FEC FORM 3X
1. NAME OF COMMITTEE (in full)
REPORT OF RECEIPTS AND DISBURSEMENTS
For Other Than An Authorized Committee
TYPE OR PRINT
Office Use Only
Example: If typing, type over the lines.
12FE4M5
ADDRESS (number and street)
Check if different than previously reported. (ACC)
Y Y Y
C
4. TYPE OF REPORT
(Choose One) (a) Quarterly Reports: April 15 Quarterly Report (Q1) July 15 Quarterly Report (Q2) October 15 Quarterly Report (Q3) January 31 Year-End Report (YE) July 31 Mid-Year Report (Non-election Year Only) (MY) Termination Report (TER) (d) (b) Monthly Report Due On:
3. IS THIS REPORT
Feb 20 (M2) Mar 20 (M3) Apr 20 (M4) (c) 12-Day PRE-Election Report for the:
NEW (N)
OR
May 20 (M5) Jun 20 (M6) Jul 20 (M7) Primary (12P) Convention (12C)
M M / D D / Y
General (12G) Special (12S)
Y Y Y
Election on 30-Day POST-Election Report for the: Election on
General (30G)
M M / D D / Y
Runoff (30R)
Y Y Y
5.
Covering Period
M
M
/
D
D
/
Y
Y
Y
Y
through
M
M
/
D
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 of Treasurer
M M / D D / Y
Signature of Treasurer
Date
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g.
Office Use Only
FE6AN026
2.
FEC IDENTIFICATION NUMBER
CITY
STATE
ZIP CODE AMENDED (A)
Aug 20 (M8) Sep 20 (M9) Oct 20 (M10)
Nov 20 (M11)
(Non-Election Year Only) (Non-Election Year Only)
Dec 20 (M12) Jan 31 (YE) Runoff (12R)
in the State of
Special (30S) in the State of
D
/
Y
Y
Y
Y
FEC FORM 3X
Rev. 12/2004
FEC Form 3X (Rev. 02/2003 ) Write or Type Committee Name
OF RECEIPTS AND DISBURSEMENTS
SUMMARY PAGE
Page 2
Report Covering the Period:
From:
M
M
/
D
D
/
Y
Y
Y
Y
To:
M
M
/
D
D
/
Y
Y
Y
Y
COLUMN A This Period
6. (a) Cash on Hand January 1,
Y Y Y Y
COLUMN B Calendar Year-to-Date
, , , , , , , , , , , , , , , . . . . . . . , , , ,
,
.
(b) Cash on Hand at Beginning of Reporting Period ............
(c) Total Receipts (from Line 19) ............. (d) Subtotal (add Lines 6(b) and 6(c) for Column A and Lines 6(a) and 6(c) for Column B) ...............
, , , ,
. . . .
7. 8.
Total Disbursements (from Line 31) ........... Cash on Hand at Close of Reporting Period (subtract Line 7 from Line 6(d)) ................. Debts and Obligations Owed TO the Committee (Itemize all on Schedule C and/or Schedule D) ................
9.
10. Debts and Obligations Owed BY the Committee (Itemize all on Schedule C and/or Schedule D) ................
This committee has qualified as a multicandidate committee. (see FEC FORM 1M)
For further information contact: Federal Election Commission 999 E Street, NW Washington, DC 20463 Toll Free 800-424-9530 Local 202-694-1100
FE6AN026
DETAILED SUMMARY PAGE
FEC Form 3X (Rev. 06/2004 ) Write or Type Committee Name
of Receipts
Page 3
Report Covering the Period:
From:
M
M
/
D
D
/
Y
Y
Y
Y
To:
M
M
/
D
D
/
Y
Y
Y
Y
I. Receipts
11. Contributions (other than loans) From: (a) Individuals/Persons Other Than Political Committees (i) Itemized (use Schedule A) ............ (ii) Unitemized ..................................... (iii) TOTAL (add Lines 11(a)(i) and (ii) .................
COLUMN A Total This Period
COLUMN B Calendar Year-to-Date
, , , , , , , , , , , , , , , , ,
, , , , , , , , , , , , , , , , ,
. . . . . . . . . . . . . . . . .
, , , , , , , , , , , , , , , , ,
, , , , , , , , , , , , , , , , ,
. . . . . . . . . . . . . . . . .
(b) Political Party Committees .................. (c) Other Political Committees (such as PACs).................................... (d) Total Contributions (add Lines 11(a)(iii), (b), and (c)) (Carry Totals to Line 33, page 5) .............. 12. Transfers From Affiliated/Other Party Committees ........................................ 13. All Loans Received ..................................... 14. Loan Repayments Received ....................... 15. Offsets To Operating Expenditures (Refunds, Rebates, etc.) (Carry Totals to Line 37, page 5)............... 16. Refunds of Contributions Made to Federal Candidates and Other Political Committees .................................... 17. Other Federal Receipts (Dividends, Interest, etc.) ............................ 18. Transfers from Non-Federal and Levin Funds (a) Non-Federal Account (from Schedule H3) ............................. (b) Levin Funds (from Schedule H5) ......... (c) Total Transfers (add 18(a) and 18(b)) ..
19. Total Receipts (add Lines 11(d), 12, 13, 14, 15, 16, 17, and 18(c)) ......... 20. Total Federal Receipts (subtract Line 18(c) from Line 19) .........
FE6AN026
DETAILED SUMMARY PAGE
FEC Form 3X (Rev. 02/2003 ) 21. Operating Expenditures: (a) Allocated Federal/Non-Federal Activity (from Schedule H4) (i) Federal Share ............................. (ii) Non-Federal Share...................... (b) Other Federal Operating Expenditures ....................................... (c) Total Operating Expenditures (add 21(a)(i), (a)(ii), and (b)) ............. Transfers to Affiliated/Other Party Committees ................................................. Contributions to Federal Candidates/Committees and Other Political Committees ................. Independent Expenditures (use Schedule E) ....................................... Coordinated Party Expenditures (2 U.S.C. §441a(d)) (use Schedule F)........................................
of Disbursements
II. Disbursements
COLUMN A Total This Period
Page 4
COLUMN B Calendar Year-to-Date
, , , , , , , , , , , , , , , , , , , ,
, , , , , , , , , , , , , , , , , , , , ,
. . . . . . . . . . . . . . . . . . . . .
, , , , , , , , , , , , , , , , , , , , ,
, , , , , , , , , , , , , , , , , , , , ,
. . . . . . . . . . . . . . . . . . . . .
22. 23. 24. 25.
,
26. Loan Repayments Made ............................ 27. Loans Made................................................ 28. Refunds of Contributions To: (a) Individuals/Persons Other Than Political Committees ................. (b) Political Party Committees ................. (c) Other Political Committees (such as PACs)................................... (d) Total Contribution Refunds (add Lines 28(a), (b), and (c)) ........... 29. Other Disbursements ................................. 30. Federal Election Activity (2 U.S.C. §431(20)) (a) Allocated Federal Election Activity (from Schedule H6) (i) Federal Share ................................ (ii) "Levin" Share................................. (b) Federal Election Activity Paid Entirely With Federal Funds ................. (c) Total Federal Election Activity (add .. Lines 30(a)(i), 30(a)(ii) and 30(b)) ....
31. Total Disbursements (add Lines 21(c), 22, 23, 24, 25, 26, 27, 28(d), 29 and 30(c)) .. 32. Total Federal Disbursements (subtract Line 21(a)(ii) and Line 30(a)(ii) from Line 31) ..............................................
FE6AN026
DETAILED SUMMARY PAGE
III. Net Contributions/Operating Expenditures
33. Total Contributions (other than loans) (from Line 11(d), page 3) .......................... 34. Total Contribution Refunds (from Line 28(d)) ........................................ 35. Net Contributions (other than loans) (subtract Line 34 from Line 33) ................ 36. Total Federal Operating Expenditures (add Line 21(a)(i) and Line 21(b)) ......... 37. Offsets to Operating Expenditures (from Line 15, page 3)............................... 38. Net Operating Expenditures (subtract Line 37 from Line 36) ................ FEC Form 3X (Rev. 02/2003 )
of Disbursements
COLUMN A Total This Period
Page 5
COLUMN B Calendar Year-to-Date
, , , , , ,
, , , , , ,
. . . . . .
, , , , , ,
, , , , , ,
. . . . . .
FE6AN026
SCHEDULE A (FEC Form 3X) ITEMIZED RECEIPTS
Use separate schedule(s) for each category of the Detailed Summary Page
FOR LINE NUMBER: (check only one)
13 11a 14 11b
PAGE
11c 15 12
OF
16
17
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) Mailing Address City FEC ID number of contributing federal political committee. Name of Employer Receipt For: Primary General Other (specify) Full Name (Last, First, Middle Initial) Mailing Address City FEC ID number of contributing federal political committee. Name of Employer Receipt For: Primary General Other (specify) Full Name (Last, First, Middle Initial) Mailing Address City FEC ID number of contributing federal political committee. Name of Employer Receipt For: Primary General Other (specify) State Zip Code State Zip Code State Zip Code
Date of Receipt
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
C
Occupation Aggregate Year-to-Date
,
,
.
,
,
.
Date of Receipt
M M / D D / Y Y Y Y
B.
Amount of Each Receipt this Period
C
Occupation Aggregate Year-to-Date
,
,
.
,
,
.
Date of Receipt
M M / D D / Y Y Y Y
C.
Amount of Each Receipt this Period
C
Occupation Aggregate Year-to-Date
,
,
.
,
,
. , , , , . .
SUBTOTAL of Receipts This Page (optional) ............................................................................ TOTAL This Period (last page this line number only) ...............................................................
FE6AN026
FEC Schedule A (Form 3X) Rev. 02/2003
SCHEDULE B (FEC Form 3X) ITEMIZED DISBURSEMENTS
Use separate schedule(s) for each category of the Detailed Summary Page
FOR LINE NUMBER: (check only one)
21b 27 22 28a
PAGE
23 24 25 29
OF
26
28b
28c
30b
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)
Date of Disbursement
M M / D D / Y Y Y Y
Mailing Address City Purpose of Disbursement Candidate Name Office Sought: House Senate President District: Disbursement For: Primary General Other (specify) Category/ Type State Zip Code
Amount of Each Disbursement this Period
,
,
.
State:
B.
Full Name (Last, First, Middle Initial)
Date of Disbursement
M M / D D / Y Y Y Y
Mailing Address City Purpose of Disbursement Candidate Name Office Sought: House Senate President District: Disbursement For: Primary General Other (specify) Category/ Type State Zip Code
Amount of Each Disbursement this Period
,
,
.
State:
C.
Full Name (Last, First, Middle Initial)
Date of Disbursement
M M / D D / Y Y Y Y
Mailing Address City Purpose of Disbursement Candidate Name Office Sought: House Senate President District: Disbursement For: Primary General Other (specify) State Zip Code
Amount of Each Disbursement this Period Category/ Type
,
,
.
State:
SUBTOTAL of Disbursements This Page (optional) .................................................................. TOTAL This Period (last page this line number only) ...............................................................
, ,
, ,
. .
FE6AN026
FEC Schedule B (Form 3X) Rev. 02/2003
SCHEDULE C (FEC Form 3X) LOANS
NAME OF COMMITTEE (In Full) LOAN SOURCE Full Name (Last, First, Middle Initial)
Use separate schedule(s) for each category of the Detailed Summary Page
PAGE
OF
FOR LINE 13 OF FORM 3X
Mailing Address City
Original Amount of Loan
Election: Primary General Other (specify)
State
ZIP Code
Balance Outstanding at Close of This Period
Cumulative Payment To Date
,
TERMS
M M / D D /
,
Date Incurred
Y Y Y
.
Y M M /
,
D D / Y
,
Y Y Y
.
Interest Rate
,
,
.
Secured: Yes No
Date Due
.
% (apr)
List All Endorsers or Guarantors (if any) to Loan Source
1. Full Name (Last, First, Middle Initial) Mailing Address
Name of Employer Occupation Amount Guaranteed Outstanding: Name of Employer Occupation Amount Guaranteed Outstanding: Name of Employer Occupation Amount Guaranteed Outstanding: Name of Employer Occupation Amount Guaranteed Outstanding:
City
State
ZIP Code
,
,
.
2. Full Name (Last, First, Middle Initial) Mailing Address
City
State
ZIP Code
,
,
.
3. Full Name (Last, First, Middle Initial) Mailing Address
City
State
ZIP Code
,
,
.
4. Full Name (Last, First, Middle Initial) Mailing Address
City
State
ZIP Code
, , ,
, , ,
. . .
SUBTOTALS This Period This Page (optional) ................................................................ TOTALS This Period (last page in this line only) .............................................................
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
FE6AN026
FEC Schedule C (Form 3X) Rev. 02/2003
SCHEDULE C1 (FEC Form 3X) LOANS AND LINES OF CREDIT FROM LENDING INSTITUTIONS
Federal Election Commission, Washington, D.C. 20463
Supplementary for Information found on Page of Schedule C
NAME OF COMMITTEE (In Full)
FEC IDENTIFICATION NUMBER
C
LENDING INSTITUTION (LENDER) Full Name
Amount of Loan
Interest Rate (APR)
,
State Zip Code Date Due
,
.
M M / D D / M M / D D
Y Y Y
.
Y
%
Y
Mailing Address City
Date Incurred or Established
/
Y
Y
Y
A. Has loan been restructured? B. If line of credit, Amount of this Draw:
No
Yes
If yes, date originally incurred
M
M
/
D
D
/
Y
Y
Y
Y
,
,
.
Total Outstanding Balance:
,
,
.
C. Are other parties secondarily liable for the debt incurred? No Yes (Endorsers and guarantors must be reported on Schedule C.) 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:
What is the value of this collateral?
,
,
.
E. Are any future contributions or future receipts of interest income, pledged as collateral for the loan? No Yes If yes, specify:
Does the lender have a perfected security interest in it? No Yes What is the estimated value?
,
,
.
A depository account must be established pursuant to 11 CFR 100.82(e)(2) and 100.142(e)(2). Date account established:
M M / D D / Y Y Y Y
Location of account: Address: 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 Typed Name Signature H. I. Attach a signed copy of the loan agreement. DATE
M M / D D / Y Y Y Y
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
FE6AN026
FEC Schedule C-1 (Form 3X) Rev. 02/2003
SCHEDULE D (FEC Form 3X) DEBTS AND OBLIGATIONS
Excluding Loans
NAME OF COMMITTEE (In Full)
(Use separate schedule(s) for each numbered line)
PAGE FOR LINE NUMBER: (check only one)
OF
9
10
A. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Nature of Debt (Purpose):
Mailing Address City State Zip Code
Outstanding Balance Beginning This Period
Amount Incurred This Period
, ,
, ,
. .
,
Payment This Period
,
.
Outstanding Balance at Close of This Period
,
,
.
B. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Nature of Debt (Purpose):
Mailing Address City State Zip Code
Outstanding Balance Beginning This Period
Amount Incurred This Period
, ,
, ,
. .
,
Payment This Period
,
.
Outstanding Balance at Close of This Period
,
,
.
C. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Nature of Debt (Purpose):
Mailing Address City Outstanding Balance Beginning This Period State Zip Code
Amount Incurred This Period
, ,
, ,
. .
,
Payment This Period
,
.
Outstanding Balance at Close of This Period
,
,
.
1) SUBTOTALS This Period This Page (optional)................................................................... 2) TOTALS This Period (last page this line number only) ...................................................... 3) TOTAL OUTSTANDING LOANS from Schedule C (last page only) ................................. 4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
, , , ,
, , , ,
. . . .
FE6AN026
FEC Schedule D (Form 3X) Rev. 02/2003
SCHEDULE E (FEC Form 3X)
NAME OF COMMITTEE (In Full)
ITEMIZED INDEPENDENT EXPENDITURES
PAGE OF FOR LINE 24 OF FORM 3X FEC IDENTIFICATION NUMBER
Check if
Full Name (Last, First, Middle Initial) of Payee Mailing Address
24-hour notice
48-hour notice Date
M
C
M / D D / Y Y Y Y
Amount City Purpose of Expenditure State Zip Code Office Sought:
,
House Senate
,
President
.
State: District: Oppose General
Category/ Type
Name of Federal Candidate Supported or Opposed by Expenditure:
Check One:
Support Primary
D /
Calendar Year-To-Date Per Election for Office Sought Full Name (Last, First, Middle Initial) of Payee Mailing Address
,
,
.
Disbursement For:
Other (specify) Date
M M / D
Y
Y
Y
Y
Amount City Purpose of Expenditure State Zip Code Office Sought:
,
House Senate
,
President
.
State: District: Oppose General
Category/ Type
Name of Federal Candidate Supported or Opposed by Expenditure:
Check One:
Support Primary
Calendar Year-To-Date Per Election for Office Sought
,
,
.
Disbursement For:
Other (specify)
(a) SUBTOTAL of Itemized Independent Expenditures ............................................................ (b) SUBTOTAL of Unitemized Independent Expenditures ........................................................ (c) TOTAL Independent Expenditures .......................................................................................
, , ,
, , ,
. . .
Under penalty of perjury I certify that the independent expenditures reported herein were not made in cooperation, consultation, or concert with, or at the request or suggestion of, any candidate or authorized committee or agent of either, or (if the reporting entity is not a political party committee) any political party committee or its agent.
M M
Signature
Date
/
D
D
/
Y
Y
Y
Y
FE6AN026
FEC Schedule E (Form 3X) Rev. 02/2003
SCHEDULE F (FEC Form 3X)
ITEMIZED COORDINATED PARTY EXPENDITURES MADE BY POLITICAL PARTY COMMITTEES OR DESIGNATED AGENT(S) ON BEHALF OF CANDIDATES FOR FEDERAL OFFICE (2 U.S.C. §441a(d))
NAME OF COMMITTEE (In Full)
PAGE
OF
(To be used only by Political Committees in the General Election)
FOR LINE 25 OF FORM 3X
Has your committee been designated to make coordinated expenditures by a political party committee? YES NO If YES, name the designating committee:
Full Name of Subordinate Committee
Mailing Address City State Purpose of Expenditure ZIP Code
Full Name (Last, First, Middle Initial) of Each Payee
Mailing Address Date City Name of Federal Candidate Supported State Office Sought: Zip Code House Senate Presidential State: District:
M M / D D / Y Y
Category/ Type
Y Y
Amount
, .
Purpose of Expenditure
,
.
Aggregate General Election Expenditure for this Candidate
,
,
Full Name (Last, First, Middle Initial) of Each Payee
Mailing Address Date City Name of Federal Candidate Supported State Office Sought: Zip Code House Senate Presidential State: District:
M M / D D / Y Y
Category/ Type
Y Y
Amount
, .
Purpose of Expenditure
,
.
Aggregate General Election Expenditure for this Candidate
,
,
Full Name (Last, First, Middle Initial) of Each Payee
Mailing Address Date City Name of Federal Candidate Supported State Office Sought: Zip Code House Senate Presidential Aggregate General Election Expenditure for this Candidate State: District:
M M / D D / Y Y
Category/ Type
Y Y
Amount
, . , ,
,
.
,
,
SUBTOTAL of Expenditures This Page (optional) ..................................................................... TOTAL This Period (last page this line number only) ...............................................................
, ,
. .
FEC Schedule F (Form 3X) Rev. 02/2009
SCHEDULE H1 (FEC Form 3X) METHOD OF ALLOCATION FOR:
ALLOCATED ALLOCATED ALLOCATED
FEDERAL AND NONFEDERAL ADMINISTRATIVE, GENERIC VOTER DRIVE AND EXEMPT ACTIVITY COSTS EXPENSES (State, District and Local Party Committees Only) FEDERAL AND LEVIN FUNDS FEDERAL ELECTION ACTIVITY
PUBLIC COMMUNICATIONS THAT REFER TO ANY POLITICAL PARTY (BUT NOT A CANDIDATE) (Separate Segregated Funds And Nonconnected Committees Only)
NAME OF COMMITTEE (In Full)
USE ONLY ONE SECTION, A or B A. State and Local Party Committees
Fixed Percentage (select one) Presidential-Only Election Year (28% Federal) Presidential and Senate Election Year (36% Federal) Senate-Only Election Year (21% Federal) Non-Presidential and Non-Senate Election Year (15% Federal)
B. Separate Segregated Funds and Nonconnected Committees
Flat Minimum Federal Percentage If the committee will allocate using the flat minimum percentage of 50% federal funds, check
or
If the committee is spending more than 50% federal funds, indicate ratio below Federal....................................................................... Nonfederal ................................................................. This ratio applies to (check all that apply): Administrative Generic Voter Drive Public Communications Referencing Party Only
.
% %
.
FE6AN026
FEC Schedule H1 (Form 3X) Rev.12/2004
SCHEDULE H2 (FEC Form 3X) ALLOCATION RATIOS
NAME OF COMMITTEE (In Full)
PAGE
OF
RATIOS FOR ALLOCABLE FUNDRAISING EVENTS AND DIRECT CANDIDATE SUPPORT ACTIVITIES APPEARING ON THIS REPORT.
Methods of allocation:
I. FUNDRAISING activities are allocated using the "funds received method" where the federal proportion of expenses must equal the federal proportion of monies raised.
II. Shared DIRECT CANDIDATE SUPPORT activities are allocated according to benefit expected to be derived, where the federal proportion of disbursements is based on the benefit derived by federal candidates from the activity. For PACs Only: Direct candidate support includes public communications or voter drives that refer to both federal and nonfederal candidates, regardless of whether there is a reference to a political party. Such expenses are allocated using a time/space method.
ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported ACTIVITY OR EVENT IDENTIFIER ACTIVITY IS: Fundraising Direct Candidate Support CHECK IF THE RATIO IS: New Revised Same as Previously Reported FEDERAL % NONFEDERAL %
.
%
.
%
FEDERAL %
NONFEDERAL %
.
%
.
%
FEDERAL %
NONFEDERAL %
.
%
.
%
FEDERAL %
NONFEDERAL %
.
%
.
%
FEDERAL %
NONFEDERAL %
.
%
.
%
FEDERAL %
NONFEDERAL %
.
%
.
%
FE6AN026
FEC Schedule H2 (Form 3X) Rev. 12/2004
SCHEDULE H3 (FEC Form 3X)
TRANSFERS FROM NONFEDERAL ACCOUNTS FOR ALLOCATED FEDERAL / NONFEDERAL ACTIVITY
NAME OF COMMITTEE (In Full)
PAGE
OF
FOR LINE 18a OF FORM 3X
NAME OF ACCOUNT
DATE OF RECEIPT
M M / D D / Y Y Y Y
TOTAL AMOUNT TRANSFERRED
, , , ,
, , , ,
. . . .
BREAKDOWN OF TRANSFER RECEIVED
i) Total Administrative .............................................................................................................
ii) Generic Voter Drive ............................................................................................................. iii) Exempt Activities ................................................................................................................... iv) Direct Fundraising (List Activity or Event Identifier) a) b)
, ,
, ,
. . , , .
c) Total Amount Transferred For Direct Fundraising ............................................................. v) Direct Candidate Support (List Activity or Event Identifier) a) b)
, ,
, ,
. . , , , , , , , , , , , , , , . . . . . . . , , . .
c) Total Amount Transferred For Direct Candidate Support .................................................. vi) Public Communications Referring Only to Party (Made by PAC) .................................. TOTALS FOR BREAKDOWN OF TRANSFER RECEIVED TOTAL This Period (Administrative) .......................................................... TOTAL This Period (Generic Voter Drive) ....................................................... TOTAL This Period (Exempt Activities) .................................................................. TOTAL This Period (Direct Fundraising) ....................................................................... TOTAL This Period (Direct Candidate Support) .................................................................. TOTAL This Period (Public Communications Referring Only to Party) ...................................... TOTAL This Period (Total Amount Transferred)................................................................................
FE6AN026
, ,
FEC Schedule H3 (Form 3X) Rev. 12/2004
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
NAME OF COMMITTEE (In Full) A. Full Name (Last, First, Middle Initial) Mailing Address City Purpose of Disbursement: Activity or Event Identifier: State Zip Code
PAGE
OF
FOR LINE 21a OF FORM 3X
Allocated Activity or Event: Administrative Voter Drive Fundraising Exempt Direct Candidate Support
Public Comm (ref to party only) by PAC Allocated Activity or Event Year-To-Date
,
M
,
D
.
Y
Category/ Type
M
/
D
/
Y
Y
Y
FEDERAL SHARE
+
Date
NONFEDERAL SHARE
=
TOTAL AMOUNT
,
B. Mailing Address City
,
.
,
,
.
Full Name (Last, First, Middle Initial)
Allocated Activity or Event: Administrative Voter Drive
,
,
.
Exempt
Fundraising
Direct Candidate Support
State
Zip Code
Public Comm (ref to party only) by PAC Allocated Activity or Event Year-To-Date
Purpose of Disbursement: Activity or Event Identifier:
,
Category/ Type
M M / D
,
D / Y
.
Y Y Y
FEDERAL SHARE
+
Date
NONFEDERAL SHARE
=
TOTAL AMOUNT
C.
Full Name (Last, First, Middle Initial) Mailing Address City Purpose of Disbursement: Activity or Event Identifier:
,
,
.
,
,
.
Allocated Activity or Event: Administrative Voter Drive
,
,
.
Exempt
Fundraising
Direct Candidate Support
State
Zip Code
Public Comm (ref to party only) by PAC Allocated Activity or Event Year-To-Date
,
Category/ Type
M M / D
,
D / Y
.
Y Y Y
FEDERAL SHARE
+
Date
NONFEDERAL SHARE
=
TOTAL AMOUNT
, , ,
FE6AN026
, , ,
. . .
+
, , ,
, , ,
. . .
=
, , ,
,
TOTAL AMOUNT
. . .
SUBTOTAL of Allocated Federal and NonFederal Activity This Page FEDERAL SHARE
NONFEDERAL SHARE
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii)) FEDERAL SHARE NONFEDERAL SHARE
, ,
TOTAL AMOUNT
FEC Schedule H4 (Form 3X) Rev. 12/2004
TRANSFERS OF LEVIN FUNDS RECEIVED FOR ALLOCATED FEDERAL ELECTION ACTIVITY
NAME OF COMMITTEE (In Full)
NAME OF ACCOUNT
SCHEDULE H5 (FEC Form 3X)
(To be used by State, District and Local Party Committees Only)
PAGE OF FOR LINE 18b OF FORM 3X
DATE OF RECEIPT
M M / D D / Y Y Y Y
TOTAL AMOUNT TRANSFERRED
, .
GOTV
,
.
BREAKDOWN OF THIS TRANSFER
i) Voter Registration Total Amount Transferred for Voter Registration...... ii) Voter ID Total Amount Transferred for Voter ID ...............................
,
VOTER REGISTRATION
,
,
VOTER ID
,
. .
iii) GOTV Total Amount Transferred for GOTV ................................................. iv) Generic Campaign Activity Total Amount Transferred for Generic Campaign Activity .............................. NAME OF ACCOUNT DATE OF RECEIPT
M M / D D / Y Y Y Y
,
GENERIC CAMPAIGN ACTIVITY
,
,
,
. .
TOTAL AMOUNT TRANSFERRED
, .
GOTV
,
BREAKDOWN OF THIS TRANSFER
i) Voter Registration Total Amount Transferred for Voter Registration...... ii) Voter ID Total Amount Transferred for Voter ID ...............................
,
VOTER REGISTRATION
,
,
VOTER ID
,
. .
iii) GOTV Total Amount Transferred for GOTV ................................................. iv) Generic Campaign Activity Total Amount Transferred for Generic Campaign Activity ..............................
,
GENERIC CAMPAIGN ACTIVITY
,
, .
,
.
TOTALS FOR BREAKDOWN OF TRANSFER RECEIVED (Last Page Only) TOTAL This Period (Voter Registration) .............................. TOTAL This Period (Voter ID) ....................................................... TOTAL This Period (GOTV)............................................................................. TOTAL This Period (Generic Campaign Activity)....................................................... TOTAL This Period (Total Amount of Transfers Received) ....................................................
, ,
, , ,
. , . , , , . .
,
FE6AN026
FEC Schedule H5 (Form 3X) Rev. 02/2003
SCHEDULE H6 (FEC Form 3X) DISBURSEMENTS OF FEDERAL AND LEVIN FUNDS FOR ALLOCATED FEDERAL ELECTION ACTIVITY
NAME OF COMMITTEE (In Full)
PAGE
OF
(To be used by State, District and Local Party Committees Only)
FOR LINE 30a OF FORM 3X
A. Full Name (Last, First, Middle Initial) / Full Organization Name
Type of Allocated Activity or Event: Voter Registration GOTV Voter ID Generic Campaign Allocated Activity or Event Year-To-Date
Mailing Address City Purpose of Disbursement FEDERAL SHARE State Zip Code Category/ Type
,
M
,
D
.
Y
M
/
D
/
Y
Y
Y
Date
,
,
.
+
,
LEVIN SHARE
,
.
=
,
TOTAL AMOUNT
,
.
B. Full Name (Last, First, Middle Initial) / Full Organization Name
Type of Allocated Activity or Event: Voter Registration GOTV Voter ID Generic Campaign Allocated Activity or Event Year-To-Date
Mailing Address City Purpose of Disbursement FEDERAL SHARE State Zip Code Category/ Type
,
M
,
D
.
Y
M
/
D
/
Y
Y
Y
Date
,
,
.
+
,
LEVIN SHARE
,
.
=
,
TOTAL AMOUNT
,
.
C. Full Name (Last, First, Middle Initial) / Full Organization Name
Type of Allocated Activity or Event: Voter Registration GOTV Voter ID Generic Campaign Allocated Activity or Event Year-To-Date
Mailing Address City Purpose of Disbursement FEDERAL SHARE State Zip Code Category/ Type
,
M
,
D
.
Y
M
/
D
/
Y
Y
Y
Date
, , ,
FE6AN026
,
. . .
+
, ,
LEVIN SHARE
,
. .
=
, , ,
TOTAL AMOUNT
,
. . .
SUBTOTAL of Shared Federal and Levin Activity This Page FEDERAL SHARE
TOTAL This Period (last page for each line only)(Federal share to 30(a)(i) and Levin share to 30(a)(ii)) FEDERAL SHARE
, ,
+
LEVIN SHARE
,
=
TOTAL AMOUNT
, ,
TOTAL AMOUNT
TOTAL This Period for the Levin Share
,
LEVIN SHARE
,
.
FEC Schedule H6 (Form 3X) Rev. 02/2003
SCHEDULE L (FEC Form 3X) AGGREGATION PAGE: LEVIN FUNDS
NAME OF COMMITTEE (In Full) NAME OF ACCOUNT COLUMN A TOTAL THIS PERIOD COLUMN B YEAR-TO-DATE
1.
RECEIPTS FROM PERSONS (a) Itemized .....................................
(Use Schedule LA)
, , , , ,
, , , , ,
. . . . .
, , , , ,
, , , , ,
. . . . .
(b) Unitemized .................................. (c) Total ............................................. 2. 3. 4. OTHER RECEIPTS ................................ TOTAL RECEIPTS .................................
(Add Lines 1c and 2)
TRANSFERS TO FEDERAL OR ALLOCATION ACCOUNT
(Use Schedule LB)
(a) Voter Registration ....................... (b) Voter ID ....................................... (c) GOTV .......................................... (d) Generic Campaign ...................... (e) Total ............................................. 5. 6. 7. 8. 9. 10. 11. OTHER DISBURSEMENTS ................... TOTAL DISBURSEMENTS ....................
(Add Lines 4e and 5)
, , , , , , , , , , , ,
, , , , , , , , , , , ,
. . . . . . . . . . . .
, , , , , , , , , , , ,
, , , , , , , , , , , ,
. . . . . . . . . . . .
BEGINNING CASH ON HAND ..............
(for Column B, use cash as of January 1st)
RECEIPTS ..............................................
(from Line 3)
SUBTOTAL ............................................
(Add Lines 7 and 8)
DISBURSEMENTS .................................
(From Line 6)
ENDING CASH ON HAND ..............................
(Subtract Line 10 From Line 9) ....................................
FE6AN026
FEC Schedule L (Form 3X) Rev. 02/2003
SCHEDULE LA (FEC Form 3X) ITEMIZED RECEIPTS OF LEVIN FUNDS
Use separate schedule(s) for each category of the Aggregation Page
PAGE FOR LINE NUMBER: (check only one)
1a
OF
2
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) / Full Organization Name Mailing Address City Name of Employer or Principal Place of Business Occupation Full Name (Last, First, Middle Initial) / Full Organization Name Mailing Address City Name of Employer or Principal Place of Business Occupation Full Name (Last, First, Middle Initial) / Full Organization Name Mailing Address City Name of Employer or Principal Place of Business Occupation Full Name (Last, First, Middle Initial) / Full Organization Name Mailing Address City Name of Employer or Principal Place of Business Occupation State Zip Code State Zip Code State Zip Code State Zip Code
Date of Receipt
M M / D D / Y Y Y Y
Amount of Each Receipt this Period
Aggregate Year-to-Date
,
,
. .
Y Y Y
,
Date of Receipt
M M / D D /
,
Y
B.
Amount of Each Receipt this Period
, ,
/
, ,
Y Y
. .
Y Y
Aggregate Year-to-Date
C.
Date of Receipt
M M D D /
Amount of Each Receipt this Period
,
Date of Receipt
M M / D D /
, ,
Y Y
. .
Y Y
Aggregate Year-to-Date
,
D.
Amount of Each Receipt this Period
, , , ,
, , , ,
. . . .
Aggregate Year-to-Date
SUBTOTAL of Receipts This Page (optional) ............................................................................ TOTAL This Period (last page this line number only) ...............................................................
FE6AN026
FEC Schedule LA (Form 3X) Rev. 02/2003
SCHEDULE LB (FEC Form 3X) ITEMIZED DISBURSEMENTS OF LEVIN FUNDS
NAME OF COMMITTEE (In Full)
Use separate schedule(s) for each category of the Aggregation Page
FOR LINE NUMBER: (check only one)
PAGE 4a 4b 4c 4d
OF 5
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.
A.
Full Name (Last, First, Middle Initial) / Full Organization Name
Date of Disbursement
M M / D D / Y Y Y Y
Mailing Address City Purpose of Disbursement Full Name (Last, First, Middle Initial) / Full Organization Name State Zip Code
Amount of Each Disbursement this Period
,
Date of Disbursement
M M / D D /
,
Y Y Y
.
Y
B.
Mailing Address City Purpose of Disbursement Full Name (Last, First, Middle Initial) / Full Organization Name State Zip Code
Amount of Each Disbursement this Period
,
Date of Disbursement
M M / D D /
,
Y Y Y
.
Y
C.
Mailing Address City Purpose of Disbursement Full Name (Last, First, Middle Initial) / Full Organization Name State Zip Code
Amount of Each Disbursement this Period
,
Date of Disbursement
M M / D D /
,
Y Y Y
.
Y
D.
Mailing Address City Purpose of Disbursement Full Name (Last, First, Middle Initial) / Full Organization Name State Zip Code
Amount of Each Disbursement this Period
,
Date of Disbursement
M M / D D /
,
Y Y Y
.
Y
E.
Mailing Address City Purpose of Disbursement State Zip Code
Amount of Each Disbursement this Period
, , ,
, , ,
. . .
SUBTOTAL of Disbursements This Page (optional) .................................................................. TOTAL This Period (last page this line number only) ...............................................................
FE6AN026
FEC Schedule LB (Form 3X) Rev. 02/2003
Free Revised Form 03X Final.indd - Federal
| File Size: | 806.6 kB |
| Pages: | 21 |
| Date: | February 23, 2009 |
| File Format: | |
| State: | Federal |
| Category: | Government |
| Word Count: | 4,952 Words, 38,618 Characters |
| Page Size: | Letter (8 1/2" x 11") |
| URL |
http://www.fec.gov/pdf/forms/fecfrm3x.pdf |
| Download Revised Form 03X Final.indd ( 806.6 kB) |
Preview Revised Form 03X Final.indd
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