FEC Form 9 (REV. 01/2018)

4. COVERED PERIOD: FROM THROUGH

10. TOTAL DONATIONS THIS STATEMENT.........................................................................

11. TOTAL DISBURSEMENTS/OBLIGATIONS THIS STATEMENT .....................................

NOTE: Submission of false, erroneous or incomplete information may subject the person signing this report to the penalties of 52 U.S.C. §30109. 

C

7. THE FILER IS: 

TYPE OR PRINT NAME OF PERSON COMPLETING FORM SIGNATURE DATE

5. IS THIS REPORT AN AMENDMENT? No Yes, it amends the report filed on

6. (a) DATE OF PUBLIC DISTRIBUTION(S)

 (b) COMMUNICATIONS TITLE

8. WERE THE DISBURSEMENTS MADE EXCLUSIVELY FROM 

DONATIONS TO A SEGREGATED BANK ACCOUNT?

M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

	 ▲	 ▲	 ▲ , , .

(a) an Individual

 Yes No

(c) an Unincorporated Organization

(b) a Corporation or Labor Organization making communications under 11 CFR 114.10

(d) Other, specify:

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

9. CUSTODIAN OF RECORDS

FEC FORM 9

24 HOUR NOTICE OF DISBURSEMENTS/OBLIGATIONS FOR

ELECTIONEERING COMMUNICATIONS

1. (a) Name of Individual, Organization or Corporation

(b) Address (number and street) check if different than previously reported

(c) City, State and ZIP Code

2. Occupation and Name of Employer (for Individual Filers Only)

C

3. FEC Identification Number

Under penalty of perjury I certify that this statement is true, correct and complete.
FEC Form 9 (REV. 01/2018)

12. Person(s) Sharing/Exercising Control 

List of Person(s) Sharing/Exercising Control

(use additional pages as necessary)

A.

B.

C.

D.

E.

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

(a) Name

(b) Address (number and street)

(c) City, State and ZIP Code

(d) Name of Employer or Principal Place of Business (e) Occupation

PAGE OF
FEC Form 9 (REV. 01/2018)

Full Name of Donor

Mailing Address of Donor

City State Zip

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Receipt

Amount

Full Name of Donor

Mailing Address of Donor

City State Zip

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Receipt

Amount

Full Name of Donor

Mailing Address of Donor

City State Zip

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Receipt

Amount

Full Name of Donor

Mailing Address of Donor

City State Zip

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Receipt

Amount

Full Name of Donor

Mailing Address of Donor

City State Zip

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Receipt

Amount

SCHEDULE 9-A PAGE OF

Donation(s) Received

A.

B.

C.

D.

E.

	 ▲	 ▲	 ▲ , , . SUBTOTAL of Donations This Page (optional)..........................................................................

TOTAL This Period (last page this line number only) ...............................................................

 (carry total from last page to Line 10)

▼

▼

	 ▲	 ▲	 ▲ , , .
FEC Form 9 (REV. 01/2018)

A.

B.

SCHEDULE 9-B

Disbursement(s) Made or Obligation(s)

PAGE OF

	 ▲	 ▲	 ▲ , , .

	 ▲	 ▲	 ▲ , , . SUBTOTAL of Disbursements/Obligations This Page (optional)................................................

TOTAL This Period (last page this line number only) ...............................................................

 (carry total from last page to Line 11)

▼

▼

Date of Disbursement or Obligation

Amount

Communication Date

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

Full Name (Last, First, Middle Initial) of Payee

Mailing Address of Payee

City State Zip Code

Name of Employer Occupation

Purpose of Disbursement (Including title(s) of communication(s))

Name of Federal Candidate Office Sought: House

 Senate

 President 

Name of Federal Candidate Office Sought: House

 Senate

 President 

Name of Federal Candidate Office Sought: House

 Senate

 President 

 

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

Date of Disbursement or Obligation

Amount

Communication Date

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

Full Name (Last, First, Middle Initial) of Payee

Mailing Address of Payee

City State Zip Code

Name of Employer Occupation

Purpose of Disbursement (Including title(s) of communication(s))

Name of Federal Candidate Office Sought: House

 Senate

 President 

Name of Federal Candidate Office Sought: House

 Senate

 President 

Name of Federal Candidate Office Sought: House

 Senate

 President

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

State:

District:

Disbursement/Obligation For:

Primary General

Other (specify) ▼

M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .