Free FEC FORM 6 - Federal

48 HOUR NOTICE OF CONTRIBUTIONS/LOANS RECEIVED
(See Reverse Side for Instructions)

To be used to report all contributions (including loans) of $1000 or more, received within 20 days of the election.
1. NAME OF COMMITTEE IN FULL

ADDRESS (number and street)

CITY, STATE, and ZIP CODE

2.

NAME OF CANDIDATE

3. OFFICE SOUGHT (State and District)

Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions or for commercial purposes other than using the name and address of any political committee to solicit contributions from such committee.

4. FEC IDENTIFICATION NUMBER

A. Full Name, Mailing Address and ZIP Code

Name of Employer

Date (month, day, year)

Amount

Occupation Date (month, day, year) Amount

B. Full Name, Mailing Address and ZIP Code

Name of Employer

Occupation

C. Full Name, Mailing Address and ZIP Code

Name of Employer

Date (month, day, year)

Amount

Occupation Date (month, day, year) Amount

D. Full Name, Mailing Address and ZIP Code

Name of Employer

Occupation

E. Full Name, Mailing Address and ZIP Code

Name of Employer

Date (month, day, year)

Amount

Occupation

SIGNATURE (optional)

DATE

For further information contact: Federal Election Commission 999 E Street, NW, Washington, DC 20463 Toll Free 800-424-9530, Local 202-694-1100

FEC FORM 6
(Revised 1/2001)
FE1AN053.PDF