GUIDELINE FOR PRESENTATION IN GOOD ORDER 

APPENDICES 

LETTER FORMATS/FORMS 

l Suggested Letter of Candidate Agreements/Certifications 

2 Certification from Committee Treasurer 

 Re: Information Submitted 

3 Notices of Threshold Submission Review 

4 Contributor File Requirements 

5 Notices - Failure to Meet Standards of Good Order 

6 Summaries - Results of Review 

FORMATS FOR ADDITIONAL DOCUMENTATION LETTERS 

7 Contributions Drawn on Employee Participation Plan Account Lacking 

Contributor's Signature 

8 Loans Forgiven 

9 Possible Foreign Contributions 

10 Attribution of Unmatched Portion of Written Instrument to Another 

Individual 

11 Reattribution of an Excessive Contribution to Another Individual 

12 Contribution Drawn on Business Account 

13 Contribution Drawn on Partnership, Group, or Association Account 

14 Contribution Drawn on Trust, Escrow, or Estate Account 
GUIDELINE FOR PRESENTATION IN GOOD ORDER 

APPENDICES 

FORMATS FOR ADDITIONAL DOCUMENTATION LETTERS (Cont.) 

15 Listing of Non-Matchable/Matchable Account Designations 

16 Contribution Drawn on Individual's Designated Account 

17 Signature other than Accountholder (Contributor identified as 

accountholder, signed by other) 

18 Signature other than Accountholder (signed by contributor not identified 

as Accountholder) 

19 Signature Discrepancy on Joint Account 

20 Written Instrument Omitting Information Regarding Date, Payee, Amount 

21 Written Instrument Which Cannot be Associated with Listed Contributor 

22 Documentation Required for Initial Submission of Money Orders, 

Cashier's Checks or Other Similar Negotiable Written Instruments 
Appendix 1 

Page 1 of 3 

SUGGESTED FORMAT 

FOR CANDIDATE AND COMMITTEE AGREEMENTS 

AND CERTIFICATIONS 

Chairman 

Federal Election Commission 

999 E Street, N.W. 

Washington, D.C. 20463 

Dear Mr. Chairman: 

As a candidate seeking to become eligible to receive Presidential primary matching 

funds, I certify and agree to the following provisions as prescribed at 11 CFR §9033.1 and 11 

CFR §9033.2. 

I. In accordance with 11 CFR §9033.2(b)(1) and 11 CFR §9033.2(b)(3), I certify that 

I am seeking the nomination of the (name of political party) for election to the 

Office of President in more than one State. I and/or my authorized committee(s) 

have received matchable contributions, which in the aggregate exceed $5,000 from 

residents of each of at least twenty States, which with respect to any one person do 

not exceed $250.00. 

II. Pursuant to 11 CFR §9033.2(b)(2), I and/or my authorized committee(s) have not 

incurred and will not incur qualified campaign expenses in excess of the 

expenditure limitations prescribed by 26 U.S.C. §9035 and 11 CFR §9035. 

III. In accordance with 11 CFR §9033.1(b)(1), I acknowledge that I have the burden of 

proving that disbursements made by me, and any of my authorized committee(s) or 

agents are qualified campaign expenses as defined at 11 CFR §9032.9. 

IV. Pursuant to 11 CFR §9033.1(b)(2), I and my authorized committee(s) will comply 

with the documentation requirements set forth in 11 CFR §9033.11. 

V. Upon the request of the Commission, I and my authorized committee(s) will supply 

an explanation of the connection between any disbursement made by me or my 

authorized committee(s) and the campaign as prescribed by 11 CFR §9033.1(b)(3). 

VI. In accordance with 11 CFR §9033.1(b)(4), I and my authorized committee(s) agree 

to keep and furnish to the Commission all documentation for matching fund 

submissions, any books, records (including bank records for all accounts) and 

supporting documentation and other information that the Commission may request. 

VII. As provided at 11 CFR §9033.1(b)(5), I and my authorized committee(s) agree to 

keep and furnish to the Commission all documentation relating to disbursements 
Appendix 1 

Page 2 of 3 

and receipts including any books, records (including bank records for all accounts), 

all documentation required by this section (including those required to be 

maintained under 11 CFR §9033.11), and other information that the Commission 

may request. If I or my authorized committee(s) maintains or uses computerized 

information containing any of the categories of data listed in 11 CFR §9033.12(a), 

the committee will provide computerized magnetic media, such as magnetic tapes 

or magnetic diskettes, containing the computerized information at the times 

specified in 11 CFR §9038.1(b)(1) that meet the requirements of 11 CFR 

§9033.12(b). Upon request, documentation explaining the computer system's 

software capabilities shall be provided and such personnel as are necessary to 

explain the operation of the computer system's software and the computerized 

information prepared or maintained by the committee(s) shall be made available. 

VIII. As prescribed at 11 CFR §9033.1(b)(6), I and my authorized committee(s) will 

obtain and furnish to the Commission upon request all documentation relating to 

funds received and disbursements made on my behalf by other political committees 

and organizations associated with me. 

IX. In accordance with 26 U.S.C. §9038 and 11 CFR §9033.1(b)(7), I and my 

authorized committee(s) shall permit an audit and examination pursuant to 11 CFR 

§9038 of all receipts and disbursements, including those made by me, all authorized 

committee(s) and any agent or person authorized to make expenditures on my 

behalf or on behalf of my authorized committee(s). I and my authorized 

committee(s) shall also provide any material required in connection with an audit, 

investigation, or examination conducted pursuant to 11 CFR §9039. I and my 

authorized committee(s) shall facilitate the audit by making available in one central 

location, office space, records and such personnel as are necessary to conduct the 

audit and examination, and shall pay any amounts required to be repaid under 11 

CFR §9038 and 11 CFR §9039. 

X. Pursuant to 11 CFR §9033.1(b)(8), the person listed below is entitled to receive 

matching fund payments on my behalf, which will be deposited into the listed 

depository, which I have designated as the campaign depository. Any change in the 

information required by this paragraph shall not be effective until submitted to the 

Commission in a letter signed by me or the Treasurer of my authorized principal 

campaign committee. 

Name of Person: _________________________________________ 

Mailing Address: _________________________________________ 

 _________________________________________ 

Designated 

Depository: ______________________________________________ 
Appendix 1 

Page 3 of 3 

Address: ________________________________________________ 

 ________________________________________________ 

XI. Pursuant to 11 CFR §9033.1(b)(9), 11 CFR §9033.1(b)(10), and 11 CFR 

§9033.1(b)(11), I and my authorized committee(s) will: (A) prepare matching fund 

submissions in accordance with the Federal Election Commission's Guideline for 

Presentation in Good Order, including the provision of any magnetic media 

pertaining to the matching fund submissions and which conforms to the 

requirements specified at 11 CFR §9033.12; (B) comply with the applicable 

requirements of 2 U.S.C. §431 et seq. 26 U.S.C. §9031 et seq. and the 

Commission's regulations at 11 CFR Parts 100-300, and 9031-9039; (C) pay any 

civil penalties included in a conciliation agreement or otherwise imposed under 2 

U.S.C. §437g against myself, any of my authorized committee(s) or any agent 

thereof. 

XII. Pursuant to 11 CFR §9033.1(b)(12), any television commercial prepared or 

distributed by me or my authorized committee(s) will be prepared in a manner 

which ensures that the commercial contains or is accompanied by closed captioning 

of the oral content of the commercial to be broadcast in line 21 of the vertical 

blanking interval, or is capable of being viewed by deaf and hearing impaired 

individuals via any comparable successor technology to line 21 of the vertical 

blanking interval. 

Signed: ________________________________________________ 

 Candidate Signature* 

* 11 CFR §9033.2(a)(1) requires the Candidate and Committee Agreements and Certifications 

to be signed by the Candidate. 
Appendix 2 

 TO ACCOMPANY ANY THRESHOLD SUBMISSION, 

NON-THRESHOLD SUBMISSION AND RESUBMISSION 

(11 CFR §104.14) 

Chairman 

Federal Election Commission 

999 E Street, NW 

Washington, D.C. 20463 

Dear Mr. Chairman: 

 I, (Name of Treasurer), as Treasurer of (Name of Committee), certify that the 

information contained in the Committee's (Threshold Submission, Matching Fund 

Submission No. ___, or Resubmission No. ___) is complete and accurate. This 

submission lists contributions deposited from ____________ to ____________. (Note: 

For a Matching Fund Submission also listing contributions that were withheld from 

earlier submissions, the certification shall further state: “and also contributions 

deposited in periods covered by earlier submission.”) 

CERTIFICATION FROM COMMITTEE TREASURER REQUIRED 

I also certify the Submission has been prepared in accordance with the 

Commission's Guideline for Presentation in Good Order. 

If credit card contributions are included in the submission the following statements 

must be included: I further certify that a method of billing address verification is in 

place for credit card contributions. Only credit card contributions where the billing 

address verification system verifies an exact match with the address information provided 

by the contributor have been accepted. 

Note: For eligible candidates making submissions/resubmissions prior to the last 

submission/resubmission date in the year preceding the presidential election and for 

ineligible candidates the following statement must be included: 

In the event the Commission's initial review estimates that less than 85% of the 

submitted contributions are matchable, I agree to accept its return for corrective action. 

(See 11 CFR §9036.2(c)) 
 

Appendix 2 

Note: For ineligible candidates the following statement must also be included: 

I also certify that as of the close of business on (last business day preceding the 

date of the submission) the committee’s net outstanding campaign obligations equal or 

exceed the amount submitted for matching 

 Signed,

 _________________________ 

 Committee Treasurer 
________________________ 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 3(a) 

Page 1 of 2 

SUMMARY RESULTS OF 

REVIEW THRESHOLD SUBMISSION 

FOR STATE OF 

Candidate/Committee:_____________________________________________________ 

Date Submitted:___________________ Amount Submitted: $__________________ 

Amount Matchable: $__________________ 

Amount Non-Matchable: $______________ 

The portion of the Threshold Submission for the State 

identified above has been reviewed in accordance with the 

Commission's review procedures. The results of the review, 

summarized below, indicate that the threshold requirements 

for establishing eligibility in the State have not been met. 

Attached to this summary is a listing of the contributions 

that were identified as non-matchable, and where 

appropriate, copies of the associated written instruments. 

For a thorough explanation of the exceptions to matchability noted, see the Commission’s 

Guideline for Presentation in Good Order, Chapter V, "Standard Exception Codes for 

Review of Matching Fund Submissions." Requirements for resubmission of rejected 

contributions are also contained in this chapter. 

Exception Subcategory Amount 

 Code Number Rejected 

A ___________ $___________ 

 B ___________ ___________ 

C ___________ ___________ 

D ___________ ___________ 

E ___________ ___________ 

F ___________ ___________ 

G ___________ ___________ 

H ___________ ___________ 

I ___________ ___________ 

J ___________ ___________ 

Other ___________ ___________ 

Other ___________ ___________ 

Subtotal $___________ 

NSF Adjustment ___________ 

TOTAL $___________ 
________________________ 

 

 

 

Appendix 3(a) 

Page 2 of 2 

SUMMARY RESULTS OF 

REVIEW THRESHOLD SUBMISSION 

FOR STATE OF 

As a result of the 100% review of contributions submitted for the State that found that the 

eligibility requirements were not met, the portions of the Threshold Submission 

pertaining to the State that require correction or supplemental information are being 

returned for remedial action. See also Chapter I, Part P. of the Guideline for Presentation 

in Good Order regarding the failure of a candidate/committee to establish eligibility. The 

supplemental information, corrections and/or replacement contributions may be 

submitted on any business day. 

Signed:_____________________________ Signed:_____________________________ 

for the Assistant Staff Director

 Office of General Counsel for Audit 

Date:_______________________________ Date:_______________________________ 

INVENTORY OF RETURNED THRESHOLD SUBMISSION MATERIALS 

_____ Contributor List _____Bank Documentation 

_____ Written Instruments _____Other:_____________________________ 

 _______________________________________ 

I acknowledge that, on the date noted above, the above Threshold Submission materials 

for the State of __________________________________ were returned to 

_____(Name of Candidate/Committee)_____ for review and corrective action. I also 

acknowledge that, because of the additional time needed for these actions under 11 CFR 

§9033.4(a)(2), the Commission will not be obligated to consider an eligibility 

determination until after corrected information has been submitted. I further 

acknowledge that such eligibility determination will generally be made within 

__________business days of the Commission's receipt of the corrected threshold 

submission, provided the corrected threshold submission documents have met the 

eligibility requirements. 

Received by:______________________________ Date:____________________ 

 Committee Representative 
Appendix 3(b) 

Page 1 of 2 

NOTICE 

STATUS OF REVIEW 

THRESHOLD SUBMISSION 

Candidate/Committee: ____________________________________________________ 

Date Submitted: _______________________________ 

Amount Submitted: $___________________________ No. of States: ___________ 

The Commission's Guideline for Presentation in Good Order, Chapter I.P., provides a 

candidate/committee an opportunity to take corrective action where the staff review indicates 

that the eligibility requirements in at least 20 States will not be met. The following state listings 

are presented for your information in taking the appropriate corrective actions. Attached to this 

notice is a summary for each reviewed state where the eligibility requirements have not been 

met, together with the identification of the contributions that were identified as non-matchable, 

and the reasons. 

The provisions in the Guideline for Presentation in Good Order provide for Commission staff to 

halt the review of a threshold submission when it reaches a point indicating the eligibility 

requirements will not be met. The candidate/committee is afforded a maximum of two 

opportunities to take corrective actions with respect to the threshold submission before the 

Commission proceeds to an initial determination that the candidate/committee has not met the 

eligibility requirements in at least 20 states. 

Listed below are the states submitted in the threshold submission, grouped into three categories. 

For those states in which non-matchable contributions caused the threshold requirements not to 

be met, a summary and a listing of the contributions identified as non-matchable are included. 

The submitted contributor list and associated documentation for each unreviewed state is being 

returned with this notice for your review and to permit you to make any corrections necessary to 

ensure that only matchable contributions totaling in excess of $5,000 are submitted with the 

corrected threshold submission. 
 

 

Appendix 3(b) 

Page 2 of 2 

NOTICE 

STATUS OF REVIEW 

THRESHOLD SUBMISSION 

Eligibility of Reviewed States States 

Established Not Established Not Reviewed 

Signed: _______________________________ Signed: _______________________________ 

 for the Assistant Staff Director 

 Office of General Counsel for Audit 

Date: _________________________________ Date: _________________________________ 

Signed: _______________________________ 

 Committee Representative 

Date: ________________________________ 
 Appendix 4 

Required Fields for Contributor File 

Submission Number 

Contributor ID Number 

Name Prefix 

First Name 

Last Name 

Name Suffix 

Address1 Must be residential for Threshold 

Submission 

Address2 Must be residential for Threshold 

Submission 

City 

State 

Zip Code 

Occupation Required for Threshold Submission 

Name of Employer Required for Threshold Submission 

Contribution Deposit Batch 

Number 

A series of characters which 

uniquely identify a given deposit 

batch. Typically, YYMMDD, 

followed by three for a 

sequential number for multiple 

deposits on the same day. i.e. 

070102005 = 5th deposit batch on 

January 2, 2007), or some other 

method which results in a unique 

identifier to a specific deposit 

batch for contributions. 

Batch Sequence Number The location of a given 

contribution within the deposit 

batch (i.e., 17 = 17th check in 

the batch). 

Contribution Amount 

Contribution Deposit Date 

Amount Submitted for Matching 

Aggregate Amount Submitted this

Submission 

Aggregate Amount Submitted all

Submissions 

Digital Image Address May be Contribution Deposit Batch 

Number plus the Batch Sequence 

Number. 
 

______ 

Appendix 5(a) 

Page 1 of 3 

NOTICE 

FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT 

TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER 

COMMITTEE: __________________________________________ SUB. NO.: 

DATE RECEIVED: ___________________________ 

The matching fund request identified above has failed to meet the requirements of the 

Commission's Guideline for Presentation in Good Order. As provided by 11 CFR 

§9036.4(a), the Commission will not accept for review and certification of payment any 

matching fund request that has not been prepared or presented in conformance with the 

standards of good order as outlined in the Guideline. 

The following requirement(s) must be met before a determination of good order can be 

made: 

1) Contributor Data File 

_____ must include all information specified in the Guideline at Chapter III.E., 

_____ other: _________________________________________________ 

 _________________________________________________ 

2) Supporting Documentation 

_____ must submit full-size copies or scanned images of written instruments, 

_____ if photocopies, they must be grouped into same order as the contributor list 

or by deposit batch, 

_____ must be referenced to deposit date, 

_____ other: _________________________________________________ 

 _________________________________________________ 

3) Bank Documentation 

_____ must submit either unvalidated deposit slips and copy of bank statement, or 

_____ validated deposit slips, 

_____ other: _________________________________________________ 

 _________________________________________________ 

4) NSF Listing 

_____ must include all checks returned as NSF regardless of whether submitted, 

_____ check copies must have associated debit memos attached, 

_____ other: _________________________________________________ 

 _________________________________________________ 
 Appendix 5(a)

Page 2 of 3 

NOTICE 

FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT 

TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER 

5) Refunded Contribution Listing 

_____ must be in straight alphabetical order and include full name and mailing 

address of contributor, date and full amount of check, deposit date, total 

amount of contributions received from contributors and amount of refund. 

6) Documentation for Joint Fundraising Proceeds 

_____ must submit copy of joint fundraising agreement, signed by representative 

of each participant, 

_____ must include explanation of any allocation different from that specified in 

agreement, 

_____ other: _________________________________________________ 

 _________________________________________________ 

7) Documentation for Entertainment Event Proceeds 

_____ must submit copy of promotional material, 

_____ must submit copy of a ticket at each price, 

_____ other: _________________________________________________ 

 _________________________________________________ 

8) Certification from Committee Treasurer Regarding Accuracy and Completeness 

of Information Submitted 

_____ must bear signature of responsible official, 

_____ other: _________________________________________________ 

 _________________________________________________ 

9) _____ other: _________________________________________________ 

 _________________________________________________ 
 Appendix 5(a)

Page 3 of 3 

NOTICE 

FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT 

TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER 

As also provided at 11 CFR §9036.4(a)(3), if the above requirements can be satisfied by 

the close of business on _____________________, the matching fund request will be 

accepted for review. A payment for the actual value will be certified (as specified at 11 

CFR §9036.2(d)(1) and 11 CFR §9036.2(d)(2)) for the next regular payment date. 

Signed: 

________________________________Signed:_______________________________ 

 for the Assistant Staff Director 

 Office of General Counsel for Audit 

Date:_____________________________Date:_____________________________ 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 5(b) 

Page 1 of 2 

NOTICE 

RESULTS OF INITIAL REVIEW 

ERROR RATE IN EXCESS OF 15% 

COMMITTEE: __________________________________________ SUB. No.: _______ 

DATE SUBMITTED: ____________________________ 

The matching fund submission identified above has been initially reviewed in accordance with 

the Commission's review procedures. The results of this review, summarized below, indicate the 

matching fund request does not meet the "quality of content" standard of the Commission's 

Guideline for Presentation in Good Order. Accordingly, as provided by 11 CFR §9036.2, the 

review was suspended in order for the matching fund request to be returned for corrective action. 

For a thorough explanation of the Commission's policy on the exceptions noted, see the 

Guideline, Chapter V - "Standard Exception Codes for Review of Matching Fund Requests." 

Furthermore, requirements for resubmission of rejected contributions are also contained in this 

chapter. 

 Exception Subcategory Error 

 Code Number Percentage 

A __________ __________ 

B __________ __________ 

C __________ __________ 

D __________ __________ 

E __________ __________ 

F __________ __________ 

G __________ __________ 

H __________ __________ 

I __________ __________ 

J __________ __________ 

 TOTAL __________ 

* * * * * * * * * * * * 

Submission No. ________ __________________________________________________ 

 (Signature of Treasurer or Committee Representative) 

Date Submission Returned: _______________________ 
 

_____________________________________________________ 

Appendix 5(b) 

Page 2 of 2 

COMMITTEE: __________________________________________ SUB. No.: _______ 

DATE SUBMISSION RETURNED: ______________________________ 

Inventory of Matching Fund Request No. _______ 

Returned for Corrective 

 Action Retained by FEC

 ______ Deposit Batches _______ 

 ______ Written Instruments _______ 

 ______ Bank Statements _______ 

 ______ Deposit Slips _______ 

 ______ NSF Listing _______ 

 ______ Refund Listing _______ 

 ______ Joint Fundraising Documentation _______ 

 ______ Entertainment Event Documentation _______ 

 ______ Treasurer's Certification _______ 

 ______ Electronic Files _______ 

 Other: ____________________________________ _______ 

 ______ ____________________________________ _______ 

I agree the above inventory is correct with respect to documents returned to the Committee for 

corrective action and those remaining at the Federal Election Commission. 

(Signature of Treasurer or Committee Representative) 

Date: ______________________________ 
 

 

 

 

 

__________________________________________________________________________ 

__________________________________________________________________________ 

 

 

___________________________________________________________________________ 

 

Appendix 6 

Page 1 of 4 

SUMMARY OF SUBMISSION 

RESULTS OF REVIEW 

COMMITTEE: ________________________________________ SUB. No.: ___________ 

DATE SUBMITTED: __________________________________ RESUB. No.: ________ 

SUMMARY OF REVIEW 

AMOUNT NSF PREVIOUSLY 

REQUESTED: $______________ MATCHED: ($_____________) 

(SEE II. BELOW) 

 REFUNDED 

AMOUNT CONTRIBUTIONS 

ADJUSTED: $______________ PREVIOUSLY MATCHED: $______________ 

(SEE I. BELOW) (SEE III BELOW) 

AMOUNT CERTIFIABLE 

REJECTED: $______________ PER REVIEW: $______________ 

 FINAL AMOUNT CERTIFIED: $______________ 

I. The original amount requested by this Submission/ Resubmission was adjusted prior to 

the review in the amount of $________________________for the following reason(s): 

( ) NSF Items included in the Submission/ 

Resubmission $______________ 

( ) Mathematical Errors $______________ 

( ) Other: ________________________________ $______________ 

 _____________________________________ $______________ 

 _____________________________________ $______________ 
 

 

 

 

 

Appendix 6 

Page 2 of 4 

II. ( ) The NSF Adjustment shown on the Summary was made with respect to 

contributions matched in previous submissions. Each NSF item was adjusted in 

accordance with the percentage of the amount certified for payment for the 

submission. Following is a breakdown of the NSF Adjustment: 

 Submission Amount Percent Adjusted 

 Number NSF Items Certified _Amount 

III. ( ) The adjustment for refunded contributions matched in previous submission is 

calculated in the same manner as the NSF Adjustment above. 

Submission Amount Percent Adjusted 

 Number Refunded Items Certified Amount 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix 6 

Page 3 of 4 

SUMMARY 

RESULTS OF REVIEW 

COMMITTEE: __________________________________________ SUB. No.: _______ 

DATE SUBMITTED: _____________________________________ RESUB. No.: _______ 

The matching fund submission/resubmission identified above has been reviewed in accordance 

with the Commission's review procedures. The results of the review are summarized below. For 

a thorough explanation of the Commission's policy on the exceptions noted, see the 

Commission's Guideline for Presentation in Good Order, Chapter V, "Standard Exception Codes 

for Review of Matching Fund Requests." Furthermore, requirements for resubmission of 

rejected contributions are also contained in this chapter. 

Exception Subcategory Amount Error 

 Code Number_ Rejected Percentage

 A __________ $__________ __________ 

 B __________ __________ __________ 

 C __________ __________ __________ 

 D __________ __________ __________ 

 E __________ __________ __________ 

 F __________ __________ __________ 

 G __________ __________ __________ 

 H __________ __________ __________ 

 I __________ __________ __________ 

 J __________ __________ __________ 

TOTAL $__________ __________ 

As a result of this review, the final amount shown on page 1 will be certified to the Secretary of 

the Treasury on __________________________. 

* * * * * * * 
 

Appendix 6 

Page 4 of 4 

COMMITTEE: __________________________________________ SUB. No.: _______ 

DATE SUBMITTED: _____________________________________ RESUB. No.: ________ 

I am requesting the identification of the rejected contributions in the submission/resubmission 

noted above. I agree that this precludes the resubmission of the submission/resubmission in its 

entirety and limits resubmission by the Committee to only the identified items. Further, payment 

is limited to solely the matchable face value of each resubmitted contribution that has been 

corrected. 

Sub. No.: _________ __________________________________________________ 

 (Signature of Treasurer or Committee Representative) 

Resub. No.: _______ 

Amount Requested: $___________________ Date: ____________________ 
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Appendix 7 

CONTRIBUTION THROUGH AN 

EMPLOYEE PARTICIPATION PLAN 

CONTRIBUTION LACKING CONTRIBUTOR'S SIGNATURE 

Exception Code A-2 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on accounts of 

employee participation plans and do not bear the contributor's signature. 

Your contribution of $____________, dated _____________________, and drawn on check 

#_______ of the account identified as ______________________________________________ 

will qualify for matching only if the statement below is true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly. 

 Sincerely,

 Committee Representative 

This is to verify that I authorized the contribution to the Candidate/Committee through the 

account maintained for me by the employee participation plan. 

NAME ___________________________________________________________________ 

ADDRESS ________________________________________________________________ 

CITY _____________________________________________________________________ 

STATE _________________________________________ ZIP ______________________ 

YOUR 

SIGNATURE ____________________________________ DATE ____________________ 

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Appendix 8 

LOANS FORGIVEN 

Exception Code A-3 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that were initially loans to the 

Committee, but subsequently forgiven. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the statement(s) below are true and verified by your signature. 

If the statement below is not accurate, please provide a short explanation so the contribution can 

be attributed properly (or disposed of, if from an incorporated source). 

 Sincerely,

 Committee Representative 

This is to verify that the written instrument described above initially represented a loan from me 

to the Committee. However, on _____(provide date)_____ the loan was forgiven, and therefore, 

became a contribution from me. 

(If drawn on a non-personal account, the following language must be included): The 

account on which the written instrument is drawn represents my personal funds. It is not 

maintained or controlled by an incorporated entity. 

NAME __________________________________________________________________ 

ADDRESS _______________________________________________________________ 

CITY ____________________________________________________________________ 

STATE __________________________________________ ZIP ____________________ 

YOUR 

SIGNATURE _____________________________________ DATE __________________ 

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Appendix 9 

POSSIBLE FOREIGN CONTRIBUTION 

Exception Code A-6 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are from contributors 

having a mailing address outside of the United States or its territories. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the statement below is true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly (or disposed of, if prohibited). 

 Sincerely,

 Committee Representative 

This is to verify that I am a citizen of the United States or have been admitted as a permanent 

resident. 

NAME __________________________________________________________________ 

ADDRESS _______________________________________________________________ 

CITY ____________________________________________________________________ 

STATE _________________________________________ ZIP _____________________ 

YOUR 

SIGNATURE ____________________________________ DATE ___________________ 

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Appendix 10 

ATTRIBUTION OF UNMATCHED PORTION OF WRITTEN 

INSTRUMENT TO ANOTHER INDIVIDUAL 

Exception Code B-2 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on one check, 

but represent contributions from more than one person. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the statement below is true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly. 

 Sincerely,

 Committee Representative 

TO BE VERIFIED AND SIGNED BY INDIVIDUAL ASSUMING ALL OR 

PORTION OF ORIGINAL CONTRIBUTION 

The contribution described above also represents my personal funds. The amount of 

$____________ should be attributed to me. 

NAME __________________________________________________________________ 

ADDRESS _______________________________________________________________ 

CITY ___________________________________________________________________ 

STATE _________________________________________ ZIP _____________________ 

YOUR 

SIGNATURE ____________________________________ DATE ___________________ 

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Appendix 11 

Page 1 of 2 

REATTRIBUTION OF AN EXCESSIVE CONTRIBUTION 

TO ANOTHER INDIVIDUAL 

Exception Code A-4 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on one check, 

but represent contributions from more than one person. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the statement below is true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly. 

** If this document is to be used as evidence of a reattribution of an excessive contribution 

within 60 days from the date of receipt, it must either be date-stamped as received by the 

Candidate/ Committee, accompanied by a copy of the envelope containing the postmark and 

other identifying documentation, or be dated by the contributors. 

 Sincerely,

 Committee Representative 
____________________________________ ___________________________________ 

Appendix 11 

Page 2 of 2 

TO BE VERIFIED AND SIGNED BY INDIVIDUALS ASSUMING ALL OR 

PORTION OF ORIGINAL CONTRIBUTION 

The contribution described above also represents our personal funds. 

NAME_______________________________ 

ADDRESS___________________________ 

CITY________________________________ 

STATE__________ ZIP_________________ 

YOUR 

SIGNATURE_________________________ 

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DATE_________________________ 

AMOUNT CONTRIBUTED_____________ 

NAME______________________________ 

ADDRESS__________________________ 

CITY_______________________________ 

STATE__________ ZIP________________ 

 YOUR 

SIGNATURE________________________ 

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DATE_________________________ 

AMOUNT CONTRIBUTED____________ 
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Appendix 12 

APPARENT BUSINESS ACCOUNTS 

Exception Code C-1 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on accounts 

maintained by a business entity. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the conditions below are true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly (or disposed of, if from an incorporated source). 

 Sincerely,

 Committee Representative 

This is to verify that the business maintaining the account identified above is not incorporated. 

The contribution represents my personal funds, as I am a member of the unincorporated 

business. The full amount as listed above should be attributed to me, as it does not represent 

contributions from more than one person. 

NAME ____________________________________________________________________ 

ADDRESS _________________________________________________________________ 

CITY _____________________________________________________________________ 

STATE _________________________________________ ZIP _______________________ 

YOUR 

SIGNATURE ____________________________________ DATE _____________________ 

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Appendix 13 

Page 1 of 2 

PARTNERSHIP, GROUP, ASSOCIATION ACCOUNTS 

OR OTHER NON-PERSONAL ACCOUNTS 

Exception Code C-2 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on accounts 

maintained by partnerships, groups, or associations, or other types of non-personal accounts. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the following information is provided and verified by your 

signature. If you cannot verify the statements below because of they are inaccurate, please 

provide a short explanation so the contribution can be attributed properly (or disposed of, if from 

prohibited sources). 

 Sincerely,

 Committee Representative 

(1) The contribution described above is drawn on an account maintained by: 

_____ a partnership, which is non-incorporated. 

____ a professional association or professional corporation that is not treated as a 

corporation under applicable state laws in the State of 

_______________________________________. 

____ a limited liability company (LLC) that elects to be treated as a partnership 

or a person by the Internal Revenue Code. (11 CFR §110.1(g)). 

_____ other group or association (describe). 

 _______________________________________________________ 

 _______________________________________________________ 
 

Appendix 13 

Page 2 of 2 

(2) _____ the contribution described above represents my personal funds, as I am a 

partner in the partnership (or a member of the association). The full amount 

as listed above should be attributed to me, as it does not represent 

contributions from more than one person. 

NAME ____________________________________________________________________ 

ADDRESS _________________________________________________________________ 

CITY _____________________________________________________________________ 

STATE __________________________________________ ZIP ______________________ 

YOUR 

SIGNATURE _____________________________________ DATE ____________________ 

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Appendix 14 

TRUST/ESCROW/ESTATE ACCOUNTS 

Exception Code C-3 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on Trust, 

Escrow, or Estate Accounts. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the conditions below are true and verified by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly. 

 Sincerely,

 Committee Representative 

This is to verify that I have equitable ownership of the account described above. The account on 

which the contribution is drawn represents my personal funds. 

NAME ___________________________________________________________________ 

ADDRESS ________________________________________________________________ 

CITY ____________________________________________________________________ 

STATE _________________________________________ ZIP ______________________ 

YOUR 

SIGNATURE ____________________________________ DATE ____________________ 

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Appendix 15(a) 

MATCHABLE AND NON-MATCHABLE DESIGNATED ACCOUNTS 

MATCHABLE 

Providing that the personal check1 is matchable in every other respect, the following types of 

designated accounts are considered acceptable for matching purposes without additional 

documentation signed by the contributor: 

 Attorney Account 

 Beach Account 

 Campaign Contribution Account 

 Cash Management Account 

 Charter Account 

 Construction Account 

 Drawing Account 

 Farm Account 

 Gift Account 

 Household Account 

 Installment Account 

 Investment Account 

 Medical Account 

 Oil Account 

 Photography Account 

 Property Account 

 Rental Account 

Special Account 

 Stock Account 

 Attorney Fee Account 

 Building Account 

 Capital Account 

 Cattle Account 

 Condominium Account 

 Discretionary Account 

 Expense Account 

 Gas Account 

 Hotel Account 

 Income Account 

 Insurance Account 

 Livestock Account 

 Motel Account 

 Payment Account 

 Professional Account 

 Real Estate Account 

 Separate Property Account 

 Special Disbursement Account 

 Sub-Division Account 

Tax Account 

See definition of "personal appearance" at Exception Code C-4 (Chapter V) of the Guideline. 1 
Appendix 15(b) 

MATCHABLE AND NON-MATCHABLE DESIGNATED ACCOUNTS 

NON-MATCHABLE 

The types of accounts listed below, although maintained by an individual, will require additional 

documentation from the contributor that acknowledges the account contains solely personal 

funds and is not funded by an incorporated entity: 

 Business Account 

 Campaign Account (or Fund) 

 Collection Account 

 Commercial Account 

 D/B/A Account 

 Firm Account 

 Office Account 

 Operating Account 

 Overhead Account 

 Store Account 

 T/A Account 

 Trade Account 
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Appendix 16 

INDIVIDUAL'S DESIGNATED PERSONAL ACCOUNTS 

(Office Account, Business Account, etc.) 

Exception Code C-4 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching that are drawn on certain types 

of personal accounts which bear a designation indicating the possibility that the account may 

contain funds other than your personal funds. 

Your contribution of $____________, dated ______________________, and drawn on check 

#_______of the account identified as _______________________________________________ 

will qualify for matching only if the statements below are true and confirmed by your signature. If 

the statement below is not accurate, please provide a short explanation so the contribution can be 

attributed properly (or disposed of, if from an incorporated source). 

 Sincerely,

 Committee Representative 

This is to verify that the contribution described above is drawn on an account that contains only 

my personal funds. The account is not funded for my use on an unreimbursed basis by an 

incorporated entity. 

NAME __________________________________________________________________ 

ADDRESS _______________________________________________________________ 

CITY ____________________________________________________________________ 

STATE _________________________________________ ZIP ______________________ 

YOUR 

SIGNATURE ____________________________________ DATE ____________________ 

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Appendix 17 

SIGNATURE OTHER THAN ACCOUNTHOLDER 

(Written Instrument is signed by other than accountholder and 

contribution is to be attributed to accountholder) 

Exception Code D-1 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are 

entitled to receive federal funds from the Presidential Primary Matching Payment 

Account in an amount up to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission 

requires additional documentation for contributions submitted for matching that are 

signed by someone other than the accountholder identified on the face of the check. 

A contribution of $____________, dated _____________________, and drawn on check 

#_______ of the account that identifies you as the accountholder, but is signed by 

someone other than yourself, will qualify for matching only if the statement below is true 

and verified by your signature. If the statement below is not accurate, please provide a 

short explanation so the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

This is to verify that the contribution described above represents my personal 

contribution and my signature appears below. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE __________________________________________ ZIP ___________________ 

YOUR 

SIGNATURE _____________________________________ DATE ________________ 

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Appendix 18 

SIGNATURE OTHER THAN ACCOUNTHOLDER 

(Written Instrument is signed by an individual 

not identified as an accountholder and 

contribution is to be attributed to signatory) 

Exception Code D-1 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are 

entitled to receive federal funds from the Presidential Primary Matching Payment 

Account in an amount up to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission 

requires additional documentation for contributions submitted for matching that are 

signed by someone other than the identified accountholder. 

A contribution of $____________, dated _____________________, and drawn on check 

#_______ of the account identified as ________________________________________, 

but bearing your signature, will qualify for matching only if the statement below is true 

and verified by your signature. If the statement below is not accurate, please provide a 

short explanation so the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

TO BE COMPLETED BY CONTRIBUTOR TO WHOM ATTRIBUTED 

(NON-ACCOUNTHOLDER): 

This is to verify that the contribution described above is drawn on an account which 

contains/represents my personal funds as well as those of the identified accountholder. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE __________________________________________ ZIP ___________________ 

YOUR 

SIGNATURE _____________________________________ DATE ________________ 

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Appendix 19 

JOINT ACCOUNTS 

NOT SIGNED BY INDIVIDUAL TO WHOM 

CONTRIBUTION IS ATTRIBUTED 

Exception Code D-2 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are 

entitled to receive federal funds from the Presidential Primary Matching Payment 

Account in an amount up to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission 

requires additional documentation for contributions submitted for matching that are 

drawn on written instruments not bearing the signature of the contributor. 

Your contribution of $____________, dated __________________, and drawn on check 

#_______ of the joint account identified as _____________________________________ 

will qualify for matching only if the statement below is true and verified by your 

signature. If the statement below is not accurate, please provide a short explanation so 

the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

This is to certify that a contribution of $________________, effected on the written 

instrument described above, should be attributed to me. The account contains my 

personal funds and my signature appears below. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE __________________________________________ ZIP ___________________ 

YOUR 

SIGNATURE _____________________________________ DATE ________________ 

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Appendix 20 

OMITTED INFORMATION ON WRITTEN INSTRUMENT 

(Date, Payee, Amount) 

Exception Code E 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are 

entitled to receive federal funds from the Presidential Primary Matching Payment 

Account in an amount up to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission 

requires additional documentation for contributions submitted for matching that do not 

fully contain the contributor's signature, the amount, the date, or identify the Committee 

as the payee. 

Your contribution of $____________, dated __________________, and drawn on check 

#_______ of the account identified as _________________________________________ 

will qualify for matching only if the information below is provided and verified by your 

signature. If the statement below is not accurate, please provide a short explanation so 

the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

This is to verify that the full date of contribution described above is (day, month, year). 

The written instrument described above was intended to be my personal contribution of 

$___________ to the Candidate/Committee. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE __________________________________________ ZIP ___________________ 

YOUR 

SIGNATURE _____________________________________ DATE ________________ 

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Appendix 21 

WRITTEN INSTRUMENT APPEARS TO HAVE NO ASSOCIATION 

WITH LISTED CONTRIBUTOR 

Exception Code G-3 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

additional documentation for contributions submitted for matching for individuals who are not 

identified on the written instrument, as accountholders, remitters/ purchasers, or signatories. 

Your contribution of $____________, dated __________________, and drawn on check 

#_______ of the account (or, if a money order or similar written instrument, the issuer and 

remitter/purchaser must be acknowledged) identified as ______________________ 

___________________________ will qualify for matching only if the conditions below are true 

and verified by your signature. If the statement below is not accurate, please provide a short 

explanation so the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

TO BE COMPLETED BY INDIVIDUAL TO WHOM CONTRIBUTION IS ATTRIBUTED 

This is to verify that the written instrument described above represents a joint contribution to 

the Candidate/Committee from me and___________________________. The account contains 

(or written instrument was purchased with) my personal funds and the amount of 

$______________ is my personal contribution. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE __________________________________________ ZIP ___________________ 

YOUR 

SIGNATURE _____________________________________ DATE ________________ 

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Appendix 22 

DOCUMENTATION REQUIRED FOR INITIAL SUBMISSION OF 

CONTRIBUTIONS RECEIVED IN THE FORM OF MONEY 

ORDERS, CASHIER'S CHECKS OR OTHER 

NEGOTIABLE WRITTEN INSTRUMENTS 

Exception Code G-4 

Dear Contributor: 

Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to 

receive federal funds from the Presidential Primary Matching Payment Account in an amount up 

to $250 from an individual contributor. 

To ensure only contributions that qualify are matched, the Federal Election Commission requires 

contributions received in the form of money orders or cashiers' checks to be accompanied by a 

signed statement from the contributor before they can be submitted for matching. 

Your contribution of $____________, dated __________________, and drawn on a (identify 

whether money order or cashier's check), issued by (name of issuer), serial 

#_______________________, will qualify for matching only if the contribution is confirmed by 

the statement below and by your signature. If the statement below is not accurate, please provide 

a short explanation so the contribution can be attributed properly. 

 Sincerely,

 Committee Representative 

This is to confirm that the written instrument described above was obtained by me and was 

purchased solely with my personal funds. It represents my personal contribution to the 

Candidate/ Committee. 

NAME _________________________________________________________________ 

ADDRESS ______________________________________________________________ 

CITY __________________________________________________________________ 

STATE ___________________________________________ ZIP __________________ 

YOUR 

SIGNATURE ______________________________________ DATE _______________ 

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