Report of receipts and expenditures of a political committee



Download 351.88 Kb.
Page1/11
Date conversion29.04.2016
Size351.88 Kb.
  1   2   3   4   5   6   7   8   9   10   11

REPORT OF RECEIPTS AND EXPENDITURES OF A POLITICAL COMMITTEE State Form 4606 (R13/11-05) Indiana Election Commission (IC 3-9-5-14)


(CFA-4)

Summary Sheet

FILE NUMBER


INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this form. For assistance in completing this form, see instructions on the reverse side.







TOTAL PAGES IN ENTIRE CFA-4 REPORT

IS THIS AN AMENDMENT?  Yes  No



COMMITTEE INFORMATION


1. Full Name of Committee (as on Statement of Organization)  Check if this is a new name


2. Acronym or Abbreviated Name (if any)

3. Committee Telephone Number

( )


4. Mailing Address (address where all campaign finance correspondence is received)  Check if this is a new address


5. City, State, ZIP Code


6. Party Affiliation (if applicable)

CANDIDATE INFORMATION (For Candidate’s Committees Only)

7. Full Name of Candidate (include any nickname)


8. Party Affiliation or If Independent Candidate


9. Office Sought (Include district number, if any. Not required for exploratory committee.)


10. County of Residence

TYPE OF REPORT

CONVENTION CANDIDATES ONLY

11. Check one:

 Pre-Primary  Pre-Election  Annual  Nomination  Other __________________________________________________

 Final/Disbands Committee (lines 18, 19, and 20 must be “0”)  Outgoing Treasurer (within 10 days amend Statement of Organization)


Check one:

 Pre-Convention

 Post-Convention


12. Reporting Period:

From: Through:



COLUMN A

This Period


COLUMN B

Year to Date

13. Cash on hand and investments at the beginning of this reporting period.







14. Cash on hand and investments January 1, current year.






CONTRIBUTIONS AND RECEIPTS








(Note: these amounts include in-kind contributions and loans, as well as cash contributions.)







15a. Itemized (use Schedule A)







15b. Unitemized







15c. Add lines 15a and 15b in both columns SUBTOTAL







16. Add lines 13 and 15c in Column A and lines 14 and 15c in Column B TOTAL






  1   2   3   4   5   6   7   8   9   10   11


The database is protected by copyright ©essaydocs.org 2016
send message

    Main page