Ss 93-59 Political Committee'S Report Of Receipts And Disbursements Nitiative Measure Form - Eric Clark Page 3
ADVERTISEMENT
1
2
3Name of Candidate or Committee _____________________________________________________
Reporting period _____________________________ through _______________________________
ITEMIZED DISBURSEMENTS
A. Full name
Date
Amount of each
disbursement this period
(Mo., Day, Year)
Mailing Address
$
___ / ___ / ___
City, State, Zip Code
$
___ / ___ / ___
Purpose of Disbursement (Optional)
$
Aggregate
Year-to-date
B. Full name
Date
Amount of each
disbursement this period
(Mo., Day, Year)
Mailing Address
$
___ / ___ / ___
City, State, Zip Code
$
___ / ___ / ___
Aggregate
Purpose of Disbursement (Optional)
$
Year-to-date
C. Full name
Date
Amount of each
disbursement this period
(Mo., Day, Year)
Mailing Address
$
___ / ___ / ___
City, State, Zip Code
$
___ / ___ / ___
Purpose of Disbursement (Optional)
Aggregate
$
Year-to-date
D. Full name
Date
Amount of each
disbursement this period
(Mo., Day, Year)
Mailing Address
$
___ / ___ / ___
City, State, Zip Code
$
___ / ___ / ___
Purpose of Disbursement (Optional)
Aggregate
$
Year-to-date
E. Full name
Date
Amount of each
disbursement this period
(Mo., Day, Year)
Mailing Address
$
___ / ___ / ___
City, State, Zip Code
$
___ / ___ / ___
Purpose of Disbursement (Optional)
Aggregate
$
Year-to-date
SS 93-59 02/99
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal