Committee for Fair Taxes for All Students
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT'
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
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2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
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4.b. CANDIDATE'S HOME ADDRESS ('d different than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, I applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
7. CATEGORY OR REPORT (Check one)
FIRT SEO❑OND THM FdUkTH P❑RE P❑RE- MI ❑Y AR YEAR,-END
QUARTER QUARTER QUARTER QUARTER MARY GENERAL SUPPLEMENTAL SURPLEMENTAI_
8.a. BEGINNING DATE OF REPORTING PERIOD 6.b. ENDING DATE OF REPORTING PERIOD
9. (Check one)
a. This campaign is exempt from detailed demure because contributions (including in-kind) received total $1,000 or less AND expendi-
tures total $1,000 or less for this reporting period. (Complete Items 12d., 12e. and 12f.)
b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000
and/or expenditures total more than $1,000 for this reporting period.
10. Uwe do solemnly swear or affirm that the information contained In this campaign financial disclosure report is true and that this report is an
accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. Additionally, Uwe swear or affirm that no campaign contributions have been expended for the personal financial
benefit of the candidate or for any other nonpolitical purpose as defined by the fade 1 intemal nue code.
signature of candidate date signature of political treasurer date
11. WITNESS SIGNATURE
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTALRECEIPTS THIS PERIOD ................................................................................................3 y
c. TOTAL DISBURSEMENTS THIS PERIOD ...................................................................................3 0
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING $ 0
f. TOTALOBLIGATIONS OUTSTANDING $ O
SSA 109 (Rev. 2106) Pape 1 of RDA 1159