Recipient Committee Campaign Statement

Form 460 Instructions

Part 1 of 19: Statement Covers Period

From:
Through:
Date of Election, If Applicable:

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Part 2 of 19: Type of Recipient Committee

All Committees Complete Parts 2, 3, 4, and 5.

Officeholder, Candidate Controlled Committee
State Candidate Election Committee
Recall

Also Complete Part 6

General Purpose Committee
Sponsored
Small Contributor Committee
Political Party/Central Committee Primarily Formed Ballot Measure Committee
Controlled
Sponsored

Also Complete Part 7

Primarily Formed Candidate/Officeholder Committee

Also Complete Part 8

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Part 3 of 19: Type of Statement

Pre-Election Statement
Semi-Annual Statement
Termination Statement (Also File a Form 410 Termination)
Quarterly Statement
Special Odd-Year Report
Amendment Explain Amendment

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Part 4 of 19: Committee Information

ID Number:
Committee Name or candidate's name if no committee:
Committee Street Address (NO PO BOX):
Committee City:
Committe State:
Committee Zip Code:
Committee Phone Number:
Committee Mailing Address (if different) Number and street OR P.O. BOX:
City:
State:
Zip Code:
Phone Number:
Optional: Fax/E-Mail Address:

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Name of Treasurer:
Treasurer's Mailing Address:
Treasurer's City:
Treasurer's State:
Treasurer's Zip Code:
Treasurer's Phone Number:

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Name of Assistant Treasurer, If Any:
Assistant Treasurer's Mailing Address:
Assistant Treasurer's City:
Assistant Treasurer's State:
Assistant Treasurer's Zip Code:
Assistant Treasurer's Phone Number:
Optional: Fax/E-Mail Address:

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Part 5 of 19: Verification

Please fill in dates, print, and have signed by the Treasurer or Assistant Treasurer in the first line and, the Controlling Officeholder, State Measure Proponent, or Responsible Officer of Sponsor on the following three lines.

Executed On:
Executed On:
Executed On:
Executed On:

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Part 6 of 19: Officeholder or Candidate Controlled Committee

Name of Officholder or Candidate:
Office Sought or Held (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE):
Resident/Business Address
City:
State:
Zip Code:

First Related Committees Not Included in this Statement

List any committees not included in this statement that are controlled by you or are the primarily formed to receive contributions or make expenditures on behalf of your candidacy.

ID Number:
Committee Name:
Name of Treasurer:

Is this a controlled Committee?

Yes
No
Committee Address (NO P.O. BOX):
City:
State:
Zip Code:
Phone Number:

Second Related Committees Not Included in this Statement

List any committees not included in this statement that are controlled by you or are the primarily formed to receive contributions or make expenditures on behalf of your candidacy.

ID Number:
Committee Name:
Name of Treasurer:

Is this a controlled Committee?

Yes
No
Committee Address(NO P.O. BOX):
City:
State:
Zip Code:
Phone Number:

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Part 7 of 19: Primarily Formed Ballot Measure Committee

Name of Ballot Measure:
Ballot Number or Letter:
Jurisdiction:
Support
Oppose

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Identify the controlling officeholder, candidate, or state measure proponent, if any.

Name of Officeholder, Candidate, or Proponent:
Office Sought or Held:
District Number, If Any:

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Part 8 of 19: Primarily Formed Candidate/Officeholder Committee

List names of officeholder(s) or candidate(s) for which this committee is primarily formed

First Officeholder or Candidate

Name of Officeholder or Candidate:
Office Sought or Held:
Support
Oppose

Second Officeholder or Candidate

Name of Officeholder or Candidate:
Office Sought or Held:
Support
Oppose

Third Officeholder or Candidate

Name of Officeholder or Candidate:
Office Sought or Held:
Support
Oppose

Fourth Officeholder or Candidate

Name of Officeholder or Candidate:
Office Sought or Held:
Support
Oppose

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Part 9 of 19: Disclosure Statement

Column A amounts will reflect attached schedules.

To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any).

 

Contributions Received

1. Monetary Contributions (Schedule A, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

2. Loans Recieved (Schedule B, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

3. Subtotal Cash Contributions (Add Lines 1 and 2)

Column A: Total This Period
Column B: Calendar Year Total to Date

4. Nonmonetary Contributions (Schedule C, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

5. Total Contributions Received (Add Lines 3 and 4)

Column A: Total This Period
Column B: Calendar Year Total to Date

Expenditures Made

6. Payments Made (Schedule E, Line 4)

Column A: Total This Period
Column B: Calendar Year Total to Date

7. Loans Made (Schedule H, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

8. Subtotal Cash Payments (Add Lines 6 and 7)

Column A: Total This Period
Column B: Calendar Year Total to Date

9. Accrued Expenses (Unpaid Bills) (Schedule F, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

10. Nonmonetary Adjustment (Schedule C, Line 3)

Column A: Total This Period
Column B: Calendar Year Total to Date

11. Total Expenditures Made (Add Lines 8, 9, and 10)

Column A: Total This Period
Column B: Calendar Year Total to Date

Current Cash Statement

To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any).

12. Beginning Cash Balance (Previous Summary Page, Line 16)

Column A: Total This Period

13. Cash Receipts (Column A, Line 3 above)

Column A: Total This Period

14. Miscellaneous Increases to Cash (Schedule I, Line 4)

Column A: Total This Period

15. Cash Payments (Column A, Line 8 above)

Column A: Total This Period

16. Ending Cash Balance (If this a termination statement, Line 16 must be zero) (Add Lines 12, 13, 14, then subtract Line 15)

Column A: Total This Period

To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any).

17. Loan Guarantees Received (Schedule B, Part 2)

Column A: Total This Period

Cash Equivalents and Outstanding Debts

To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any).

18. Cash Equivalents (See instructions)

Column A: Total This Period

19. Outstanding Debts (Add Line 2 and 9 in Column B above)

Column A: Total This Period

Calendar Year Summary for Candidates Running in Both the State Primary and General Elections

20. Contributions Received

Contributions Received January 1 Through June 30
Contributions Received July 1 to Current Date

Expenditures Made

Expenditures Made January 1 Through June 30
Expenditures Made July 1 to Current Date

Expenditure Limit Summary for State Candidates

Amounts in this section may be different from amounts reported in Column B.

22. Cumulative Expenditures Made (If subjet to voluntary expenditure limit)

Date of Election
Total to Date

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Date of Election
Total to Date

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Part 10 of 19: Schedule A - Monetary Contributions Received

Amounts may be rounded to whole dollars

First Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Second Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Third Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Fourth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Fifth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Subtotal

Subtotal for Contributions Received 1 Through 5

Sixth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Seventh Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor(IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Eigth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year  (JAN. 1 - DEC. 31)
Per Election to Date

Ninth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year  (JAN. 1 - DEC. 31)
Per Election to Date

Tenth Contribution Received

Date Received
Full Name, Street Address and Zip Code of Contributor (IF COMMITTEE, ALSO ENTER I.D. NUMBER)

Contribuor Codew

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, business entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Amount Reveived This Period
Cumulative to Date Calendar Year (JAN. 1 - DEC. 31)
Per Election to Date

Subtotal

Subtotal for Contributions Received 6 Through 10

Schedule A Summary

1. Amount Received this period - itemized monetary contributions.
2. Amount received this period - unitemized monetary contributions of less than $100
3. Total monetary contributions received this period (Add Lines 1 and 2)

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Part 11 of 19: Schedule B - Part 1: Loans Recevied

First Loan Received

Full Name, Street Address and Zip Code of Lender

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
A. Outstanding Balance Beginning This Period
B. Amount Received This Period

C. Amount Paid or Forgiven This Period. Amounts forgiven or paid by another party must also be reported on Schedule A.

Paid Amount Paid

OR

Forgiven Amount Forgiven
D. Outstanding Balance at Close of This Period
Due Date

E. Interest Paid This Period

Percentage of Interest Paid This Period
Amount of Interest Paid This Period
F. Original Amount of Loan
Date Incurred:

G. Cumulative Contributions to Date

Calendar Year
Per Election

Second Loan Received

Full Name, Street Address and Zip Code of Lender

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
A. Outstanding Balance Beginning This Period
B. Amount Received This Period

C. Amount Paid or Forgiven This Period. Amounts forgiven or paid by another party must also be reported on Schedule A.

Paid Amount Paid

OR

Forgiven Amount Forgiven
D. Outstanding Balance at Close of This Period
Due Date

E. Interest Paid This Period

Percentage of Interest Paid This Period
Amount of Interest Paid This Period
F. Original Amount of Loan
Date Incurred:

G. Cumulative Contributions to Date

Calendar Year
Per Election

Third Loan Received

Full Name, Street Address and Zip Code of Lender

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
A. Outstanding Balance Beginning This Period
B. Amount Received This Period

C. Amount Paid or Forgiven This Period. Amounts forgiven or paid by another party must also be reported on Schedule A.

Paid Amount Paid

OR

Forgiven Amount Forgiven
D. Outstanding Balance at Close of This Period
Due Date

E. Interest Paid This Period

Percentage of Interest Paid This Period
Amount of Interest Paid This Period
F. Original Amount of Loan
Date Incurred:

G. Cumulative Contributions to Date

Calendar Year
Per Election

Subtotals

Subtotal for Amount Received This Period
Subtotal for Amount Paid or Forgiven This Period
Subtotal for Outstanding Balance at Close of This Period
Subtotal for Interest Paid This Period

Schedule B Summary

1. Loans received this period (Total Column B plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period (Total Column C plu loans under $100 paid or forgiven)
3. Net change this period (Subtract Line 2 from Line 1.)

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Part 12 of 19: Schedule B - Part 2: Loan Guarantors

Amounts may be rounded to whole dollars

First Loan Guarantors

Full Name, Street Address, and Zip Code of Guarantor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer

Loan

Name of Lender
Date of Loan
Amount Guaranteed This Period

Cumulative To Date

Calendar Year
Per Elections
Balance Outstanding to Date

Second Loan Guarantors

Full Name, Street Address, and Zip Code of Guarantor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer

Loan

Name of Lender
Date of Loan
Amount Guaranteed This Period

Cumulative To Date

Calendar Year
Per Elections
Balance Outstanding to Date

Third Loan Guarantors

Full Name, Street Address, and Zip Code of Guarantor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer

Loan

Name of Lender
Date of Loan
Amount Guaranteed This Period

Cumulative To Date

Calendar Year
Per Elections
Balance Outstanding to Date

Fourth Loan Guarantors

Full Name, Street Address, and Zip Code of Guarantor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer

Loan

Name of Lender
Date of Loan
Amount Guaranteed This Period

Cumulative To Date

Calendar Year
Per Elections
Balance Outstanding to Date

Subtotal

Subtotal for Amount Guaranteed This Period

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Part 13 of 19: Schedule C - Nonmonetary Contributions Received

Amounts may be rounded to whole dollars.

Attach additional information on appropriately labeled continuation sheets.

First Nonmonetary Contribution Received

Date Received
Full Name, Street Address, and Zip Code of Contributor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Description of Goods or Services
Amount/Fair Market Value
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date (If required)

Second Nonmonetary Contribution Received

Date Received
Full Name, Street Address, and Zip Code of Contributor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Description of Goods or Services
Amount/Fair Market Value
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date (If required)

Third Nonmonetary Contribution Received

Date Received
Full Name, Street Address, and Zip Code of Contributor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Description of Goods or Services
Amount/Fair Market Value
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date (If required)

Fourth Nonmonetary Contribution Received

Date Received
Full Name, Street Address, and Zip Code of Contributor

Contributor Code

Individual
Recipient Committee (Other Than PTY or SCC)
Other (example, Business Entity)
Political Party
Small Contributor Committee If an Individual, Enter Occupation and Employer
Description of Goods or Services
Amount/Fair Market Value
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date (If required)

Subtotal

Subtotal for Amount/Fair Market Value

Schedule C Summary

1. Amount received this period - itemized nonmonetary contributions.
2. Amount received this period - unitemized nonmonetary contributions of less than $100
3. Total nonmonetary contributions received this period (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10)

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Part 14 of 19: Schedule D - Summary of Expenditures Supporting/Opposing Other Candidates, Measures, and Committees

Amounts may be rounded to whole dollars.

First Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Second Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Third Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Subotal

Subtotal For Expenditures One Through Three

Fourth Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Fifth Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Sixth Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Seventh Expenditure

Date:
Name of Candidate, Office, and District, or Measure Number or Letter and Jurisdiction, or Committee
Support
Oppose

Type of Payment

Monetary Contribution
Nonmonetary Contribution
Independent Expenditure Description
Amount This Period
Cumulative to Date Calendar Year (January 1 to December 31)
Per Election to Date

Subtotal

Subtotals For Expenditures Four Through Seven

Schedule D Summary

1. Itemized contributions and independent expenditures made this period
2. Unitemized contributions and independent expenditures made this period of under $100
3. Total contributions and independent expenditures made this period (Add Lines 1 and 2)

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Part 15 of 19: Schedule E - Payments Made

If one of the following codes accurately describes the payment, you may enter tht code. Otherwise, describe the payment.

• CMP - campaign paraphernalia/misc.
• CNS - campaign consultants
• CTB - contribution (explain nonmonetary)*
• CVC - civic donations
• FIL - candidate filing/ballot fees
• FND - fundraising events
• IND - independent expenditure supporting/opposing others (explain)*
• LEG - legal defense
• LIT - campaign literature and mailings
• MBR - member communications
• MTG - meetings and appearances
• OFC - office expenses
• PET - petition circulating
• PHO - phone banks
• POL - polling and survey research
• POS - postage, delivery and messenger services
• PRO - professional services (legal, accounting)
• PRT - print ads
• RAD - radio airtime and production costs
• RFD - returned contributions
• SAL - campaign workers’ salaries
• TEL - t.v. or cable airtime and production costs
• TRC - candidate travel, lodging, and meals
• TRS - staff/spouse travel, lodging, and meals
• TSF - transfer between committees of the same candidate/sponsor
• VOT - voter registration
• WEB - information technology costs (internet, e-mail)

Payments that are contributions or independenty expenditures must also be summarized on Schedule D.

First Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Second Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Third Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Subtotal

Subtotal for Amounts Paid One Through Three

Fourth Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Fifth Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Sixth Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Seventh Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Eigth Payment Made

Name and Address of Payee(If committee also enter ID number)
Code

OR

Description of Payment
Amount Paid

Subtotal

Subtotal for Amounts Paid Four Through Eight

Schedule E Summary

1. Itemized payments made this period
2. Unitemized payments made this period of under $100
3. Total interest paid this period on loans
4. Total payments made this period (Add Lines 1, 2, and 3)

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Part 16 of 19: Schedule F - Accrued Expenses (Unpaid Bills)

Amounts may be rounded to whole dollars.

• CMP - campaign paraphernalia/misc.
• CNS - campaign consultants
• CTB - contribution (explain nonmonetary)*
• CVC - civic donations
• FIL - candidate filing/ballot fees
• FND - fundraising events
• IND - independent expenditure supporting/opposing others (explain)*
• LEG - legal defense
• LIT - campaign literature and mailings
• MBR - member communications
• MTG - meetings and appearances
• OFC - office expenses
• PET - petition circulating
• PHO - phone banks
• POL - polling and survey research
• POS - postage, delivery and messenger services
• PRO - professional services (legal, accounting)
• PRT - print ads
• RAD - radio airtime and production costs
• RFD - returned contributions
• SAL - campaign workers’ salaries
• TEL - t.v. or cable airtime and production costs
• TRC - candidate travel, lodging, and meals
• TRS - staff/spouse travel, lodging, and meals
• TSF - transfer between committees of the same candidate/sponsor
• VOT - voter registration
• WEB - information technology costs (internet, e-mail)

Payments that are contributions or independent expenditures must also be summarized on Schedule D.

First Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Second Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Third Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Subtotal

Subtotals for Coulmns A, B, C, and D for rows One through Three

A. Subtotal For Outstanding Balances Beginnin of This Period
B. Subtotal For Amount Incurred This Period
C. Subtotal For Amount Paid This Period
D. Subtotal For Outstanding Balance at Close of This Period

Fourth Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Fifth Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Sixth Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Seventh Accrued Expense

Name and Address of Creditor
Code or Description of Payment
A. Outstanding Balance Beginning of This Period
B. Amount Incurred This Period
C. Amount Paid This Period
D. Outstanding Balance at Close of This Period

Subtotal

Subtotals for Coulmns A, B, C, and D for rows Four through Seven

A. Subtotal For Outstanding Balances Beginnin of This Period
B. Subtotal For Amount Incurred This Period
C. Subtotal For Amount Paid This Period
D. Subtotal For Outstanding Balance at Close of This Period

Schedule F Summary

1. Total accrued expenses incurred this period (Include all Schedule F, Column B subtotal for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100)
2. Total accrued expenses paid this period (Include all Schedule F, Column C subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100)
3. Net change this period (Subtract Line 2 from Line 1)

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Part 17 of 19: Schedule G - Payments Made by an Agent or Independent Contractor (on Behalf of This Committee)

Attach additional information on appropriately labeled continuation sheets.

Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E.

Name of Agent or Independent Contractor

Amounts may be rounded to whole dollars.

• CMP - campaign paraphernalia/misc.
• CNS - campaign consultants
• CTB - contribution (explain nonmonetary)*
• CVC - civic donations
• FIL - candidate filing/ballot fees
• FND - fundraising events
• IND - independent expenditure supporting/opposing others (explain)*
• LEG - legal defense
• LIT - campaign literature and mailings
• MBR - member communications
• MTG - meetings and appearances
• OFC - office expenses
• PET - petition circulating
• PHO - phone banks
• POL - polling and survey research
• POS - postage, delivery and messenger services
• PRO - professional services (legal, accounting)
• PRT - print ads
• RAD - radio airtime and production costs
• RFD - returned contributions
• SAL - campaign workers’ salaries
• TEL - t.v. or cable airtime and production costs
• TRC - candidate travel, lodging, and meals
• TRS - staff/spouse travel, lodging, and meals
• TSF - transfer between committees of the same candidate/sponsor
• VOT - voter registration
• WEB - information technology costs (internet, e-mail)

Payments that are contributions or independent expenditures must also be summarized on Schedule D.

First Payment Made by an Agent or Independent Contractor

Name and Address of Payee or Creditor
Code

OR

Description of Payment
Amount Paid

Second Payment Made by an Agent or Independent Contractor

Name and Address of Payee or Creditor
Code

OR

Description of Payment
Amount Paid

Third Payment Made by an Agent or Independent Contractor

Name and Address of Payee or Creditor
Code

OR

Description of Payment
Amount Paid

Fourth Payment Made by an Agent or Independent Contractor

Name and Address of Payee or Creditor
Code

OR

Description of Payment
Amount Paid

Total

Total For Amounts Paid by an Agent or Independent Contractor

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Part 18 of 19: Schedule H - Loans Made to Others

Amounts may be rounded to whole dollars.

Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be reported on Schedule E.

First Loan Made

Full Name, Street Address, and Zip Code of Recipient
If an Individual, Enter Occupation and Employer
A. Outstanding Balance Beginning This Period
B. Amount Loaned This Period

C. Repayment of Forgiveness This Period

Paid
Amount Paid

OR

Forgiven
AmountForgiven

D. Outstanding Balance at Close of This Period

Outstanding Balance:
Date Due:

E. Interest Received

Percentage of Rate
Interest Received

F. Original Amount of Loan

Amount of Loan
Date Incurred

G. Cumulative Loans to Date

Calendar Year
Per Election

Second Loan Made

Full Name, Street Address, and Zip Code of Recipient
If an Individual, Enter Occupation and Employer
A. Outstanding Balance Beginning This Period
B. Amount Loaned This Period

C. Repayment of Forgiveness This Period

Paid
Amount Paid

OR

Forgiven
AmountForgiven

D. Outstanding Balance at Close of This Period

Outstanding Balance
Date Due

E. Interest Received

Percentage of Rate
Interest Received

F. Original Amount of Loan

Amount of Loan
Date Incurred

G. Cumulative Loans to Date

Calendar Year
Per Election

Subtotals

Subtotal For Column B - Amount Loaned This Period
Subtotal For Column C - Payment or Forgiveness This Period
Subtotal For Column D - Outstanding Balance at Close of This Period
Subtotal For Column E - Interest Received

Schedule H Summary

1. Loans made this period (Total Column B plus unitemized loans of less than $100)
2. Payments received on loans (Total Column C plus unitemized paymets of less than $100)
3. Net change this period (Subtract Line 2 from Line 1)

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Part 19 of 19: Schedule I - Miscellaneous Increases to Cash

Amounts may be rounded to whole dollars.

Attach additional information on appropriately labeled continuation sheets.

First Miscellaneous Increase to Cash

Date Received
Full Name and Address of Source
Description of Receipt
Amount of Increase to Cash

Second Miscellaneous Increase to Cash

Date Received
Full Name and Address of Source
Description of Receipt
Amount of Increase to Cash

Third Miscellaneous Increase to Cash

Date Received
Full Name and Address of Source
Description of Receipt
Amount of Increase to Cash

Fourth Miscellaneous Increase to Cash

Date Received
Full Name and Address of Source
Description of Receipt
Amount of Increase to Cash

Fifth Miscellaneous Increase to Cash

Date Received
Full Name and Address of Source
Description of Receipt
Amount of Increase to Cash

Subtotal

Subtotal for Amount of Increase to Cash

Schedule I Summary

1. Itemized increases to cash this period
2. Unitemized increases to cash of under $100
3. Total of all interest received this period on loans made to others (Schedule H, Column E)
4. Total miscellaneous increases to cash this period (Add Lines 1, 2, and 3.

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