First Name (required)
Last Name (required)

Your Email (required)

Street Address (required)

City (required)
Zip Code (required)

Cell Phone (required)
Home Phone

Proposed Tax Increase Information (Levy, Income Tax, etc.):

1. Sponsoring Political Tax Subdivision. (Example: Local school board, township trustees, library, mental health, etc.) *Required*

2. Purpose of tax increase. (Example: Operating, roads, capital, etc.) *Required*

3. Amount of "Mils" of Levy on the ballot *Required*:

4. Dollar Value *Required*

5. Current Rate of existing tax for the Taxing Political Subdivision in question In Mils *Required*:

6. Last time Citizens passed a Levy for this Taxing Political Subdivision *Date Required*:
7. Voting Population within the Taxing Political Subdivision:

Provide any informational material concerning justification of the proposed tax 'Levy' or 'Issue' from the taxing political subdivision or any committee supporting the 'Levy' / 'Issue'.

Informational Material (required):

Organizational Information

1. Do you have an organization or are you a part of one? *Required* YesNo

2. Describe your organization. *Required*

3. Number of volunteers
4. Do you or your volunteers have any previous campaign experience? *Required* YesNo
If so, please describe.

5. How much money do you have or how much are you willing to committed to the effort of Challenging a 'Levy' or 'Issue'? *Required*
6. What is your current plan to Challenge the Levy or Issue? *Required*