Fec Form 3 - Report Of Receipts And Disbursements Page 5

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PAGE
OF
FOR LINE NUMBER:
SCHEDULE A (FEC Form 3)
Use separate schedule(s)
(check only one)
for each category of the
ITEMIZED RECEIPTS
11a
11b
11c
11d
Detailed Summary Page
12
13a
13b
14
15
Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions
or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.
NAME OF COMMITTEE (In Full)
Full Name (Last, First, Middle Initial)
A.
Date of Receipt
Mailing Address
M
M
/
D
D
/
Y
Y
Y
Y
City
State
Zip Code
FEC ID number of contributing
C
Amount of Each Receipt this Period
federal political committee.
,
,
.
Name of Employer
Occupation
Memo Item
Receipt For:
Election Cycle-to-Date
Primary
General
,
,
.
Other (specify)
Full Name (Last, First, Middle Initial)
Date of Receipt
B.
Mailing Address
M
M
/
D
D
/
Y
Y
Y
Y
City
State
Zip Code
FEC ID number of contributing
C
Amount of Each Receipt this Period
federal political committee.
,
,
.
Name of Employer
Occupation
Memo Item
Receipt For:
Election Cycle-to-Date
Primary
General
,
,
.
Other (specify)
Full Name (Last, First, Middle Initial)
Date of Receipt
C.
Mailing Address
M
M
/
D
D
/
Y
Y
Y
Y
City
State
Zip Code
FEC ID number of contributing
C
Amount of Each Receipt this Period
federal political committee.
,
,
.
Name of Employer
Occupation
Memo Item
Receipt For:
Election Cycle-to-Date
Primary
General
,
,
.
Other (specify)
,
,
.
SUBTOTAL of Receipts This Page (optional) ............................................................................
,
,
.
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule A (Form 3) (Revised 05/2016)

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