Form 8872 (Rev. 11-2013)
Schedule A
Itemized Contributions
Schedule A page
of
Name of organization
Employer identification number
Name of contributor's employer
Contributor's name, mailing address and ZIP code
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Name of contributor's employer
Amount of contribution
Contributor's name, mailing address and ZIP code
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Contributor's name, mailing address and ZIP code
Name of contributor's employer
Amount of contribution
Contributor's occupation
$
Date of contribution
Aggregate contributions
$
year-to-date .
.
.
.
.
▶
Subtotal of contributions reported on this page only. Enter here and also include this amount in the total on line 9 of
$
Form 8872
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8872
Form
(Rev. 11-2013)