FEC FORM 13
1. NAME OF COMMITTEE (in full)
REPORT OF DONATIONS ACCEPTED
For Inaugural Committee
Office Use Only
TYPE OR PRINT
Example: If typing, type over the lines.
12FE4M5
MAILING ADDRESS
Check if different than previously reported. (ACC) 2.
FEC IDENTIFICATION NUMBER
C
3a. Type of Filing (check one) Report (90D) Supplement to Report (90S)
M M / D D / Y Y Y Y
3b. (check one) New Amendment to Report or Supplement filed on:
M M / D D / M M / D D / Y Y Y Y
4.
Covering Period
through
Y
Y
Y
Y
Cumulative Total (From Committees Inception) 5. Total Donations Accepted ............................................................
, , ,
, , ,
. . .
6. Total Donations Refunded ...........................................................
7. Net Donations (subtract Line 6 from Line 5) ................................
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name and Title of Officer Designated to Sign this Report
Signature of Designated Officer
Date
M
M
/
D
D
/
Y
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g.
FE5AN013
Office Use Only
FEC FORM 13
10/2004
Y Y Y
CITY
STATE
ZIP CODE
SCHEDULE 13A ITEMIZED DONATIONS ACCEPTED
PAGE
OF
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. NAME OF COMMITTEE (In Full)
A.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y
Mailing Address
Amount of This Donation
City
,
Zip Code
, ,
. .
Donors Aggregate Donations To Date
State
,
B.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y
Mailing Address
Amount of This Donation
City
,
Zip Code
, ,
. .
Donors Aggregate Donations To Date
State
,
C.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Donation Received
M M / D D / Y Y Y Y
Mailing Address
Amount of This Donation
City
,
Zip Code
, , , ,
. . . .
Donors Aggregate Donations To Date
State
, , ,
SUBTOTAL of Donations This Page (optional) .........................................................................
TOTAL (optional) .........................................................................................................................
FEC Schedule 13A (Form 13) 10/2004
FE5AN013
SCHEDULE 13B ITEMIZED REFUNDS OF DONATIONS
PAGE
OF
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. NAME OF COMMITTEE (In Full)
A.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y
Mailing Address Amount of This Refund
City
State
Zip Code
,
,
.
B.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y
Mailing Address Amount of This Refund
City
State
Zip Code
,
,
.
C.
Full Name (Last, First, Middle Initial) or Full Organization Name Date Refund Made
M M / D D / Y Y Y Y
Mailing Address Amount of This Refund
City
State
Zip Code
, , ,
, , ,
. . .
SUBTOTAL of Refunds This Page (optional) ............................................................................ TOTAL (optional) .........................................................................................................................
FEC Schedule 13B (Form 13) 10/2004
FE5AN013