ITEMIZED CONTRIBUTION FOR ELECTIONEERING COMMUNICATIONS ($50 OR MORE) Name of Person/Entity 1. Date Received _ _/_ _/_ _ 4. Name (last, 2. Contribution Amount 5. Address $ 6. City/State/Zip Cash  3. Loan  In-Kind 1. Date Received _ _/_ _/_ _ 4. Name (last, first) 2. Contribution Amount 5. Address $ 6. City/State/Zip Cash  3. Loan  In-Kind 1. Date Received _ _/_ __/_ _ 4. Name (last, first) 2. Contribution Amount 5. Address $ 6. City/State/Zip Cash Loan 3. In-Kind 1. Date Received _ _/___/_ 4. Name (last, first) 2. Contribution Amount 5. Address $ 6. City/State/Zip Cash  3. Loan In-Kind 1. Date Received _ __/_ __/_ __ 4. Name (last, 2. Contribution Amount 5. Address $ 6. City/State/Zip Cash  3. Loan In-Kind
ITEMIZED CONTRIBUTION FOR ELECTIONEERING COMMUNICATIONS ($50 OR MORE) Name of Person/Entity 1. Date Received _ _/_ _/_ _ 2. Contribution Amount $ 3. Cash  Loan  In-Kind 4. Name (last, 5. Address 6. City/State/Zip 1. Date Received _ _/_ _/_ _ 2. Contribution Amount $ 3. Cash  Loan  In-Kind 4. Name (last, first) 5. Address 6. City/State/Zip 1. Date Received _ _/_ __/_ _ 2. Contribution Amount $ 3. Cash Loan In-Kind 4. Name (last, first) 5. Address 6. City/State/Zip 1. Date Received _ _/___/_ 2. Contribution Amount $ 3. Cash  Loan In-Kind 4. Name (last, first) 5. Address 6. City/State/Zip 1. Date Received _ __/_ __/_ __ 2. Contribution Amount $ 3. Cash  Loan In-Kind 4. Name (last, 5. Address 6. City/State/Zip