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Any infarmaticn ccpiad ircrn such Hep-arts. and Statements may not true acid 134* used try my perecn fer the pLa'p-c-aa cf sclicit'ng 
or far pup-e535. 131m Lia'a'lg the name and addreaa cf any pumice] committee tc aciicit each committee.

 

MAI-1E CIF {In FLrl]:

Dbama tar Mierica

 

 

A. Full Name [Lac-1.. First. Middle Initial]
Welter Shaun Jr

Date of Fleceipt

 

h'fail'me r335 Firsl 5  Apt and

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Ed-

 

Tmaac?un ID G1 1553-51l?

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(3in State Err: Code
Mammal 22314-1?5
FEE ID number at I:

federal pclili-cai 

Name of Empicyat Dccupaticn

San-Emqu Altcmay

 

Flecedpt Fur: 21112

Primary  Geman
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Bacticn Cycle-te?Date 

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