Free FEC Form 13 FINAL.indd - Federal

FEC FORM 13
1. NAME OF COMMITTEE (in full)

REPORT OF DONATIONS ACCEPTED
For Inaugural Committee
Office Use Only

TYPE OR PRINT

Example: If typing, type over the lines.

12FE4M5

MAILING ADDRESS

Check if different than previously reported. (ACC) 2.



FEC IDENTIFICATION NUMBER

C
3a. Type of Filing (check one) Report (90D) Supplement to Report (90S)
M M / D D / Y Y Y Y

3b. (check one) New Amendment to Report or Supplement filed on:
M M / D D / M M / D D / Y Y Y Y

4.

Covering Period

through

Y

Y

Y

Y

Cumulative Total (From Committees Inception) 5. Total Donations Accepted ............................................................

, , ,

, , ,

. . .

6. Total Donations Refunded ...........................................................

7. Net Donations (subtract Line 6 from Line 5) ................................

I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name and Title of Officer Designated to Sign this Report

Signature of Designated Officer

Date

M

M

/

D

D

/

Y

NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g.

FE5AN013

Office Use Only

FEC FORM 13
10/2004


Y Y Y





CITY

STATE

ZIP CODE

SCHEDULE 13­A ITEMIZED DONATIONS ACCEPTED

PAGE

OF

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)

A.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y

Mailing Address

Amount of This Donation

City

,
Zip Code

, ,

. .

Donors Aggregate Donations To Date

State

,

B.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y

Mailing Address

Amount of This Donation

City

,
Zip Code

, ,

. .

Donors Aggregate Donations To Date

State

,

C.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y

Mailing Address

Amount of This Donation

City

,
Zip Code

, , , ,

. . . .

Donors Aggregate Donations To Date

State

, , ,


SUBTOTAL of Donations This Page (optional) .........................................................................

TOTAL (optional) .........................................................................................................................

FEC Schedule 13­A (Form 13) 10/2004
FE5AN013

SCHEDULE 13­B ITEMIZED REFUNDS OF DONATIONS

PAGE

OF

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)

A.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y

Mailing Address Amount of This Refund

City

State

Zip Code

,

,

.

B.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y

Mailing Address Amount of This Refund

City

State

Zip Code

,

,

.

C.

Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y

Mailing Address Amount of This Refund

City

State

Zip Code

, , ,

, , ,

. . .

SUBTOTAL of Refunds This Page (optional) ............................................................................ TOTAL (optional) .........................................................................................................................

FEC Schedule 13­B (Form 13) 10/2004
FE5AN013