Fec Form 3 - Report Of Receipts And Disbursements Page 8
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10SCHEDULE C-1 (FEC Form 3)
Supplementary for
Information found on
LOANS AND LINES OF CREDIT FROM LENDING INSTITUTIONS
Page
of Schedule C
Federal Election Commission, Washington, D.C. 20463
NAME OF COMMITTEE (In Full)
FEC IDENTIFICATION NUMBER
C
Amount of Loan
LENDING INSTITUTION (LENDER)
Interest Rate (APR)
Full Name
.
,
,
.
%
Mailing Address
M
M
/
D
D
/
Y
Y
Y
Y
Date Incurred or Established
City
State Zip Code
M
M
/
D
D
/
Y
Y
Y
Y
Date Due
M
M
/
D
D
/
Y
Y
Y
Y
A. Has loan been restructured?
No
Yes
If yes, date originally incurred
B. If line of credit,
Total
Outstanding
,
,
.
,
,
.
Amount of this Draw:
Balance:
C. Are other parties secondarily liable for the debt incurred?
No
Yes
(Endorsers and guarantors must be reported on Schedule C.)
What is the value of this collateral?
D. Are any of the following pledged as collateral for the loan: real estate, personal
property, goods, negotiable instruments, certificates of deposit, chattel papers,
,
,
.
stocks, accounts receivable, cash on deposit, or other similar traditional collateral?
No
Yes
If yes, specify:
Does the lender have a perfected security
interest in it?
No
Yes
E. Are any future contributions or future receipts of interest income, pledged as
What is the estimated value?
collateral for the loan?
No
Yes
If yes, specify:
,
,
.
Location of account:
A depository account must be established pursuant
to 11 CFR 100.82(e)(2) and 100.142(e)(2).
Address:
Date account established:
M
M
/
D
D
/
Y
Y
Y
Y
City, State, Zip:
F. If neither of the types of collateral described above was pledged for this loan, or if the amount pledged does not equal or
exceed the loan amount, state the basis upon which this loan was made and the basis on which it assures repayment.
G. COMMITTEE TREASURER
DATE
Typed Name
M
M
/
D
D
/
Y
Y
Y
Y
Signature
H.
Attach a signed copy of the loan agreement.
I.
TO BE SIGNED BY THE LENDING INSTITUTION:
I.
To the best of this institution’s knowledge, the terms of the loan and other information regarding the extension of the loan
are accurate as stated above.
II.
The loan was made on terms and conditions (including interest rate) no more favorable at the time than those imposed for
similar extensions of credit to other borrowers of comparable credit worthiness.
III.
This institution is aware of the requirement that a loan must be made on a basis which assures repayment, and has
complied with the requirements set forth at 11 CFR 100.82 and 100.142 in making this loan.
AUTHORIZED REPRESENTATIVE
DATE
Typed Name
M
M
/
D
D
/
Y
Y
Y
Y
Signature
Title
FEC Schedule C-1 (Form 3) (Revised 05/2016)
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