REPORTOFRECEIPTSANDEXPENDITURESOFAPOLITICAL.doc

REPORT OF RECEIPTS AND EXPENDITURES OF A POLITICAL COMMITTEE State Form 4606 (R13/11-05) Indiana Election Commission (IC 3-9-5-14) (CFA-4) Summary Sheet FILE NUMBER INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this form. For assistance in completing this form, see instructions on the reverse side. TOTAL PAGES IN ENTIRE CFA-4 REPORT IS THIS AN AMENDMENT? Yes No COMMITTEE INFORMATION 1. Full Name of Committee (as on Statement of Organization) Check if this is a new name 2. Acronym or Abbreviated Name (if any) 3. Committee Telephone Number ( ) 4. Mailing Address (address where all campaign finance correspondence is received) Check if this is a new address 5. City, State, ZIP Code 6. Party Affiliation (if applicable) CANDIDATE INFORMATION (For Candidate’s Committees Only) 7. Full Name of Candidate (include any nickname) 8. Party Affiliation or If Independent Candidate 9. Office Sought (Include district number, if any. Not required for exploratory committee.) 10. County of Residence TYPE OF REPORT CONVENTION CANDIDATES ONLY 11. Check one: Pre-Primary Pre-Election Annual Nomination Other __________________________________________________ Final/Disbands Committee (lines 18, 19, and 20 must be “0”) Outgoing Treasurer (within 10 days amend Statement of Organization) Check one: Pre-Convention Post-Convention 12. Reporting Period: From: Through: COLUMN A This Period COLUMN B Year to Date 13. Cash on hand and investments at the beginning of this reporting period. 14. Cash on hand and investments January 1, current year. CONTRIBUTIONS AND RECEIPTS (Note: these amounts incl