FE5AN013

FEC FORM 13

FEC 

FORM 13

1. NAME OF 

COMMITTEE (in full)

MAILING

ADDRESS

Check if different 

than previously 

reported. (ACC)

Office 

Use 

Only

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

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

CITY STATE ZIP CODE

2. FEC IDENTIFICATION NUMBER ▼

 TYPE OR PRINT

REPORT OF 

DONATIONS ACCEPTED

For Inaugural Committee

4. Covering Period through

▼ ▼ ▼

Office Use Only

C

▼

▼

Example:If typing, type 

over the lines. 12FE4M5

M M / D D / Y Y Y Y M M / D D / Y Y Y Y

M M / D D / Y Y Y Y

	 ▲	 ▲	 ▲ , , .

	 ▲	 ▲	 ▲ , , .

	 ▲	 ▲	 ▲ , , .

 5. Total Donations Accepted ............................................................

 6. Total Donations Refunded............................................................

 

 7. Net Donations (subtract Line 6 from Line 5) ................................

Cumulative Total (From Committee’s Inception)

3a. Type of Filing (check one) 3b. (check one)

Report (90D) New

Supplement to Report (90S) Amendment to Report or 

 Supplement filed on:

M M / D D / Y Y Y Y

10/2004
FE5AN013

SCHEDULE 13–A 

ITEMIZED DONATIONS ACCEPTED

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)

 ▲ ▲ ▲ , , .

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

TOTAL (optional) ......................................................................................................................... ▼

▼

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

A.

FEC Schedule 13–A (Form 13) 10/2004

PAGE OF

Amount of This Donation

Donorʼs Aggregate Donations To Date

Date Donation Received

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

 ▲ ▲ ▲ , , .

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

B.

Amount of This Donation

Donorʼs Aggregate Donations To Date

Date Donation Received

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

 ▲ ▲ ▲ , , .

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

C.

Amount of This Donation

Donorʼs Aggregate Donations To Date

Date Donation Received

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

 ▲ ▲ ▲ , , .
FE5AN013

SCHEDULE 13–B

ITEMIZED REFUNDS OF DONATIONS

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)

 ▲ ▲ ▲ , , .

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

TOTAL (optional) ......................................................................................................................... ▼

▼

FEC Schedule 13–B (Form 13) 10/2004

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

A.

Amount of This Refund

Date Refund Made

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

B.

Amount of This Refund

Date Refund Made

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

 Full Name (Last, First, Middle Initial) or Full Organization Name

 Mailing Address

City

 State Zip Code

C.

Amount of This Refund

Date Refund Made

 M M / D D / Y Y Y Y

 ▲ ▲ ▲ , , .

PAGE OF