In accordance to O.C.G.A. § 21-5-34, This form is used to collect contributor information required for campaign finance reporting in the State of Georgia. Please complete all fields.
Legal Compliance Statement
By signing below, I certify that:
Campaign Use Only: Mail Check to:
Date Received: ___________ Committee to Elect San Taylor
Amount Received: $________ P.O. Box 2022, Tifton, GA 31793
Received by: _____________
Check Number: __________