Free FEC Form 09 - Federal

FEC FORM 9
(a) Name

24 HOUR NOTICE OF DISBURSEMENTS/OBLIGATIONS FOR ELECTIONEERING COMMUNICATIONS
1. Person Making the Disbursements/Obligations

(b) Address (number and street) (c) City, State and ZIP Code

check if different than previously reported

2. FEC Identification Number

C
(e) Occupation

(d) Name of Employer or Principal Place of Business

New 3. Is This Statement
or

M

M

/

D

D

/

Y

Y

Y

Y

4. Covering Period Amended
M M / D

through
D / Y Y Y Y

5. (a) Date of Public Distribution(s) 6. The filer is a(n):
(d) (e) (a)

M

M

/

D

D

/

Y

Y

Y

Y

(b) Communication Title
Qualified Nonprofit Corporation (11 CFR 114.10)

Individual (b)

Unincorporated Organization (c)

Corporation, Labor Organization or Qualified Nonprofit Corporation making communications under 11 CFR 114.15 Other, specify:
Yes No

7. If the filer is an individual, unincorporated organization or qualified nonprofit corporation, were the disbursements made exclusively from donations to a segregated bank account? 8. Custodian of Records
(a) Name

(b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

9. Total Donations This Statement 10. Total Disbursements/Obligations This Statement
Under penalty of perjury, I certify that this statement is true, correct and complete.
TYPE OR PRINT NAME OF PERSON COMPLETING FORM SIGNATURE

, ,

, ,

. .

DATE

NOTE: Submission of false, erroneous or incomplete information may subject the person signing this statement to the penalties of 2 U.S.C. §437g.
FEC FORM 9 (REV. 12/2007)

List of Person(s) Sharing/Exercising Control
(use additional pages as necessary)

PAGE

OF

11. Person(s) Sharing/Exercising Control A.
(a) Name (b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

B.

(a) Name (b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

C.

(a) Name (b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

D.

(a) Name (b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

E.

(a) Name (b) Address (number and street) (c) City, State and ZIP Code (d) Name of Employer or Principal Place of Business (e) Occupation

FE3AN038.PDF

FEC FORM 9 (REV. 12/2007)

SCHEDULE 9-A
Donation(s) Received
A.
Full Name of Donor
M M /

PAGE

OF

Date of Receipt
D D / Y Y Y Y

Mailing Address of Donor Amount City State Zip

,

,
Date of Receipt

.

B.

Full Name of Donor
M M /

D

D

/

Y

Y

Y

Y

Mailing Address of Donor Amount City State Zip

,

,
Date of Receipt

.

C.

Full Name of Donor
M M /

D

D

/

Y

Y

Y

Y

Mailing Address of Donor Amount City State Zip

,

,
Date of Receipt

.

D.

Full Name of Donor
M M /

D

D

/

Y

Y

Y

Y

Mailing Address of Donor Amount City State Zip

,

,
Date of Receipt

.

E.

Full Name of Donor
M M /

D

D

/

Y

Y

Y

Y

Mailing Address of Donor Amount City State Zip

, , ,

, , ,

. . .

TOTAL This Period (last page this line number only) .............................................................. (carry total from last page to Line 9)

FE3AN038.PDF





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

FEC FORM 9 (REV. 12/2007)

SCHEDULE 9-B
Disbursement(s) Made or Obligation(s)
A.
Full Name (Last, First, Middle Initial) of Payee Mailing Address of Payee City Name of Employer State Occupation Zip Code

PAGE

OF

Date of Disbursement or Obligation
M M / D D / Y Y Y Y

Amount

,
Communication Date
M M / D D

,
/ Y Y

.
Y Y

Purpose of Disbursement (Including title(s) of communication(s)) Name of Federal Candidate Office Sought: House Senate Name of Federal Candidate Office Sought: President House Senate President Name of Federal Candidate Office Sought: House Senate President Disbursement/Obligation For: Primary General

State: District: State: District: State: District:

Disbursement/Obligation For: Primary Other (specify) General

Disbursement/Obligation For: Primary General

B.

Full Name (Last, First, Middle Initial) of Payee Mailing Address of Payee City Name of Employer State Occupation Zip Code

Date of Disbursement or Obligation
M M / D D / Y Y Y Y

Amount

,
Communication Date
M M / D D



Other (specify)





Other (specify)

,
/ Y Y

.
Y Y

Purpose of Disbursement (Including title(s) of communication(s)) Name of Federal Candidate Office Sought: House Senate President Name of Federal Candidate Office Sought: House Senate President Name of Federal Candidate Office Sought: House Senate President

State: District: State: District: State: District:

Disbursement/Obligation For: Primary Other (specify) General

Disbursement/Obligation For: Primary General

Disbursement/Obligation For: Primary Other (specify) General

SUBTOTAL of Disbursements/Obligations This Page (optional) .............................................. TOTAL This Period (last page this line number only) .............................................................. (carry total from last page to Line 10)

, ,





Other (specify)



, ,

. .

FE3AN038.PDF





FEC FORM 9 (REV. 12/2007)