Form A - Financial Disclosure Statement - 2016 Page 11
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12SCHEDULE I – PAYMENTS MADE TO CHARITY IN
LIEU OF HONORARIA
Name:
Page______ of _______
List the source, activity (i.e., speech, appearance, or article), date, and amount of any payment made by the sponsor of an event to a charitable organization in lieu of paying an honorarium to you. A separate
confidential list of charities receiving such payments must be filed directly with the Committee on Ethics.
Source
Activity
Date
Amount
Association of American Associations, Washington, DC
Speech
Feb, 2, 2016
$2,000
Examples:
XYZ Magazine
Article
Aug. 13, 2016
$500
Use additional sheets if more space is required.
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