Fec Form 3 - Report Of Receipts And Disbursements Page 6
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10PAGE
OF
FOR LINE NUMBER:
SCHEDULE B (FEC Form 3)
Use separate schedule(s)
(check only one)
ITEMIZED DISBURSEMENTS
for each category of the
17
18
19a
19b
Detailed Summary Page
20a
20b
20c
21
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)
Date of Disbursement
A.
M
M
/
D
D
/
Y
Y
Y
Y
Mailing Address
City
State
Zip Code
FEC Identification Number
C
Purpose of Disbursement
Candidate Name
Amount of Each Disbursement this Period
Category/
Type
,
,
.
Disbursement For:
Office Sought:
House
▲
▲
▲
Primary
General
Senate
President
Other (specify)
Memo Item
State:
District:
Full Name (Last, First, Middle Initial)
Date of Disbursement
B.
M
M
/
D
D
/
Y
Y
Y
Y
Mailing Address
City
State
Zip Code
FEC Identification Number
C
Purpose of Disbursement
Candidate Name
Amount of Each Disbursement this Period
Category/
Type
,
,
.
Disbursement For:
Office Sought:
House
▲
▲
▲
Primary
General
Senate
President
Other (specify)
Memo Item
State:
District:
Full Name (Last, First, Middle Initial)
Date of Disbursement
C.
M
M
/
D
D
/
Y
Y
Y
Y
Mailing Address
City
State
Zip Code
FEC Identification Number
C
Purpose of Disbursement
Candidate Name
Amount of Each Disbursement this Period
Category/
Type
,
,
.
Office Sought:
House
Disbursement For:
▲
▲
▲
Primary
General
Senate
Other (specify)
President
Memo Item
State:
District:
SUBTOTAL of Disbursements This Page (optional) .......................................................................
,
,
.
TOTAL This Period (last page this line number only) ....................................................................
,
,
.
FEC Schedule B (Form 3) (Revised 05/2016)
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