAX (Optional) |
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16. |
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City |
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ZIP Code |
18. County |
19. Telephone |
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20. Committee Organization Date |
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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 |
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23. FAX (Optional) |
24. |
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25. |
City |
State |
ZIP Code |
26. County |
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27. Telephone (Day) |
28. Telephone (Evening) |
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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
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 |
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35. FAX (Optional) |
36. |
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City |
State |
ZIP Code |
38. County |
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39. Telephone (Day) |
40. Telephone (Evening) |
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SECTION D. ACCEPTANCE OF APPOINTMENT (IC
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
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 |
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43. |
Typed or Printed Name of Candidate |
Signature of Candidate |
Date |
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Warning: State law requires that any change in this information be reported within 10 days of the change (IC
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
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
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
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
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)
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
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
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
WARNING: Any information contained in this statement may not be copied for sale or used for any commercial purpose. (IC