Form 31-A - Statement Of Contributions Received

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Statement of Contributions Received
Form 31-A
ORC 3517.10
Full Name of Committee
Full Name of Contributor
Registration Number, if PAC
Street Address
Employer/Occupation/Labor Organization*
Form (Cash, Check, etc.)
City
State
Zip Code
Amount
Date (MM/DD/YYYY)
OH
Full Name of Contributor
Registration Number, if PAC
Street Address
Employer/Occupation/Labor Organization*
Form (Cash, Check, etc.)
City
State
Zip Code
Amount
Date (MM/DD/YYYY)
OH
Full Name of Contributor
Registration Number, if PAC
Street Address
Employer/Occupation/Labor Organization*
Form (Cash, Check, etc.)
City
State
Zip Code
Amount
Date (MM/DD/YYYY)
OH
Full Name of Contributor
Registration Number, if PAC
Street Address
Employer/Occupation/Labor Organization*
Form (Cash, Check, etc.)
City
State
Zip Code
Amount
Date (MM/DD/YYYY)
OH
Full Name of Contributor
Registration Number, if PAC
Street Address
Employer/Occupation/Labor Organization*
Form (Cash, Check, etc.)
City
State
Zip Code
Amount
Date (MM/DD/YYYY)
OH
*Required for contributions from individuals over $100 to statewide and general assembly candidates. If contributor is
self-employed, the occupation and the name of the individual’s business, if any, rather than employer should be listed. If two or
more employees contribute via payroll deduction and exceed the aggregate of $100, the labor organization of which the
employees are members, if any, must also appear. [R.C. 3517.10(B)(4)]
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