FEC FORM 3X 1. NAME OF COMMITTEE (in full) REPORT OF RECEIPTS AND DISBURSEMENTS For Other Than An Authorized Committee TYPE OR PRINT Office Use Only Example: If typing, type over the lines. 12FE4M5 ADDRESS (number and street) Check if different than previously reported. (ACC) Y Y Y C 4. TYPE OF REPORT (Choose One) (a) Quarterly Reports: April 15 Quarterly Report (Q1) July 15 Quarterly Report (Q2) October 15 Quarterly Report (Q3) January 31 Year-End Report (YE) July 31 Mid-Year Report (Non-election Year Only) (MY) Termination Report (TER) (d) (b) Monthly Report Due On: 3. IS THIS REPORT Feb 20 (M2) Mar 20 (M3) Apr 20 (M4) (c) 12-Day PRE-Election Report for the: NEW (N) OR May 20 (M5) Jun 20 (M6) Jul 20 (M7) Primary (12P) Convention (12C) M M / D D / Y General (12G) Special (12S) Y Y Y Election on 30-Day POST-Election Report for the: Election on General (30G) M M / D D / Y Runoff (30R) Y Y Y 5. Covering Period M M / D D / Y Y Y Y M M / D through 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 of Treasurer M M / D D / Y Signature of Treasurer Date NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 52 U.S.C. § 30109. Office Use Only 2. FEC IDENTIFICATION NUMBER CITY STATE ZIP CODE AMENDED (A) Aug 20 (M8) Sep 20 (M9) Oct 20 (M10) (Non-Election Year Only) (Non-Election Year Only) Nov 20 (M11) Dec 20 (M12) Jan 31 (YE) Runoff (12R) in the State of Special (30S) in the State of D / Y Y Y Y FEC FORM 3X Rev. 05/2016 American LegalNet, Inc. www.FormsWorkFlow.com FEC Form 3X (Rev. 05/2016 ) Write or Type Committee Name OF RECEIPTS AND DISBURSEMENTS SUMMARY PAGE Page 2 M M / D D / Y Y Y Y M M / D D / Y Y Y Y Report Covering the Period: From: To: COLUMN A This Period 6. (a) Cash on Hand January 1, Y Y Y Y COLUMN B Calendar Year-to-Date , , , , , , , , , , , , , , , . . . . . . . , , , , , . (b) Cash on Hand at Beginning of Reporting Period ............ (c) Total Receipts (from Line 19) ............. (d) Subtotal (add Lines 6(b) and 6(c) for Column A and Lines 6(a) and 6(c) for Column B) ............... , , , , . . . . 7. 8. Total Disbursements (from Line 31) ........... Cash on Hand at Close of Reporting Period (subtract Line 7 from Line 6(d)) ................. Debts and Obligations Owed TO the Committee (Itemize all on Schedule C and/or Schedule D) ................ 9. 10. Debts and Obligations Owed BY the Committee (Itemize all on Schedule C and/or Schedule D) ................ This committee has qualified as a multicandidate committee. (see FEC FORM 1M) For further information contact: Federal Election Commission 999 E Street, NW Washington, DC 20463 Toll Free 800-424-9530 Local 202-694-1100 American LegalNet, Inc. www.FormsWorkFlow.com DETAILED SUMMARY PAGE FEC Form 3X (Rev. 05/2016 ) Write or Type Committee Name of Receipts Page 3 M M / D D / Y Y Y Y M M / D D / Y Y Y Y Report Covering the Period: From: To: I. Receipts 11. Contributions (other than loans) From: (a) Individuals/Persons Other Than Political Committees (i) Itemized (use Schedule A) ............ (ii) Unitemized ..................................... (iii) TOTAL (add Lines 11(a)(i) and (ii) ................. COLUMN A Total This Period COLUMN B Calendar Year-to-Date , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . (b) Political Party Committees .................. (c) Other Political Committees (such as PACs).................................... (d) Total Contributions (add Lines 11(a)(iii), (b), and (c)) (Carry Totals to Line 33, page 5) .............. 12. Transfers From Affiliated/Other Party Committees ........................................ , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . , , , , , , , , , , , , 13. All Loans Received ..................................... 14. Loan Repayments Received ....................... 15. Offsets To Operating Expenditures (Refunds, Rebates, etc.) (Carry Totals to Line 37, page 5)............... 16. Refunds of Contributions Made to Federal Candidates and Other Political Committees .................................... 17. Other Federal Receipts (Dividends, Interest, etc.) ............................ 18. Transfers from Non-Federal and Levin Funds (a) Non-Federal Account (from Schedule H3) ............................. (b) Levin Funds (from Schedule H5) ......... (c) Total Transfers (add 18(a) and 18(b)) .. 19. Total Receipts (add Lines 11(d), 12, 13, 14, 15, 16, 17, and 18(c)) ......... 20. Total Federal Receipts (subtract Line 18(c) from Line 19) ......... American LegalNet, Inc. www.FormsWorkFlow.com DETAILED SUMMARY PAGE FEC Form 3X (Rev. 05/2016 ) of Disbursements Page 4 II. Disbursements 21. Operating Expenditures: (a) Allocated Federal/Non-Federal Activity (from Schedule H4) (i) Federal Share ............................. (ii) Non-Federal Share...................... (b) Other Federal Operating Expenditures ....................................... (c) Total Operating Expenditures (add 21(a)(i), (a)(ii), and (b)) ............. Transfers to Affiliated/Other Party Committees ................................................. Contributions to Federal Candidates/Committees and Other Political Committees ................. Independent Expenditures (use Schedule E) ....................................... Coordinated Party Expenditures (52 U.S.C. § 30116(d)) (use Schedule F)........................................ COLUMN A Total This Period COLUMN B Calendar Year-to-Date , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . . . . . , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . . . . . . . . . . . . . . . . . . . . . 22. 23. 24. 25. , 26. Loan Repayments Made ............................ 27. Loans Made................................................ 28. Refunds of Contributions To: (a) Individuals/Persons Other Than Political Committees ................. (b) Political Party Committees ................. (c) Other Political Committees (such as PACs)................................... (d) Total Contribution Refunds (add Lines 28(a), (b), and (c)) ........... 29. Other Disbursements (Including Non-Federal Donations)................................... 30. Federal Election Activity (52 U.S.C. § 30101(20)) (a) Allocated Federal Election Activity (from Sche