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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-1023941

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1. Kip E Tom

60 EMS T37 Lane
Leesburg, IN 46538

2. Identification Number: H6IN03252

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Indiana - 3

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DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2016 election(s).

    Friends of Kip Tom
    FEC ID #: C00585810

    PO Box 216
    Leesburg, IN 46538

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DESIGNATION OF OTHER AUTHORIZED COMMITTEES

8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.

   

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DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)

9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by

    9A. 0.00 for the primary election, and
    9B. 0.00 for the general election

Signed as: Kip E Tom
Signed by the candidate on: 09/02/2015

Filed: 09/02/2015

(End FEC FORM 2)

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