Fec Form 3 - Report Of Receipts And Disbursements
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10REPORT OF RECEIPTS
FEC
AND DISBURSEMENTS
FORM 3
For An Authorized Committee
Office Use Only
12FE4M5
1.
NAME OF
TYPE OR PRINT
Example: If typing, type
COMMITTEE (in full)
over the lines.
ADDRESS
(number and street)
Check if different
than previously
reported. (ACC)
CITY
STATE
ZIP CODE
FEC IDENTIFICATION NUMBER
2.
STATE
DISTRICT
C
3. IS THIS
NEW
AMENDED
OR
REPORT
(N)
(A)
4. TYPE OF REPORT
(Choose One)
(b)
12-Day PRE-Election Report for the:
(a)
Quarterly Reports:
Primary (12P)
General (12G)
Runoff (12R)
April 15 Quarterly Report (Q1)
Convention (12C)
Special (12S)
July 15 Quarterly Report (Q2)
in the
M
M
/
D
D
/
Y
Y
Y
Y
October 15 Quarterly Report (Q3)
Election on
State of
January 31 Year-End Report (YE)
(c)
30-Day POST-Election Report for the:
General (30G)
Runoff (30R)
Special (30S)
Termination Report (TER)
in the
M
M
/
D
D
/
Y
Y
Y
Y
Election on
State of
M
M
/
D
D
/
Y
Y
Y
Y
M
M
/
D
D
/
Y
Y
Y
Y
5.
Covering Period
through
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 of Treasurer
M
M
/
D
D
/
Y
Y
Y
Y
Signature of Treasurer
Date
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 52 U.S.C. §30109.
Office
FEC FORM 3
Use
Only
(Revised 05/2016)
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