Yavapai County Elections

Schedule A - Forms
MONETARY CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - MORE THAN $100 DURING ELECTION CYCLE:* SCHEDULE A(1)(a)

*If in-state individual contributions of $100 or less are listed on Schedule A(1 )(b), do not include them on Schedule A(1 )(a). Form will expand as grid is filled.

1. Individual Contributor Information

	1	2	3	4	5
Individual Contributor Name
Date Contribution Received
Individual Contributor Street Address
Individual Contributor City
Individual Contributor State
Individual Contributor Zip
Individual Contributor Occupation
Individual Contributor Employer
Amount Received from Individual Contributor
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

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Enter total cumulative amount received from In-State Individual Contributors this reporting period (transfer the total received this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(a) *If in-state individual contributions of $100 or less are listed on Schedule A(1)(b), do not include them on Schedule A(1)(a)
Enter total cumulative amount received from In-State Individual Contributors this Election Cycle
MONETARY CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - $100 OR LESS (AGGREGATE):* SCHEDULE A(1)(b)

*If in-state individual contributions of more than $100 are listed on Schedule A(1)(a), do not include them on Schedule A(1)(b).

	Cumulative Amount this Reporting Period	Cumulative Amount this Election Cycle
Cumulative Contributions from In-State Individuals - $100 or Less
Enter total: (transfer the total received this reporting period to “Summary of Receipts (Schedule A),” line 1(b)) *If in-state individual contributions of more than $100 are listed on Schedule A(1)(a), do not include them on Schedule A(1)(b).

MONETARY CONTRIBUTIONS RECEIVED FROM OUT-OF-STATE INDIVIDUALS - SCHEDULE A(1)(c)

Form will expand as grid is filled.

Individual Contributor Information

	1	2	3	4	5
Individual Contributor Name
Date Contribution Received
Individual Contributor Street Address
Individual Contributor City
Individual Contributor State
Individual Contributor Zip
Individual Contributor Occupation
Individual Contributor Employer
Amount Received from Individual Contributor
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received From Out-of-State Individual Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(c)
Enter total cumulative amount received from Out-of-State Individual Contributors this Election Cycle
MONETARY CONTRIBUTIONS FROM CANDIDATE COMMITTEES - SCHEDULE A(1 )(d)

Candidate Committee Contributor Information

	1	2	3	4	5
Candidate Committee Contributor Name
Candidate Committee Contributor Street Address
Candidate Committee Contributor City
Candidate Committee Contributor State
Candidate Committee Zip
Committee ID Number
Date Contribution Received
Amount Received from Candidate Committee
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative received from Candidate Committee Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(d)
Enter total cumulative amount received from Candidate Committee Contributors this Election Cycle
MONETARY CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES - SCHEDULE A(1)(e)

Political Action Committee Contributor Information

	1	2	3	4	5
Political Action Committee Name
Political Action Committee Street Address
Political Action Committee City
Political Action Committee State
Political Action Committee Zip
Political Action Committee ID Number
Date Contribution Received
Amount Received from Political Action Committee
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative received from Political Action Committee Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(e)
Enter total cumulative amount received from Political Action Committee Contributor this Election Cycle
MONETARY CONTRIBUTIONS FROM POLITICAL PARTIES - SCHEDULE A(1)(f)

Political Party Contributor Information

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Political Party Contributor Name
Political Party Contributor Street Address
Political Party Contributor City
Political Party Contributor State
Political Party Contributor Zip
Political Party Committee ID Number
Date Contribution Received
Amount Received from Political Party Contributor
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Political Party Contributor this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(f)
Enter total cumulative amount received from Political Party Contributor this Election Cycle
MONETARY CONTRIBUTIONS FROM PARTNERSHIPS - SCHEDULE A(1)(g)

Partnership Contributor Information

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Partnership Contributor Name
Partnership Contributor Street Address
Partnership Contributor City
Partnership Contributor State
Partnership Contributor Zip
Corporation Commission File Number
Date Contribution Received
Amount Received from Partnership Contributor
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Partnership Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(g)
Enter total cumulative amount received from Political Partnership Contributors this Election Cycle
MONETARY CONTRIBUTIONS FROM CORPORATIONS AND LLCs -SCHEDULE A(1 )(h)

Corporation / LLC Contributor Information

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Corporation / LLC Contributor Name
Corporation / LLC Contributor Street Address
Corporation / LLC Contributor City
Corporation / LLC Contributor State
Corporation / LLC Contributor Zip
Corporation Commission File Number
Date Contribution Received
Amount Received from Corporation / LLC
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Corporation / LLC Contributors received this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(h)
Enter total cumulative amount received from Corporation / LLC Contributors this Election Cycle
MONETARY CONTRIBUTIONS FROM LABOR ORGANIZATIONS -SCHEDULE A(1 )(i)

Labor Organization Contributor Information

	1	2	3	4	5
Labor Organization Contributor Name
Labor Organization Contributor Street Address
Labor Organization Contributor City
Labor Organization Contributor State
Labor Organization Contributor Zip
Corporation Commission File Number
Date Contribution Received
Amount Received from Corporation / LLC
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Labor Organization Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(i)
Enter total cumulative amount received from Labor Organization Contributors this Election Cycle
MONETARY CONTRIBUTIONS FROM CANDIDATE'S PERSONAL MONIES - SCHEDULE A(1)(j)

Candidate Information

	1	2	3	4	5
Candidate Contributor Name
Date Contribution Received
Candidate Street Address
Candidate Contributor City
Candidate Contributor State
Candidate Contributor Zip
Candidate Contributor Occupation
Candidate Contributor Employer
Amount Received from Candidate
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Candidate's Personal Monies this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(j)
Enter total cumulative amount received from Candidate's Personal Monies this Election Cycle
REFUNDS GIVEN BACK TO CONTRIBUTORS - SCHEDULE A(1 )(I)

Contributor Information

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Contributor Name
Date Contribution Refunded
Contributor Street Address
Contributor City
Contributor State
Contributor Zip
ID Number (if applicable)
Date of Original Contribution
Amount Refunded
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of refunds given back to contributors (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 1(l)
Enter total cumulative amount of Refunds Given Back to Contributors this Election Cycle
LOANS RECEIVED - SCHEDULE A(2)(a)

Lender Information

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Lender Name
Date Loan Received
Lender Street Address
Lender City
Lender State
Lender Zip
Guarantor/Endorser Name
Non-Electoral Purpose? (PACs and Political Parties Only) (Yes or No)
Amount Received from Candidate
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount received from Loans this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 2(a)
Enter total cumulative amount received from Loans this Election Cycle
FORGIVENESS ON LOANS RECEIVED - SCHEDULE A(2)(b)

Lender Information

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Lender Name
Date Forgiveness Received
Lender Street Address
Lender City
Lender State
Lender Zip
Original Amount of Loan
Amount Still Outstanding
Amount Forgiven
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Loans Forgiven this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 2(b)
Enter total cumulative amount of Loans Forgiven this Election Cycle
REPAYMENT ON LOANS MADE - SCHEDULE A(2)(c)

Borrower Information

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Borrower Name
Date Repayment Received
Borrower Street Address
Borrower City
Borrower State
Borrower Zip
Original Amount of Borrowed
Amount Still Outstanding
Amount Repaid
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Repayment on Loans Made this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 2(c)
Enter total cumulative amount of Repayment on Loans Made this Election Cycle
INTEREST ACCRUED ON LOANS MADE - SCHEDULE A(2)(d)

Borrower Information

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Borrower Name
Date Interest Accrued
Borrower Street Address
Borrower City
Borrower State
Borrower Zip
Original Amount of Borrowed
Amount Still Outstanding
Amount of Interest Accrued
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Interest Accrued on Loans Made this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line 2(d)
Enter total cumulative amount of Interest Accrued on Loans Made this Election Cycle
REBATES AND REFUNDS RECEIVED - SCHEDULE A(3)(a)

Payor Information

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Payor Name
Date Rebate/Refund Received
Payor Street Address
Payor City
Payor State
Payor Zip
Original purchase Amount
Reason for Refund/Rebate
Amount Rebated or Refund
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Rebates and Refunds received this this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (3)(a)
Enter total cumulative amount of Rebates and Refunds received this Election Cycle
INTEREST ACCRUED ON COMMITTEE MONIES - SCHEDULE A(4)(a)

	Bank Name and Type of Account	Cumulative Amount this Reporting Period	Cumulative Amount this Election Cycle
Account with Interest Earned
Account with Interest Earned
Account with Interest Earned
Account with Interest Earned
Account with Interest Earned
Total Cumulative Amount this Reporting Period (transfer the total received this reporting period to "Summary of Receipts, Schedule A" line (4)(a)

IN-KIND CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - VALUED MORE THAN $100 DURING ELECTION CYCLE* - SCHEDULE A(5)(a)

*In-kind contributions valued less than $100 are listed on Schedule A(5)(b), do not include them on Schedule A(5)(a)

Individual Contributor Information

	1	2	3	4	5
Individual Contributor Name
Date In-Kind Contribution Received
Individual Contributor Street Address
Individual Contributor City
Individual Contributor State
Individual Contributor Zip
Individual Contributor Occupation
Individual Contributor Employer
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from In-State Individuals this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(a) *In-kind contributions valued less than $100 are listed on Schedule A(5)(b), do not include them on Schedule A(5)(a)
Enter total cumulative monetary value received of In-Kind Contributions received this Election Cycle
IN-KIND CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - VALUED LESS THAN $100 (AGGREGATE)* - SCHEDULE A(5)(b)

*In-kind contributions valued more than $100 are listed on Schedule A(5)(a), do not include them on Schedule A(5)(b)

	Cumulative Amount this Reporting Period	Cumulative Amount this Election Cycle
Cumulative In-Kind Contributions from Individuals - of less than $100
Enter totals (transfer the total received this reporting period to "Summary of Receipts, Schedule A" line 5(b) *In-kind contributions valued more than $100 are listed on Schedule A(5)(a), do not include them on Schedule A(5)(b).

IN-KIND CONTRIBUTIONS RECEIVED FROM OUT-OF-STATE INDIVIDUALS - SCHEDULE A(5)(c)

Individual Contributor Information

	1	2	3	4	5
Individual Contributor Name
Date In-Kind Contribution Received
Individual Contributor Street Address
Individual Contributor City
Individual Contributor State
Individual Contributor Zip
Individual Contributor Occupation
Individual Contributor Employer
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Out-of-State Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(c)
Enter total cumulative monetary value received of In-Kind Contributions from Out-of-State Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM CANDIDATE COMMITTEES - SCHEDULE A(5)(d)

Candidate Committee Contributor Information

	1	2	3	4	5
Candidate Committee Contributor Name
Candidate Committee Contributor Street Address
Candidate Committee Contributor City
Candidate Committee Contributor State
Candidate Committee Contributor Zip
Committee ID Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Candidate Committee Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(d)
Enter total cumulative monetary value received of In-Kind Contributions from Candidate Committee Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES - SCHEDULE A(5)(e)

Political Action Committee Contributor Information

	1	2	3	4	5
Political Action Committee Name
Political Action Committee Street Address
Political Action Committee City
Political Action Committee State
Political Action Committee Zip
Committee ID Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Political Action Committee Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(e)
Enter total cumulative monetary value received of In-Kind Contributions from Political Action Committee Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM POLITICAL PARTIES - SCHEDULE A(5)(f)

Political Party Contributor Information

	1	2	3	4	5
Political Party Contributor Name
Political Party Contributor Street Address
Political Party Contributor City
Political Party Contributor State
Political Party Contributor Zip
Committee ID Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Political Party Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(f)
Enter total cumulative monetary value received of In-Kind Contributions from Political Party Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM PARTNERSHIPS - SCHEDULE A(5)(g)

Partnership Contributor Information

	1	2	3	4	5
Partnership Contributor Name
Partnership Contributor Street Address
Partnership Contributor City
Partnership Contributor State
Partnership Contributor Zip
Corporation Commission File Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Partnership Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(g)
Enter total cumulative monetary value received of In-Kind Contributions from Partnership Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM CORPORATIONS AND LLCs - SCHEDULE A(5)(h)

Corporation / LLC Contributor Information

	1	2	3	4	5
Corporation / LLC Contributor Name
Corporation / LLC Contributor Street Address
Corporation / LLC Contributor City
Corporation / LLC Contributor State
Corporation / LLC Contributor Zip
Corporation Commission File Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Corporation / LLC Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(h)
Enter total cumulative monetary value received of In-Kind Contributions from Corporation / LLC Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM LABOR ORGANIZATIONS - SCHEDULE A(5)(i)

Labor Organization Contributor Information

	1	2	3	4	5
Labor Organization Contributor Name
Labor Organization Contributor Street Address
Labor Organization Contributor City
Labor Organization Contributor State
Labor Organization Contributor Zip
Corporation Commission File Number
Date In-Kind Contribution Received
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Labor Organization Contributors this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(i)
Enter total cumulative monetary value received of In-Kind Contributions from Labor Organization Contributors this Election Cycle
IN-KIND CONTRIBUTIONS FROM CANDIDATE'S PERSONAL ASSETS OR PROPERTY - SCHEDULE A(5)(j)

Candidate Information

	1	2	3	4	5
Candidate Name
Date In-Kind Contribution Received
Candidate Street Address
Candidate City
Candidate State
Candidate Zip
Asset or Property Contributed
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Candidate's Personal Assets or Property this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (5)(j)
Enter total cumulative monetary value received of In-Kind Contributions from Candidate's Personal Assets or Property this Election Cycle
IN-KIND DONATIONS RECEIVED (NON-CONTRIBUTIONS) (POLITICAL PARTIES ONLY) - SCHEDULE A(6)(a)

Source Information

	1	2	3	4	5
Source Name
Date In-Kind Contribution Received
Source Street Address
Source City
Source State
Source Zip
Type of Item Donated
Monetary Value Received
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value received of In-Kind Contributions from Non-Contributions this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (6)(a)
Enter total cumulative monetary value received of In-Kind Contributions from Non-Contributions this Election Cycle
EXTENSIONS OF CREDIT RECEIVED - SCHEDULE A(7)(a)

Creditor Information

	1	2	3	4	5
Creditor Name
Creditor Street Address
Creditor City
Creditor State
Creditor Zip
Services or Goods Provided on Credit
Date of Extension of Credit
Amount of Credit Extended
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative Extensions of Credit Received this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (7)(a)
Enter total cumulative Extensions of Credit Received this Election Cycle
PAYMENTS ON EXTENSIONS OF CREDIT RECEIVED - SCHEDULE A(7)(b)

Creditor Information

	1	2	3	4	5
Creditor Name
Creditor Street Address
Creditor City
Creditor State
Creditor Zip
Services or Goods Originally Provided on Credit
Date of Original Extension of Credit
Payment Amount on Credit Extended
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Payments on Extensions of Credit received this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (7)(b)
Enter total cumulative amount of Payments on Extensions of Credit received this Election Cycle
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS RECEIVED - SCHEDULE A(8)(a)

Payor Committee Information

	1	2	3	4	5
Payor Committee Name
Payment Date
Payor Committee Street Address
Payor Committee City
Payor Committee State
Payor Committee Zip
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (if applicable)
Payment Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Joint Fundraising / Shared Expenses Payments received this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (8)(a)
Enter total cumulative amount of Joint Fundraising / Shared Expenses Payments received this Election Cycle
PAYMENTS RECEIVED FOR GOODS/SERVICES - SCHEDULE A(9)(a)

Payor Information

	1	2	3	4	5
Payor Name
Payor Street Address
Payor City
Payor State
Payor Zip
Services or Goods Purchased
Payment Date
Payment Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Payments Received for Goods and Services this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (9)(a)
Enter total cumulative amount of Payments Received for Goods and Services this Election Cycle
OUTSTANDING ACCOUNTS RECEIVABLE / DEBTS OWED TO COMMITTEE - SCHEDULE A(10)(a)

Information

	1	2	3	4	5
Name
Street Address
City
State
Zip
Type of Account Receivable or Debt Owed
Date that Debt Accrued
Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Outstanding Accounts Receivable / Debts Owed to Committee this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (10)(a)
Enter total cumulative amount of Outstanding Accounts Receivable / Debts Owed to Committee this Election Cycle
TRANSFER IN SURPLUS MONIES / TRANSFER OUT DEBT - SCHEDULE A(11)(a) or (11)(b) (use cash and/or equity as applicable)

	Source of Surplus Monies / Recipient of Transferred Debt	Cumulative Amount this Reporting Period (CASH) (11)(a)	Cumulative Amount this Election Cycle (CASH)	Cumulative Amount this Reporting Period (EQUITY) (11)(b)	Cumulative Amount this Election Cycle (EQUITY)
1
2
3
4
5
Total Cumulative Amount this Reporting Period (transfer the total received this reporting period to "Summary of Receipts, Schedule A" line 11(a) or (11)(b) (use cash and/or equity as applicable)

MISCELLANEOUS RECEIPTS - SCHEDULE A(12)(a)

Source Information

	1	2	3	4	5
Source Name
Source Street Address
Source City
Source State
Source Zip
Receipt Type
Receipt Date
Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Miscellaneous Receipts this reporting period (transfer the total received this reporting period to "Summary of Receipts (Schedule A)," line (12)(a)
Enter total cumulative amount of Miscellaneous Receipts this Election Cycle
Summary of Receipts (Schedule A)

1. Monetary Contributions Received

	CASH
1(a) In-State Individuals - More than $100
1(b) In-State Individuals - $100 or Less (Aggregate)
1(c) Out-of-State Individuals
1(d) Candidate Committees
1(e) Political Action Committees
1(f) Political Parties
1(g) Partnerships
1(h) Corporations & Limited Liability Companies (PACs & Political Parties Only)
1(i) Labor Organizations (PACs & Political Parties Only)
1(j) Candidate's Personal Monies (Candidate Committees Only)
1(I) Refunds Given Back to Contributors

1(k) Monetary Contributions Subtotal: Add 1(a) through 1(j) (Automated)
1(m) Net Monetary Contributions - Subtract 1(l) from 1(k) (Automated)

2. Loans

	CASH	EQUITY
2(a) Loans Received (CASH)
2(b) Forgiveness on Loans Received (EQUITY)
2(c) Repayment on Loans Made (CASH)
2(d) Interest Accrued on Loans Made (CASH)

2(e) Loans Subtotal: Add 2(a), 2(c) & 2(d) (CASH) (Automated)
3. Rebates and Refunds Received

CASH

3(a) Rebates and Refunds Received
4. Interest Accrued on Committee Monies

CASH

4(a) Interest Accrued on Committee Monies

5. In-Kind Contributions Received

	EQUITY
5(a) In-State Individuals - More than $100
5(b) In-State Individuals - $100 or Less (Aggregate)
5(c) Out-of-State Individuals
5(d) Candidate Committees
5(e) Political Action Committees
5(f) Political Parties
5(g) Partnerships
5(h) Corporations & Limited Liability Companies (PACs & Political Parties Only)
5(i) Labor Organizations (PACs & Political Parties Only)
5(j) Candidate's Personal Assets or Property (Candidate Committees Only)

5(k) In-Kind Contributions Subtotal Equity: Add 5(a) through 5(j) (Automated)

6. In-Kind Donations Received (Non-Contributions) (Political Parties Only)

	EQUITY
6(a) In-Kind Donations Received (Non-Contributions) (Political Parties Only)

7. Extensions of Credit

	EQUITY
7(a) Extensions of Credit Received
7(b) Payments on Extensions of Credit Received

7(c) Net Extensions of Credit Equity: Subtract 7(b) from 7(a) (Automated)
8. Joint Fundraising / Shared Expense Payments Received

CASH

8(a) Joint Fundraising / Shared Expense Payments Received
9. Payments Received for Goods / Services

CASH

9(a) Payments Received for Goods / Services
10. Outstanding Accounts Receivable / Debts Owed to Committee

EQUITY

10(a) Outstanding Accounts Receivable / Debts Owed to Committee

11. Transfer In Surplus Monies/ Transfer Out Debt (use cash and/or equity as applicable)

	CASH (a)	EQUITY (b)
11(a) Transfer In Surplus Monies/ Transfer Out Debt (use cash and/or equity as applicable)

12. Miscellaneous Receipts (use cash and/or equity as applicable)

	CASH (a)	EQUITY (b)
12(a) Miscellaneous Receipts (use cash and/or equity as applicable)

13(a). Total Receipts: Cash: add 1(m), 2(e), 3(a), 4(a), 8(a), 9(a), 11(a), and 12(a) (Automated)
13(b). Total Receipts: Equity: Add 2(b), 5(k), 6(a), 7(c), 10(a), 11(b), and 12(b) (Automated)

Schedule B - Forms
DISBURSEMENTS FOR OPERATING EXPENSES - SCHEDULE B(1)(a)

Form will expand as grid is filled.

Recipient Information

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Recipient Name
Disbursement Date
Recipient Street Address
Recipient City
Recipient State
Recipient Zip
Type of Operating Expense Paid
Non-Electoral Purpose? (PACs and Political Parties Only) YES or NO
Amount Paid
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Disbursements for Operating Expenses this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (1)(a)
Enter total cumulative amount of Disbursements for Operating Expenses this Election Cycle
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MONETARY CONTRIBUTIONS TO CANDIDATE COMMITTEES - SCHEDULE B(2)(a)

Candidate Committee Recipient Information

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Candidate Committee Name
Candidate Committee Street Address
Candidate Committee City
Candidate Committee State
Candidate Committee Zip
Committee ID Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Candidate Committees this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(a)
Enter total cumulative amount of Monetary Contributions to Candidate Committees this Election Cycle
MONETARY CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES - SCHEDULE B(2)(b)

Political Action Committee Recipient Information

	1	2	3	4	5
Political Action Committee Name
Political Action Committee Street Address
Political Action Committee City
Political Action Committee State
Political Action Committee Zip
Committee ID Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Political Action Committees this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(b)
Enter total cumulative amount of Monetary Contributions to Political Action Committees this Election Cycle
MONETARY CONTRIBUTIONS TO POLITICAL PARTIES - SCHEDULE B(2)(c)

Political Party Recipient Information

	1	2	3	4	5
Committee Name
Committee Street Address
Committee City
Committee State
Committee Zip
Committee ID Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Political Parties this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(c)
Enter total cumulative amount of Monetary Contributions to Political Parties this Election Cycle
MONETARY CONTRIBUTIONS TO PARTNERSHIPS - SCHEDULE B(2)(d)

Partnership Recipient Information

	1	2	3	4	5
Partnership Name
Partnership Street Address
Partnership City
Partnership State
Partnership Zip
Corporation Commission File Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Partnerships this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(d)
Enter total cumulative amount of Monetary Contributions to Partnerships made this Election Cycle
MONETARY CONTRIBUTIONS TO CORPORATIONS AND LLCs - SCHEDULE B(2)(e)

Corporation / LLC Recipient Information

	1	2	3	4	5
Corporation / LLC Recipient Name
Corporation / LLC Recipient Street Address
Corporation / LLC Recipient City
Corporation / LLC Recipient State
Corporation / LLC Recipient Zip
Corporation Commission File Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Corporation / LLCs this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(e)
Enter total cumulative amount of Monetary Contributions to Corporation / LLCs this Election Cycle
MONETARY CONTRIBUTIONS TO LABOR ORGANIZATIONS - SCHEDULE B(2)(f)

Labor Organization Recipient Information

	1	2	3	4	5
Labor Organization Recipient Name
Labor Organization Recipient Street Address
Labor Organization Recipient City
Labor Organization Recipient State
Labor Organization Recipient Zip
Corporation Commission File Number
Date Contribution Made
Amount Contributed
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Monetary Contributions to Labor Organizations this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(f)
Enter total cumulative amount of Monetary Contributions to Labor Organizations made this Election Cycle
CONTRIBUTION REFUNDS RECEIVED - SCHEDULE B(2)(h)

Contributor Information

	1	2	3	4	5
Committee Name
Date Refund Received
Committee Street Address
Committee City
Committee State
Committee Zip
Committee ID Number
Date of Original Contribution
Amount Refunded
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Contribution Refunds Received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (2)(h)
Enter total cumulative amount of Contribution Refunds Received this Election Cycle
LOANS MADE - SCHEDULE B(3)(a)

Borrower Information

	1	2	3	4	5
Borrower Name
Borrower Street Address
Borrower City
Borrower State
Borrower Zip
Guarantor/Endorser Name
Date Loan Made
Amount Loaned
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Loans Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (3)(a)
Enter total cumulative amount of Loans Made this Election Cycle
LOAN GUARANTEES MADE - SCHEDULE B(3)(b)

Guarantor Information

	1	2	3	4	5
Guarantor Name
Guarantor Street Address
Guarantor City
Guarantor State
Guarantor Zip
Borrower Name
Date Loan Guaranteed
Amount Guaranteed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Loan Guarantees Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (3)(b)
Enter total cumulative amount of Loan Guarantees Made this Election Cycle
FORGIVENESS ON LOANS MADE - SCHEDULE B(3)(c)

Borrower Information

	1	2	3	4	5
Borrower Name
Date Forgiveness Made
Borrower Street Address
Borrower City
Borrower State
Borrower Zip
Original Amount Borrowed
Amount Still Outstanding
Amount Forgiven
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Forgiveness on Loans Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (3)(c)
Enter total cumulative amount of Forgiveness on Loans Made this Election Cycle
REPAYMENT ON LOANS RECEIVED - SCHEDULE B(3)(d)

Lender Information

	1	2	3	4	5
Lender Name
Date Repayment Made
Lender Street Address
Lender City
Lender State
Lender Zip
Original Amount Borrowed
Amount Still Outstanding
Amount Repaid
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Repayment on Loans Received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (3)(d)
Enter total cumulative amount of Repayment on Loans Received this Election Cycle
ACCRUED INTEREST ON LOANS RECEIVED - SCHEDULE B(3)(e)

Lender Information

	1	2	3	4	5
Lender Name
Date Interest Accrued
Lender Street Address
Lender City
Lender State
Lender Zip
Original Amount Borrowed
Amount Still Outstanding
Amount of Interest Accrued
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Accrued Interest on Loans Received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (3)(e)
Enter total cumulative amount of Accrued Interest on Loans Received this Election Cycle
REBATES AND REFUNDS MADE (NON-CONTRIBUTIONS) - SCHEDULE B(4)

Recipient Information

	1	2	3	4	5
Name of Original Payor
Date Rebate/Refund Made
Street Address
City
State
Zip
Corporation Commission File Number (if applicable)
Original Payment Amount
Date of Original Payment
Amount Rebated / Refunded
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Rebated and Refunds Made (Non-Contributions) this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (4)(a) or (4)(b) (use cash and/or equity as applicable)
Enter total cumulative amount of Rebated and Refunds Made (Non-Contributions) this Election Cycle
IN-KIND CONTRIBUTIONS TO CANDIDATE COMMITTEES - SCHEDULE B(5)(a)

Candidate Committee Recipient Information

	1	2	3	4	5
Candidate Name
Candidate Street Address
Candidate City
Candidate State
Candidate Zip
Committee ID Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Candidate Committees this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(a)
Enter total cumulative monetary value of In-Kind Contributions to Candidate Committees this Election Cycle
IN-KIND CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES - SCHEDULE B(5)(b)

Political Action Committee Recipient Information

	1	2	3	4	5
Political Action Committee Name
Political Action Committee Street Address
Political Action Committee City
Political Action Committee State
Political Action Committee Zip
Committee ID Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Political Action Committees this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(b)
Enter total cumulative monetary value of In-Kind Contributions to Political Action Committees this Election Cycle
IN-KIND CONTRIBUTIONS TO POLITICAL PARTIES - SCHEDULE B(5)(c)

Political Party Recipient Information

	1	2	3	4	5
Committee Name
Committee Street Address
Committee City
Committee State
Committee Zip
Committee ID Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Political Parties this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(c)
Enter total cumulative monetary value of In-Kind Contributions to Political Parties this Election Cycle
IN-KIND CONTRIBUTIONS TO PARTNERSHIPS - SCHEDULE B(5)(d)

Partnership Recipient Information

	1	2	3	4	5
Partnership Name
Committee Partnership Street Address
Partnership City
Partnership State
Partnership Zip
Corporation Commission File Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Partnerships this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(d)
Enter total cumulative monetary value of In-Kind Contributions to Partnerships this Election Cycle
IN-KIND CONTRIBUTIONS TO CORPORATIONS AND LLCs -SCHEDULE B(5)(e)

Corporation / LLC Recipient Information

	1	2	3	4	5
Corporation / LLC Recipient Name
Corporation / LLC Recipient Street Address
Corporation / LLC City
Corporation / LLC State
Corporation / LLC Zip
Corporation Commission File Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Corporation / LLCs this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(e)
Enter total cumulative monetary value of In-Kind Contributions to Corporation / LLCs this Election Cycle
IN-KIND CONTRIBUTIONS TO LABOR ORGANIZATIONS - SCHEDULE B(5)(f)

Labor Organization Recipient Information

	1	2	3	4	5
Labor Organization Name
Labor Organization Street Address
Labor Organization City
Labor Organization State
Labor Organization Zip
Corporation Commission File Number
Date In-Kind Contribution Made
Monetary Value Contributed
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative monetary value of In-Kind Contributions to Labor Organizations this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (5)(f)
Enter total cumulative monetary value of In-Kind Contributions to Labor Organizations this Election Cycle
INDEPENDENT EXPENDITURES MADE - SCHEDULE B(6)(a)

Expenditure Recipient Information

	1	2	3	4	5
Recipient Name
Mode of Advertising (1V, mail, etc.)
Street Address
City
State
Zip
Candidate(s) Supported (including % supported)
Candidate(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast
Election Month/Year
Office Sought
Expenditure Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Independent Expenditures Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (6)(a)
Enter total cumulative amount of Independent Expenditures Made this Election Cycle
BALLOT MEASURE EXPENDITURES MADE - SCHEDULE B(7)(a)

Expenditure Recipient Information

	1	2	3	4	5
Recipient Name
Mode of Advertising (1V, mail, etc.)
Street Address
City
State
Zip
Ballot Measure(s) Supported (including% supported)
Ballot Measure(s) Opposed (including % opposed)
Date of First Publication, Display, Delivery, or Broadcast
Election Month/Year
Expenditure Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Ballot Measure Expenditures Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (7)(a)
Enter total cumulative amount of Ballot Measure Expenditures Made this Election Cycle
RECALL EXPENDITURES MADE - SCHEDULE B(8)(a)

Expenditure Recipient Information

	1	2	3	4	5
Recipient Name
Mode of Advertising (1V, mail, etc.)
Street Address
City
State
Zip
Supporting or Opposing Issuance of Recall Order?
Candidate Sought to be Recalled
Date of First Publication, Display, Delivery, or Broadcast
Office Held
Expenditure Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total cumulative amount of Recall Expenditures Made this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (8)(a)
Enter total cumulative amount of Recall Expenditures Made this Election Cycle
SUPPORT PROVIDED TO PARTY NOMINEES (POLITICAL PARTIES ONLY) - SCHEDULE B(9)(a)

Benefitted Candidate

	1	2	3	4	5
Candidate Name
Date Benefit Provided
Street Address
City
State
Zip
Type of Benefit Provided
Notes
Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (9)(a)
Enter total cumulative amount of Recall Expenditures Made this Election Cycle
JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS MADE - SCHEDULE B(10)(a)

Recipient Committee Information

	1	2	3	4	5
Committee Name
Payment Date
Street Address
City
State
Zip
Date of Joint Fundraising Event (if applicable)
Type of Shared Expense (ff applicable)
Payment Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (10)(a)
Enter total cumulative amount of Joint Fundraising / Shared Expense Payments Made this Election Cycle
REIMBURSEMENTS MADE - SCHEDULE B(11)(a)

Recipient Information

	1	2	3	4	5
Recipient Name
Recipient Street Address
Recipient City
Recipient State
Recipient Zip
Services or Goods Reimburse
Reimbursement Date
Reimbursement Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (11)(a)
Enter total cumulative amount of Reimbursements Made this Election Cycle
OUTSTANDING ACCOUNTS PAYABLE / DEBTS OWED BY COMMITTEE - SCHEDULE B(12)(a)

Debt Information

	1	2	3	4	5
Name
Street Address
City
State
Zip
Type of Account Payable or Debt Owed
Date that Debt Accrued
Amount
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (12)(a)
Enter total cumulative amount of Outstanding Accounts Payable / Debts Owed this Election Cycle
TRANSFER OUT SURPLUS MONIES / TRANSFER IN DEBT - SCHEDULE B(13)(a) or (13)(b) (use cash and/or equity as applicable)

	Source of Surplus Monies / Recipient of Transferred Debt	Cumulative Amount this Reporting Period (CASH) (11)(a)	Cumulative Amount this Election Cycle (CASH)	Cumulative Amount this Reporting Period (EQUITY) (11)(b)	Cumulative Amount this Election Cycle (EQUITY)
1
2
3
4
5
Total Cumulative Amount this Reporting Period (transfer the total received this reporting period to "Summary of Receipts, Schedule B" line 13(a) or (13)(b) (use cash and/or equity as applicable)

MISCELLANEOUS DISBURSEMENTS - SCHEDULE B(14)(a)

Recipient Information

	1	2	3	4	5
Name
Street Address
City
State
Zip
Disbursement Type
Disbursement Date
Amount
Cash or Credit
Cumulative Amount this Reporting Period
Cumulative Amount this Election Cycle

Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (14)(a)
Enter total cumulative amount of Miscellaneous Disbursements for this Election Cycle
AGGREGATE OF DISBURSEMENTS - $250 OR LESS* - SCHEDULE B(15)(a)

*If disbursement(s) of $250 or less is listed on another disbursement schedule, do not include them on Schedule (15).

	Cumulative Amount this Reporting Period	Cumulative Amount this Election Cycle
Cumulative of Disbursements - $250 or Less
Enter total received this reporting period (transfer the total received this reporting period to "Summary of Disbursements (Schedule B)," line (15)(a) *If disbursement(s) of $250 or less is listed on another disbursement schedule, do not include them on Schedule (15)(a).

Summary of Disbursements (Schedule B)
1. Disbursements for Operating Expenses

CASH

1(a) Disbursements for Operating Expenses

2. Contributions Made

	CASH
2(a) Candidate Committees
2(b) Political Action Committees
2(c) Political Parties
2(d) Partnerships
2(e) Corporations & Limited Liability Companies (PAC & Political Parties Only)
2(f) Labor Organizations (PAC & Political Parties Only)
2(h) Contribution Refunds Provided to the Reporting Committee

2(g) Monetary Contributions Subtotal: Cash: Add 2(a) through 2(f) (Automated)
2(i) Monetary Contributions Total: Cash: Subtract 2(h) from 2(g) (Automated)

3. Loans

	CASH (a)	EQUITY (b)
3(a) Loans Made (CASH)
3(b) Loan Guarantees Made (EQUITY)
3(c) Forgiveness on Loans Made (EQUITY)
3(d) Repayment of Loans Received (CASH)
3(e) Accrued Interest on Loans Received (CASH)

3(f) Total Loans: Cash: add 3(a), 3(d) and 3(e) (Automated)
3(g) Total Loans: Equity: Add 3(b) and 3(c) (Automated)

4. Rebates and Refunds Made (Non-Contributions)

	CASH (a)	EQUITY (b)
4(a) Rebates and Refunds Made (Non-Contributions) (use cash and/or equity as applicable)

5. Value of In-Kind Contributions Provided

	EQUITY
5(a) Candidate Committees
5(b) Political Action Committees
5(c) Political Parties
5(d) Partnerships
5(e) Corporations & Limited Liability Companies (PACs & Political Parties Only)
5(f) Labor Organizations (PACs & Political Parties Only)

5(g) In-Kind Contributions Subtotal Equity: Add 5(a) through 5(f) (Automated)

6.- 11.

	CASH
6(a) Independent Expenditures Made
7(a) Ballot Measure Expenditures Made
8(a) Recall Expenditures Made
9(a) Support Provided to Party Nominees (Political Parties Only)
10(a) Joint Fundraising / Shared Expense Payments Made
11(a) Reimbursements Made

12. Outstanding Accounts Payable / Debts Owed by Committee

EQUITY (b)

12(b) Outstanding Accounts Payable / Debts Owed by Committee

13. Transfer Out Surplus Monies / Transfer In Debt (use cash and/or equity as applicable)

	CASH (a)	EQUITY (b)
13(a) or 13(b) Transfer Out Surplus Monies / Transfer In Debt (use cash and/or equity as applicable)

14. Miscellaneous Disbursements (use cash and/or equity as applicable)

	CASH (a)	EQUITY (b)
14(a) or 14(b) Miscellaneous Disbursements (use cash and/or equity as applicable)

15. Aggregate of Disbursements - $250 or Less (use cash and/or equity as applicable)

	CASH (a)	EQUITY (b)
15(a) or 15(b) Aggregate of Disbursements - $250 or Less (use cash and/or equity as applicable)

16(a) Total Disbursements: Cash: add 1(a), 2(i), 3(g), 6(a), 7(a), 8(a), 9(a), 10(a), 11(a), 13(a) 14(a), and 15(a)
16(b) Total Disbursements: Equity: add 3(fb), 5(g), 12(b), 13(b), 14(b), and 15(b) (Automated)

Financial Summary

ACTIVITY
(a) Committee value at the beginning of this reporting period(i.e., ending balance from the previous reporting period)*
(b) + Total receipts(from “Summary of Receipts,” line 13(a) (cash column) for this reporting period (Automated)*
(b)(1) + Total receipts “Summary of Receipts” for Election Cycle to Date
(c) – Total disbursements(from “Summary of Disbursements,” line 16(a) (cash column) for this reporting period (Automated)*
(c)(1) – Total disbursements “Summary of Disbursements" from Election Cycle
(d) = Balance at close of reporting period (Automated)*
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Reporting Period

Schedule A - Forms

MONETARY CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - MORE THAN $100 DURING ELECTION CYCLE:* SCHEDULE A(1)(a)

MONETARY CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - $100 OR LESS (AGGREGATE):* SCHEDULE A(1)(b)

MONETARY CONTRIBUTIONS RECEIVED FROM OUT-OF-STATE INDIVIDUALS - SCHEDULE A(1)(c)

MONETARY CONTRIBUTIONS FROM CANDIDATE COMMITTEES - SCHEDULE A(1 )(d)

MONETARY CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES - SCHEDULE A(1)(e)

MONETARY CONTRIBUTIONS FROM POLITICAL PARTIES - SCHEDULE A(1)(f)

MONETARY CONTRIBUTIONS FROM PARTNERSHIPS - SCHEDULE A(1)(g)

MONETARY CONTRIBUTIONS FROM CORPORATIONS AND LLCs -SCHEDULE A(1 )(h)

MONETARY CONTRIBUTIONS FROM LABOR ORGANIZATIONS -SCHEDULE A(1 )(i)

MONETARY CONTRIBUTIONS FROM CANDIDATE'S PERSONAL MONIES - SCHEDULE A(1)(j)

REFUNDS GIVEN BACK TO CONTRIBUTORS - SCHEDULE A(1 )(I)

LOANS RECEIVED - SCHEDULE A(2)(a)

FORGIVENESS ON LOANS RECEIVED - SCHEDULE A(2)(b)

REPAYMENT ON LOANS MADE - SCHEDULE A(2)(c)

INTEREST ACCRUED ON LOANS MADE - SCHEDULE A(2)(d)

REBATES AND REFUNDS RECEIVED - SCHEDULE A(3)(a)

INTEREST ACCRUED ON COMMITTEE MONIES - SCHEDULE A(4)(a)

IN-KIND CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - VALUED MORE THAN $100 DURING ELECTION CYCLE* - SCHEDULE A(5)(a)

IN-KIND CONTRIBUTIONS RECEIVED FROM IN-STATE INDIVIDUALS - VALUED LESS THAN $100 (AGGREGATE)* - SCHEDULE A(5)(b)

IN-KIND CONTRIBUTIONS RECEIVED FROM OUT-OF-STATE INDIVIDUALS - SCHEDULE A(5)(c)

IN-KIND CONTRIBUTIONS FROM CANDIDATE COMMITTEES - SCHEDULE A(5)(d)

IN-KIND CONTRIBUTIONS FROM POLITICAL ACTION COMMITTEES - SCHEDULE A(5)(e)

IN-KIND CONTRIBUTIONS FROM POLITICAL PARTIES - SCHEDULE A(5)(f)

IN-KIND CONTRIBUTIONS FROM PARTNERSHIPS - SCHEDULE A(5)(g)

IN-KIND CONTRIBUTIONS FROM CORPORATIONS AND LLCs - SCHEDULE A(5)(h)

IN-KIND CONTRIBUTIONS FROM LABOR ORGANIZATIONS - SCHEDULE A(5)(i)

IN-KIND CONTRIBUTIONS FROM CANDIDATE'S PERSONAL ASSETS OR PROPERTY - SCHEDULE A(5)(j)

IN-KIND DONATIONS RECEIVED (NON-CONTRIBUTIONS) (POLITICAL PARTIES ONLY) - SCHEDULE A(6)(a)

EXTENSIONS OF CREDIT RECEIVED - SCHEDULE A(7)(a)

PAYMENTS ON EXTENSIONS OF CREDIT RECEIVED - SCHEDULE A(7)(b)

JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS RECEIVED - SCHEDULE A(8)(a)

PAYMENTS RECEIVED FOR GOODS/SERVICES - SCHEDULE A(9)(a)

OUTSTANDING ACCOUNTS RECEIVABLE / DEBTS OWED TO COMMITTEE - SCHEDULE A(10)(a)

TRANSFER IN SURPLUS MONIES / TRANSFER OUT DEBT - SCHEDULE A(11)(a) or (11)(b) (use cash and/or equity as applicable)

MISCELLANEOUS RECEIPTS - SCHEDULE A(12)(a)

Summary of Receipts (Schedule A)

Schedule B - Forms

DISBURSEMENTS FOR OPERATING EXPENSES - SCHEDULE B(1)(a)

MONETARY CONTRIBUTIONS TO CANDIDATE COMMITTEES - SCHEDULE B(2)(a)

MONETARY CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES - SCHEDULE B(2)(b)

MONETARY CONTRIBUTIONS TO POLITICAL PARTIES - SCHEDULE B(2)(c)

MONETARY CONTRIBUTIONS TO PARTNERSHIPS - SCHEDULE B(2)(d)

MONETARY CONTRIBUTIONS TO CORPORATIONS AND LLCs - SCHEDULE B(2)(e)

MONETARY CONTRIBUTIONS TO LABOR ORGANIZATIONS - SCHEDULE B(2)(f)

CONTRIBUTION REFUNDS RECEIVED - SCHEDULE B(2)(h)

LOANS MADE - SCHEDULE B(3)(a)

LOAN GUARANTEES MADE - SCHEDULE B(3)(b)

FORGIVENESS ON LOANS MADE - SCHEDULE B(3)(c)

REPAYMENT ON LOANS RECEIVED - SCHEDULE B(3)(d)

ACCRUED INTEREST ON LOANS RECEIVED - SCHEDULE B(3)(e)

REBATES AND REFUNDS MADE (NON-CONTRIBUTIONS) - SCHEDULE B(4)

IN-KIND CONTRIBUTIONS TO CANDIDATE COMMITTEES - SCHEDULE B(5)(a)

IN-KIND CONTRIBUTIONS TO POLITICAL ACTION COMMITTEES - SCHEDULE B(5)(b)

IN-KIND CONTRIBUTIONS TO POLITICAL PARTIES - SCHEDULE B(5)(c)

IN-KIND CONTRIBUTIONS TO PARTNERSHIPS - SCHEDULE B(5)(d)

IN-KIND CONTRIBUTIONS TO CORPORATIONS AND LLCs -SCHEDULE B(5)(e)

IN-KIND CONTRIBUTIONS TO LABOR ORGANIZATIONS - SCHEDULE B(5)(f)

INDEPENDENT EXPENDITURES MADE - SCHEDULE B(6)(a)

BALLOT MEASURE EXPENDITURES MADE - SCHEDULE B(7)(a)

RECALL EXPENDITURES MADE - SCHEDULE B(8)(a)

SUPPORT PROVIDED TO PARTY NOMINEES (POLITICAL PARTIES ONLY) - SCHEDULE B(9)(a)

JOINT FUNDRAISING / SHARED EXPENSE PAYMENTS MADE - SCHEDULE B(10)(a)

REIMBURSEMENTS MADE - SCHEDULE B(11)(a)

OUTSTANDING ACCOUNTS PAYABLE / DEBTS OWED BY COMMITTEE - SCHEDULE B(12)(a)

TRANSFER OUT SURPLUS MONIES / TRANSFER IN DEBT - SCHEDULE B(13)(a) or (13)(b) (use cash and/or equity as applicable)

MISCELLANEOUS DISBURSEMENTS - SCHEDULE B(14)(a)

AGGREGATE OF DISBURSEMENTS - $250 OR LESS* - SCHEDULE B(15)(a)

Summary of Disbursements (Schedule B)

Financial Summary