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Below Space For Office Use Only Colorado Secretary of State Form CPF-37, Rev. 5/8/2013 INDEPENDENT EXPENDITURE COMMITTEE REGISTRATION FORM (1-45-107.5, C.R.S.) Please use this form if you are registering an Independent Expenditure Committee for Colorado campaign finance purposes. You must register an Independent Expenditure Committee within two business days of the time that you accept donations or make independent expenditures in an aggregate amount in excess of $1,000. Committee Name: Name should be descriptive Full Name of Registrant: Include any acronyms used, if registrant is a business or other entity Address: Principal place of operations Mailing Address: If different from above Phone Number: Alternate Phone Number: Fax Number: Web Address: Check Only One Filing Office: Secretary of State Municipal Clerk: Purpose (names of candidates/policy positions supported or opposed): Ownership interest, if any, held by foreign persons (calculated at time of registration): Financial Institution Information: Institution Name & Address: This committee must have a unique, dedicated bank account Parent / Subsidiary Names, D/B/A Names, and Other Affiliated Entity Information (if any): List names of any parent/subsidiary corporations and any other organizational forms associated with registrant. Attach additional pages if necessary Other Colorado Committees: Optional: List names of any other committees registered with the Colorado Secretary of State associated with this committee. Attach pages if necessary Colorado Secretary of State Elections Division 1700 Broadway, Ste. 200 Denver, CO 80290 Ph: (303) 894-2200 Fax: (303) 869-4861 Email: [EMAIL REDACTED] Website: www.sos.state.co.us ---PAGE BREAK--- Below Space For Office Use Only 2 Colorado Secretary of State Form CPF-37, Rev. 3/12/2012 Agent / Contact Information: Natural Person(s) Acting as Registered Agent or Designated Filing Agent: Under Colorado law, only the registered agent or Designated Filing Agent may file the committee reports Registered Agent: Name: Phone Number: Registered Agent E-Mail: Alternate E-Mail 1: Alternate E-Mail 2: Designated Filing Agent: (optional) Name: Phone Number: Designated Filing Agent E-Mail: Alternate E-Mail 1: Alternate E-Mail 2: Authorization: Registered Agent’s Signature: Date: Designated Filing Agent’s Signature: Date: Complete this fillable Word Doc form on your computer, then print and sign. Deliver this form to the appropriate officer. If your filing office is the Secretary of State’s Office, you may fax it to (303) 869-4861; scan and email to [EMAIL REDACTED] ; or hand deliver to 1700 Broadway Ste. 200 in Denver.