Form F-7 - West Virginia Campaign Financial Statement (Long Form) Page 3
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9CONTRIBUTIONS OF
Check if addi onal pages
Page 3
have been a ached.
MORE THAN $250
DATE
INDIVIDUAL CONTRIBUTOR OR COMMITTEE’S INFORMATION
AMOUNT
Full Name:
Address: residen al and mailing (if different)
Contributor’s occupa on :(individual contributor only)
Where contributor works: (individual contributor only)
Affilia on: (poli cal commi ee only)
Full Name:
Address: residen al and mailing (if different)
Contributor’s occupa on :(individual contributor only)
Where contributor works: (individual contributor only)
Affilia on: (poli cal commi ee only)
Full Name:
Address: residen al and mailing (if different)
Contributor’s occupa on :(individual contributor only)
Where contributor works: (individual contributor only)
Affilia on: (poli cal commi ee only)
Full Name:
Address: residen al and mailing (if different)
Contributor’s occupa on :(individual contributor only)
Where contributor works: (individual contributor only)
Affilia on: (poli cal commi ee only)
Full Name:
Address: residen al and mailing (if different)
Contributor’s occupa on :(individual contributor only)
Where contributor works: (individual contributor only)
Affilia on: (poli cal commi ee only)
MAKE COPIES OF THIS
Subtotal of all contribu ons of more than $250
PAGE AS NEEDED
+
Subtotal of all contribu ons of $250 or less (from page 2)
=
TOTAL CONTRIBUTIONS
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Parent category: Financial