County and Metro Township Candidates & Office Holders Statement of Organization

Candidate Information

First Michael

Middle H.

Last Jensen

Suffix

Work Phone (xxx) xxx-xxxx

Cell Phone (xxx) xxx-xxxx

Home Phone (xxx) xxx-xxxx

Office Council

District #/County District 2

Party Republican

Street Address XXXXXXXXXX

Suite/PO Box XXXXXXXXXX

City XXXXXXXXXX

State XX

Zip 000000

Date Created 4/4/2016

Personal Campaign Committee Secretary

Name of Secretary

First Ryan

Middle

Last Perry

Suffix

Work Phone (xxx) xxx-xxxx

Work Phone (xxx) xxx-xxxx

Work Phone (xxx) xxx-xxxx

Street Address XXXXXXXXXX

Suite/PO Box XXXXXXXXXX

City XXXXXXXXXX

State XX

Zip 000000