FORTUNE — As we reported last week, New Jersey officials are investigating whether or not venture capital firm General Catalyst Partners broke state pay-to-play rules in 2011 by not disclosing a large political donation made by Charlie Baker, a General Catalyst executive-in-residence who currently is running (again) for Massachusetts governor.

In the meantime, Fortune has obtained a copy of the (arguably incomplete) disclosure form that General Catalyst sent to New Jersey’s Department of Treasury. So, largely for the purposes of record-keeping, we are publishing it below.

General Catalyst listed 24 individuals as investment professionals. This included not only managing directors, but also a number of lower-level employees, the firm’s chief financial officer and its head of client development. At the time, General Catalyst’s website listed Baker and three other individuals as “entrepreneurs-in-residence.” None of them are listed on the disclosure form.