Free Report of Independent Expenditures Made and Contributions Received - Federal

FEC Form 5
1.

rEPorT oF INDEPENDENT EXPENDITUrES mADE AND CoNTrIBUTIoNS rECEIVED
To Be Used by Persons (Other than Political Committees) including Qualified Nonprofit Corporations
(a) Name of Individual, Organization or Corporation

(b) Address (number and street)

check if different than previously reported

(c) City, State and ZIP Code

3. FEC Identification Number

2.

Corporate filers only Is the filer a qualified nonprofit corporation? Individual filers only Name of Employer Yes No

C
Occupation

4. TYPE OF REPORT (check appropriate boxes): (a) April 15 Quarterly Report July 15 Quarterly Report 24-Hour Report October 15 Quarterly Report January 31 Year-End Report 48-Hour Report

b) Is this Report an amendment? 5. COVERING PERIOD: FROM

Yes

No

M

M

/

D

D

/

Y

Y

Y

Y

THROUGH
M M / D D / Y Y Y Y

6. TOTAl CONTRIBUTIONS ..............................................................................................

, ,

, ,

. .

7. 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 any political party committee or its agent. In addition, (if the independent expenditures reported herein were made by a corporation) I certify that the corporation is a qualified nonprofit corporation under the Commission's regulations.

TYPE OR PRINT NAME OF PERSON COMPLETING FORM

SIGNATURE

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. For further information, contact: Federal Election Commission, 999 E Street, N.W., Washington, D.C. 20463 Toll Free 800-424-9530, local 202-694-1100

5PG021

FEC Schedule 5 (REV. 09/2005)

SCHEDULE 5-A ITEMIZED RECEIPTS

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 FIlER (In Full)

A. Full Name (last, First, Middle Initial)
Date of Receipt Mailing Address City FEC ID number of contributing federal political committee. Name of Employer State Zip Code Amount of Each Receipt this Period
M M / D D / Y Y Y Y

C
Occupation

,

,

.

B. Full Name (last, First, Middle Initial)
Date of Receipt Mailing Address City FEC ID number of contributing federal political committee. Name of Employer State Zip Code Amount of Each Receipt this Period
M M / D D / Y Y Y Y

C
Occupation

,

,

.

C. Full Name (last, First, Middle Initial)
Date of Receipt Mailing Address City FEC ID number of contributing federal political committee. Name of Employer State Zip Code Amount of Each Receipt this Period
M M / D D / Y Y Y Y

C
Occupation

,

,

.

D. Full Name (last, First, Middle Initial)
Date of Receipt Mailing Address City FEC ID number of contributing federal political committee. Name of Employer State Zip Code Amount of Each Receipt this Period
M M / D D / Y Y Y Y

C
Occupation

,

,

.



SUBTOTAL of Receipts This Page (optional) ........................................................................... TOTAL This Period (last page carry total to line 6) ................................................................

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FEC Schedule 5 (Rev. 02/2003)

SCHEDULE 5-E

ITEMIZED INDEPENDENT EXPENDITURES
NAME OF FIlER (In Full)

PAGE OF FOR lINE 7 OF FORM 5

Full Name (last, First, Middle Initial) of Payee

Date
M M / D D / Y Y Y Y

Mailing Address Amount City State Zip Code

,
Office Sought: House

,
Senate President

.
State: District: Oppose General

Purpose of Expenditure

Category/ Type

Name of Federal Candidate Supported or Opposed by Expenditure: Check One: Calendar Year-To-Date Per Election for Office Sought Full Name (last, First, Middle Initial) of Payee

Support Primary
D /



,

,

.

Disbursement For:

Other (specify) Date
M M / D

Y

Y

Y

Y

Mailing Address Amount City State Zip Code

,
Office Sought: House

,
Senate President

.
State: District: Oppose General

Purpose of Expenditure

Category/ Type

Name of Federal Candidate Supported or Opposed by Expenditure: Check One: Calendar Year-To-Date Per Election for Office Sought Full Name (last, First, Middle Initial) of Payee

Support Primary
D /

,

,

.

Disbursement For:

Other (specify) Date
M M / D

Y

Y

Y

Y

Mailing Address Amount City State Zip Code

,
Office Sought: House Senate

,
President

.
State: District: Oppose General

Purpose of Expenditure

Category/ Type

Name of Federal Candidate Supported or Opposed by Expenditure: Check One: Calendar Year-To-Date Per Election for Office Sought

Support Primary



,

,

.

Disbursement For:

Other (specify)



(a) SUBTOTAL of Itemized Independent Expenditures ............................................................

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. . .

(c) TOTAL Independent Expenditures ....................................................................................... (carry total from last page forward to line 7)
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(b) SUBTOTAL of Unitemized Independent Expenditures........................................................

FEC Schedule 5 (Rev. 02/2003)