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FEC

FORM 3X

1.

NAME OF COMMITTEE (in full)

REPORT OF RECEIPTS AND DISBURSEMENTS

For Other Than An Authorized Committee

TYPE OR PRINT

Example: If typing, type over the lines.

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ADDRESS (number and street)

Check if different than previously reported. (AGO)

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FEC IDENTIFICATION NUMBER •

CITY.

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STATE A

ZIP CODE

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6

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5

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3.

IS THIS

REPORT

NEW

(N)

OR

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AMENDED

(A)

4.

TYPE OF REPORT

(Choose One)

(a)

Quarterly Reports;

(b)

Monthly

Report

Due On:

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peb 20 (M2)

Mar 20 (M3)

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May 20 (M5)

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Jun 20 (M6)

April 15 Quarterly Report (01)

July 15 Quarterly Report (02)

October 15 Quarterly Report (03)

• — ••

January 31 Year-End Report (YE)

Apr 20 (M4)

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Jul 20 (M7)

(c)

12-Day

PRE-Election Report for the:

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Primary (12P)

Convention (120)

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Election on

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Aug 20 (M8)

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Sep 20 (M9)

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Oct 20 (M10)

General (12G)

Special (12S)

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July 31 Mid-Year Report (Non-election Year Only)-(MY)

Termination Report

(TER)

(d)

30-Day

POST-Election Report for the:

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Election on

General (30G)

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Runoff (30R)

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Nov^20

Election

(Mil)

Year Only)

Dec 20 (M12)

(Non-Election

Year Only)

Jan 31

(YE)

Runoff (12R)

in the

State of

Special (308)

in the

State of

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5.

Covering Period

through

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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 LOoUfab, S^phonie.

Signature of Treasurer

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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

FEC FORM 3X

Rev. 05/2016

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FEC Form 3X (Rev. 05/2016) Write or Type Committee Name

SUMMARY PAGE

OF RECEIPTS AND DISBURSEMENTS

Orbon

Vi^on=.

Page 2

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Report Covering the Period:

From:

SJ SSJJ

6.

(a)

Cash on Hand January 1,

(b)

Cash on Hand at Beginning of Reporting Period.

COLUMN A

This Period

To:

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COLUMN B Calendar Year-to-Date

(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) ..

1

1

6

2

1

9

7.

Total Disbursements (from Line 31).

8.

Cash on Hand at Close of Reporting Period (subtract Line 7 from Line 6(d)).

9.

Debts and Obligations Owed TO

the Committee (Itemize all on

Schedule C and/or Schedule D) ..

  • 10. Debts and Obligations Owed BY the Committee (Itemize all on Schedule C and/or Schedule D) ..

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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

Toil Free 800-424-9530 Local 202-694-1100

r n DETAILED SUMMARY PAGE of Receipts FEC Form 3X (Rev. 05/2016) Write or Type Committee
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DETAILED SUMMARY PAGE
of Receipts
FEC Form 3X (Rev. 05/2016)
Write or Type Committee Name
Page 3
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Report Covering the Period:
From:
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TV.
I. Receipts
COLUMN A
Total This Period
COLUMN B
Calendar Year-to-Date
11.
Contributions (other than loans) From:
(a)
Individuals/Persons Other
Than Political Committees
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(i)
Itemized (use Schedule A)
(ii) Unitemized
(iii) TOTAL (add
Lines 11(a)(i) and (ii).
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...
ciftaooi:
(b)
Political Party Committees
(c)
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Other Political Committees
(such as PACs)
(d)
Total Contributions (add Lines
0
11(a)(iii), (b), and (c)) (Carry
Totals to Line 33, page 5)
S
12.
Transfers From Affiliated/Other
Party Committees
i
ll
13.
All Loans Received.
14.
Loan Repayments Received
2
15.
2
Offsets To Operating Expenditures
(Refunds, Rebates, etc.)
(Carry Totals to Line 37, page 5)
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16.
Refunds of Contributions Made
to Federal Candidates and Other
Political Committees
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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).

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FEC Form 3X (Rev. 05/2016)

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)).

22.

23.

24.

25.

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(d5) (use Schedule F)

  • 0 Loan Repayments Made.

26.

  • 0 Loans Made

27.

  • 6 Refunds of Contributions To:

28.

  • (a) Individuals/Persons Other Than Political Committees.
    0

5

  • (b) Political Party Committees

  • (c) Other Political Committees (such as. PACs)

  • (d) Total Contribution Refunds (add Lines 28(a), (b), and (c)).

DETAILED SUMMARY PAGE

of Disbursements

COLUMN A Total This Period

29.

Other Disbursements (Including Non-Federal Donations)

30.

Federal Election Activity (52 U.S.C. § 30101(20))

  • (a) Allocated Federal Election Activity (from Schedule H6) (i) Federal Share

a.a o.3.7 ...

...

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(ii) "Levin" Share

  • (b) Federal Election Activity Paid Entirely With Federal Funds

  • (c) Total Federal Election Activity (add Lines 30(a)(i), 30(a)(ii) and 30(b))

^

.31.

Total Disbursements (add Lines 21(c), 22, 23, 24, 25, 26, 27, 28(d), 29 and 30(c)) ..

32.

Total Federal Disbursements (subtract Line 21(a)(ii) and Line 30(a)(ii) from Line 31)

^

Page 4

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COLUMN B Calendar Year-to-Date

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EEC Form 3X (Rev. 05/2016)

III. Net Contributions/ Operating Expenditures

DETAILED SUMMARY PAGE

of Disbursements

COLUMN A Total This Period

33.

34.

35.

36.

37.

Total Contributions (other than loans) (from Line 11(d), page 3)

Total Contribution Refunds (from Line 28(d))

Net Contributions (other than loans) (subtract Line 34 from Line 33)

Total Federal Operating Expenditures (add Line 21(a)(i) and Line 21(b)) •

Offsets to Operating Expenditures (from Line 15, page 3)

  • 38. Net Operating Expenditures (subtract Line 37 from Line 36) .•

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COLUMN B Calendar Year-to-Date

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SCHEDULE A

(PEG Form 3X)

ITEMIZED RECEIPTS

Use separate schedule(s)

for each category of the

Detailed Summary Page

FOR LINE NUMBER:

PAGE

OF

(check only one)

11a

lib

11c

12

13

14

15

16

17

Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions

or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.

  • 2 G

NAME OF COMMITTEE (In Full)

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Urban

A.

Full Name of Individual JLast, First, Middle Initiab or Full Organization Name

II

Name

of

Individual JL

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or Full Organiz

AaencuX

 

Date of Receipt

Mailing Address

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City

 

V/erociCX

State

Zip Code

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Amount of Each Receipt this Period

FEC ID number of contributing

federal Dolitical committee.

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Name of Employer (for Individual)

Receipt For:

Primary

General

Other (specify)

Occupation (for Individual)

Aggregate Year-to-Date '

Memo Item

ConAriboV'ioo

Full Name of Individual (Last, First, Middle Initial) or Full Organization Name

 

B.

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Date of Receipt

Mailing Address

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State

Zip Code

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Amount of Each Receipt this Period

FEC ID number of contributing

  • 2 federal political committee.

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  • 2 Name of Employer (for Individual) Occupation (for Individual)

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Memo Item

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  • i Receipt For:

General

Aggregate Year-to-Date •

3

Primary

Other (specify)

nitial) or Full Organizatioi

Full Name of IndividualJLast, First, Middle Initial) or Full Org^ization Name

 

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Ifisorance.

Inc.

Date of Receipt

Mailing Address

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City

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state

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Zip Code

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Amount of Each Receipt this Period

 

FEC ID number of contributing

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federal political committee.

Name of Employer (for Individual) Occupation (for Individual)

 

Memo Item

Receipt For:

Aggregate Year-to-Date'

C orci'f

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Primary

General

other (specify)

SUBTOTAL of Receipts This Page (optional).

TOTAL This Period (last page this line number only).

SCHEDULE B

(PEG Form 3X)

ITEMIZED DISBURSEMENTS

Use separate schedule(s)

for each category of the

Detailed Summary Page

FOR LINE NUMBER:

 

PAGE

OF

(check only one)

21b

22

23

26

27

28a

28b

28c

29

30b

Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions

or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such committee.

NAME OF COMMITTEE (In Full)

 

Jmer'icois

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Full Name (Last, First, Middle Initial)

A.

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Mailing Address

 

Date of Disbursement

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Purpose of Disbursement

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Candidate Name

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State

Zip Code

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FEC Identification Number

 

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Category/

Category/

Amount of Each Disbursement this Period

8

Type

Type

 

Office Sought:

House

Disbursement For:

 

G

Senate

Primary

General

8

President

Other (specify)

T

Memo Item

 

State:

District:

0

Full Name (Last, First, Middle Initial)

 

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B.

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Date of Disbursement

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Purpose of Disbursement

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FEC Identification Number

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Candidate Name

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Category/

Amount of Each Disbursement this Period

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Type

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Office Sought:

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Disbursement For:

 

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Senate

Primary

General

 

President

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Memo Item

 

State:

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Full Name (Last, First, Middle Initial)

 

C.

Date of Disbursement

 

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Mailing Address

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City 'brick

State

Zip Code

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FEC Identification Number

 

Purpose of Disbursement

   

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Candidate Name

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Category/

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Amount of Each Disbursement this Period

 
 

Office Sought:

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Disbursement For:

 
 

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Primary

General

President

Other (specify)

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State:

District:

SUBTOTAL of Disbursements This Page (optional).

TOTAL This Period (last page this line number only).

SCHEDULE B

(FEC Form 3X)

ITEMIZED DISBURSEMENTS

Use separate schedule(s)

for each category of the

Detailed Summary Page

FOR LINE NUMBER:

(check only one)

21b

28a

22

28b

23

28c

PAGE

OF

26

29

27

30b

Any information copied from such Reports and Statements may not be sold or used by any person for the purpose of soliciting contributions

or for commercial purposes, other than using the name and address of any political committee to solicit contributions from such commitfee.

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6

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NAME OF COMMITTEE (In Full)

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Full Name (Last, First, Middle Initial)

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Mailing Address

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Purpose of Disbursemdnl

Zip Code

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Candidate Name

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Category/

Type

Office Sought.

House

Disbursement For:

State:

Senate

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District:

Primary

Other (specify)

General

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Full Name (Last, First, Middle Initial)

B.

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Mailing Address

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State

Zip Code

Purpose of Disbursement

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Disbursement For:

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City

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Purpose of Disbursement

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Zip Code

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Candidate Name

Office Sought:

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Disbursement For:

Category/

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District:

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Date of Disbursement

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Amount of Each Disbursement this Period

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Amount of Each Disbursement this Period

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FOR DOMESTIC AND INTERNATIONAL USE

This packaging Is the property of the U.S. Postal Service® and is provided solely for use In sending Priority Mail® shipments. Misuse may be a

violation of federal law. This

packaging Is not for

resale. EP14F © U.S. Postal Service; July 2013; All rights reserved.

Federal Election Commission

ENVELOPE REPLACEMENT PAGE FOR INCOMING DOCUMENTS

The FEC added this page to the end of this filing to indicate how it was received.

 

Date of Receipt

Hand Delivered

 

Postmarked

Date of Receipt

USPS First Class Mail

USPS Registered/Certified

Postmarked (R/C)

 

Postmarked

.^/j^SPS Priority Mail

 

Postmarked

USPS Priority Mail Express

Postmark Illegible

No Postmark

 

Shipping Date

Overnight Delivery Service (Specify):

Next Business Day Delivery

 

Date of Receipt

Received from House Records & Registration Office

 

Date of Receipt

Received from Senate Public Records Office

 

Date of Receipt

Received from Electronic Filing Office

Other (Specify):

£f

PREPARER

(3/2015)

Date of Receipt or Postmarked

DATE PREPARED