Laserfiche WebLink
Schedule A Tv. or print in ink. SCHEDULE A <br />Monetary Contributions Received Amounts may be roundedto whole dollars. Statement covers period ~~[ii' <br />SEE INSTRUCTIONS ON REVERSE through <br /> NA~E OF OFFICEHOLDE~~ ~ O~,,~ ~ ~ ~NDIDATE AND CONTROLLED CO~I~EE I I.D. NU~BER~/ ~/~ Il <br /> FULL NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND E~PLOYER A~OUNT CU~U~TIVE TO DATE ~U~U~TIVE TO DATE <br /> ~ DATE (~ C~MI~EE. I~ AD~ TO C~M~EE'S ~M[ AND A~$$. ENIE~ I.D. NUMB[~ (IF SELF-[M~OYED. EmE~ RECEIVED THIS ~LENDAR YEAR OTHE~ <br /> RECEIVED ~ · ~ LD. ~M~Ea ~S ~[N AS~eO. Eme, ~Asu~'s ~ME AND ADD~[$$) NAME ~ ~SS) PERIOD (JAN. 1 - DEC. ] 1 ) (IF APPLI~BLE) <br /> <br /> SUBTOTAL $ { 5 O <br />~oneta~ Contributions Summa~ <br />1. Amount received this ~riod -- contributions of $100 or more. <br />(Include all Sch~ule A subtotals.) .................................................................................................... <br />2. Amount receiv~ this ~riod -- contributions of less than $100. <br />(Do not itemize.) ...................................................................................................................... $ / <br />3. Total moneta~ contributions received this period. <br />(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .......... ............................... TOTAL $ <br /> <br /> <br />