this area for official use only FaiR Campaign …...ALABAMA FAIR CAMPAIGN PRACTICES ACT FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL The FCPA requires that those

Candidate & Elected OfficialCampaign Finance ReportSummaRy FORm 1a

this area for official use only

Form revised 5.24.2017

Name of Candidate or Elected Official

Telephone Number

As required by the Alabama Fair Campaign Practices Act, i hereby swear or affirm to the best of my knowledge and belief that the attached report(s) and the information contained herein are true and correct and that this information is a full and complete statement of all contributions, expenditures, and other required information during the applicable period of time.

Signature of Candidate or Elected Official

Address

Amended Annual report

date

Check box if reporting new address

City state ZiP Code

Political Party/Ballot Affiliation

Termination report

sworn to and subscribed before me this ____________ day of ____________ of the

year ____________. my commission expires the _________ day of ____________ of

the year ____________.

Print Notary's Name

signature of Notary Public

Please Print in Ink or Type.

Office Sought or Held (include district or circuit number, if applicable)

Calendar Year covered by this report.

Total Pages in Reportinclude this page in your count.

FaiR Campaign pRaCtiCES aCt StatE OF alabama

Cash Contributions

Total itemized receipts from other sources (total from Form 4)

itemized cash contributions (total from Form 2)

Non-itemized cash contributions

Itemized in-kind contributions (total from Form 3)

Total cash contributions (add lines 2a and 2b)

Non-itemized expendituresItemized expenditures (total from Form 5)

Total in-kind contributions (add lines 3a and 3b)Non-itemized in-kind contributions

Total expenditures (add lines 5a and 5b)

ending balance (add lines 1, 2c, & 4c, then subtract line 5c)

Beginning balance (ending balance from previous filing)

In-Kind Contributions

Expenditures

Receipts from Other Sources

ending balance (add lines 8, 9, & 11, then subtract line 12)

Total expenditures for yearTotal receipts from other sources for yearTotal in-kind contributions for yearTotal cash contributions for yearBeginning balance (as of January 1 of reporting year)

SECTION I - Summary of activity from last filed report through December 31 of reporting year

SECTION II - Summary of activity for entire reporting year - January 1st through December 31st

1

2b2a

2c

5b5a

5c

77

5c

5a5b

3c3b3a

2c2b

4a

2a

1

12

14

111098

1213

1110

98

15 Total campaign debt (total debt owed as of december 31) 15

4c4b Total non-itemized receipts from other sources

Total receipts from other sources (add lines 4a and 4b)

3a3b

4a

4c4b

3c

an

nu

al

Non-itemized expendituresItemized expenditures on line of credit (total from Form 6)

Total expenditures on line of credit (add lines 6a and 6b)

Expenditures on Line of Credit

6b6a

6c6c

6a6b

Total expenditures on line of credit for year1314

ALABAMA FAIR CAMPAIGN PRACTICES ACT

FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL

The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.

CONTRIBUTOR(INCLUDE FULL NAME)

ADDRESS(ADDRESS SHOULD INCLUDE

STREET OR P.O. BOX, CITY, STATE, AND ZIP)

SOURCEOF CONTRIBUTION

(CHECK ONE)

DATECONTRIBUTION

RECEIVED(mo./day/yr.)

AMOUNTOF

CONTRIBUTION

FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE

Bus

ines

s or

Cor

pora

tion

Indi

vidu

al

PA

C

Ret

urne

d

Oth

er

NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____








(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION


Bus

ines

s or

Cor

pora

tion

Indi

vidu

al

PA

C

Ret

urne

d

Oth

er









(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION


Bus

ines

s or

Cor

pora

tion

Indi

vidu

al

PA

C

Ret

urne

d

Oth

er









(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION


Bus

ines

s or

Cor

pora

tion

Indi

vidu

al

PA

C

Ret

urne

d

Oth

er









(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION


Bus

ines

s or

Cor

pora

tion

Indi

vidu

al

PA

C

Ret

urne

d

Oth

er



FORM 3: IN-KIND CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL

The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or loans on this form. Use Forms 2 and 4 for those listings.




SOURCE(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION

FORM REVISED 10.29.99TOTAL IN-KIND CONTRIBUTIONS THIS PAGE

Bus

ines

s/C

orpo

ratio

n

Indi

vidu

al

PA

C

Oth

er

NATURE OF CONTRIBUTION(CHECK ONE)

Adm

inis

trativ

e

Ren

t

Foo

d

Adv

ertis

ing

Equ

ipm

ent

Tra

nspo

rtat

ion

Con

sulta

nts/

Pol

ling

Oth

er



FORM 3: IN-KIND CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL

The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or loans on this form. Use Forms 2 and 4 for those listings.




SOURCE(CHECK ONE)

DATECONTRIBUTION


AMOUNTOF

CONTRIBUTION

FORM REVISED 10.29.99TOTAL IN-KIND CONTRIBUTIONS THIS PAGE

Bus

ines

s/C

orpo

ratio

n

Indi

vidu

al

PA

C

Oth

er

NATURE OF CONTRIBUTION(CHECK ONE)

Adm

inis

trativ

e

Ren

t

Foo

d

Adv

ertis

ing

Equ

ipm

ent

Tra

nspo

rtat

ion

Con

sulta

nts/

Pol

ling

Oth

er



FORM 4: RECEIPTS FROM OTHER SOURCES

The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or in-kind contributions on this form. Use Forms 2 and 3 for those listings.

SOURCE OF RECEIPT(INCLUDE FULL NAME)


STREET OR P.O. BOX,CITY, STATE, AND ZIP)

RECEIPT SOURCE(CHECK ONE)

DATE RECEIVED(mo./day/yr.)

AMOUNTOF

RECEIPT

FORM REVISED 10.29.99TOTAL RECEIPTS THIS PAGE

PA

C

Indi

vidu

al

Bus

ines

s

Oth

er

COMPLETE THIS BLOCK IF RECEIPTIS A LOAN

GUARANTORS

[FCPA REQUIRES FULL NAME ANDCOMPLETE ADDRESS OF INDIVIDUAL(S)ENDORSING OR GUARANTEEING LOAN]O

ther

Loan

Inte

rest

Lend

ing

Inst

itutio

n

LOANS/INTEREST/OTHER SOURCES OFINCOME TO CANDIDATE OR ELECTED OFFICIAL

FORMOF RECEIPT



FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____

The FCPA requires that expenditures over $100 be itemized.

PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE

(INCLUDE FULL NAME)



DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE

FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE

Tra

nspo

rtat

ion

PURPOSE OF EXPENDITURE(CHECK ONE)

Adm

inis

trat

ive

Fun

drai

sing

Foo

d

Adv

ertis

ing

Con

trib

utio

n

Loan

Rep

aym

ent

Con

sulta

nts/

Pol

ling

Lodg

ing

BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES

OTHER

GIVEBRIEF

EXPLANATION





(INCLUDE FULL NAME)



DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE


Tra

nspo

rtat

ion


Adm

inis

trat

ive

Fun

drai

sing

Foo

d

Adv

ertis

ing

Con

trib

utio

n

Loan

Rep

aym

ent

Con

sulta

nts/

Pol

ling

Lodg

ing


OTHER

GIVEBRIEF

EXPLANATION





(INCLUDE FULL NAME)



DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE


Tra

nspo

rtat

ion


Adm

inis

trat

ive

Fun

drai

sing

Foo

d

Adv

ertis

ing

Con

trib

utio

n

Loan

Rep

aym

ent

Con

sulta

nts/

Pol

ling

Lodg

ing


OTHER

GIVEBRIEF

EXPLANATION





(INCLUDE FULL NAME)



DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE


Tra

nspo

rtat

ion


Adm

inis

trat

ive

Fun

drai

sing

Foo

d

Adv

ertis

ing

Con

trib

utio

n

Loan

Rep

aym

ent

Con

sulta

nts/

Pol

ling

Lodg

ing


OTHER

GIVEBRIEF

EXPLANATION





(INCLUDE FULL NAME)



DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE


Tra

nspo

rtat

ion


Adm

inis

trat

ive

Fun

drai

sing

Foo

d

Adv

ertis

ing

Con

trib

utio

n

Loan

Rep

aym

ent

Con

sulta

nts/

Pol

ling

Lodg

ing


OTHER

GIVEBRIEF

EXPLANATION

AlAbAmA FAir CAmpAign prACtiCes ACt - CAmpAign FinAnCe report For CAndidAte & eleCted oFFiCiAl

Form 6: expenditures on line of Credit by candidate or elected officialnAme oF CAndidAte or eleCted oFFiCiAl:

When total expenditures to a single recipient exceed $100.00, the FCPA requires all expenditures to that recipient be itemized.

PERSON/GROUP/BUSINESS RECEIVING EXPENDITURE

(inClude Full nAme)

ADDRESS(Address should inClude

street or P.o. Box, City, stAte, And ziP)

DATE OFEXPENDITURE

(mo./day/yr.)

AMOUNTOF

EXPENDITURE

Form revised 5.19.2017TOTAL EXPENDITURES THIS PAGE

inte

rest

PURPOSE OF EXPENDITURE(CheCK one)

Adm

inis

trativ

e

Fund

rais

ing

Food

Adv

ertis

ing

Con

tribu

tion

lodg

ing

Con

sulta

nts/

Pol

ling

tran

spor

tatio

n

OThERgive BrieF

exPlAnAtion

Documents

this area for official use only FaiR Campaign …...ALABAMA FAIR CAMPAIGN PRACTICES ACT FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL The FCPA requires that those