BRUNSWICK COUNTY REPUBLICAN PARTY
Financial Disclosure Information
Mail to Brunswick County GOP, P.O. Box 107, Bolivia, NC 28422
Date: ____________________
Amount of donation: ____________________
Name:__________________________________________________________________
Mailing Address:_________________________________________________________
____________________________________________________________
Job Title or Profession:___________________________________________________
Name of Employer (or Category of Business if Self-Employed):
________________________________________________________________________
Phone number: ___________________________
E-mail Address (optional):_________________________________________________
Precinct (optional): ___________________________________
NC law requires political committees to report (to the NC Board of Elections) the name, mailing address, job title or profession and name of employer or employer’s specific field for each individual whose contributions aggregate is in excess of $100 in an election cycle. Political committees must also maintain the same records for all other contributions during the cycle. The current election cycle runs from January 1, 2003 to December 31, 2004.