Schedule A Receipts

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REPORTING PERIOD
NAME OF POLITICAL COMMITTEE:
FOR OFFICE USE ONLY
FROM
THRU
SCHEDULE A
RECEIPTS
CHECK THE PART OF FORM D-2, SECTION A, BEING ITEMIZED:
LOANS RECEIVED
POLITICAL COMMITTEE
INDIVIDUAL CONTRIBUTIONS
INCLUDING
PART #3-
PART #1-
INCLUDING TICKETS AND RAFFLE SALES
ENDORSER
IDENTIFICATION
No.
TRANSFERS IN
PART #4- OTHER RECEIPTS
POLITICAL COMMITTEE CONTRIBUTIONS
PART #2-
INCLUDING TICKET AND RAFFLE SALES
SEE PAMPHLET “A GUIDE TO CAMPAIGN DISCLOSURE” FOR GUIDANCE.
ITEMIZED RECEIPTS
AGGREGATE
DATE
FULL NAME, MAILING ADDRESS, AND ZIP
AMOUNT OF EACH RECEIPT
AMOUNT FOR THIS
RECEIVED
CODE
REPORTING PERIOD
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
$
$
EMPLOYER:
OCCUPATION:
_______________
USE A SEPARATE SCHEDULE A FOR EACH PARTS 1, 2, 3, & 4
TOTAL THIS PERIOD $
PAGE _____
THIS FORM MAY BE REPRODUCED
REVISED 1/1/11

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