REPORT OF RECEIPTS FEC AND DISBURSEMENTS …docquery.fec.gov/pdf/331/201604159012459331/...Report...
45
FE6AN026 FEC FORM 3X Rev. 12/2004 Office Use Only NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g. 4. TYPE OF REPORT (Choose One) (a) Quarterly Reports: 12-Day Primary (12P) General (12G) Runoff (12R) PRE-Election Report for the: Convention (12C) Special (12S) 30-Day POST-Election General (30G) Runoff (30R) Special (30S) Report for the: (b) Monthly Report Due On: Feb 20 (M2) May 20 (M5) Aug 20 (M8) Mar 20 (M3) Jun 20 (M6) Sep 20 (M9) Apr 20 (M4) Jul 20 (M7) Oct 20 (M10) Jan 31 (YE) FEC FORM 3X REPORT OF RECEIPTS AND DISBURSEMENTS For Other Than An Authorized Committee 1. NAME OF COMMITTEE (in full) ADDRESS (number and street) Check if different than previously reported. (ACC) TYPE OR PRINT CITY STATE ZIP CODE 2. FEC IDENTIFICATION NUMBER T T T T 5. Covering Period 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 Signature of Treasurer Date 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) in the Election on State of in the Election on State of Office Use Only C T 3. IS THIS NEW AMENDED REPORT (N) OR (A) (c) T Nov 20 (M11) (Non-Election Year Only) Dec 20 (M12) (Non-Election Year Only) Example: If typing, type over the lines. (d) M M / D D / Y Y Y Y M M / D D / Y Y Y Y M M / D D / Y Y Y Y M M / D D / Y Y Y Y M M / D D / Y Y Y Y 12FE4M5 15 92704 04 Sarah H. Rollins Sarah H. Rollins 2016 [Electronically Filed] C00589879 PAGE 1 / 45 2016 01 SANTA ANA CA COMMITTEE TO RESTORE AMERICA'S GREATNESS 3843 SOUTH BRISTOL STREET SUITE 312 04/15/2016 15 : 04 Image# 201604159012459331 2016 01 31 03
Transcript of REPORT OF RECEIPTS FEC AND DISBURSEMENTS …docquery.fec.gov/pdf/331/201604159012459331/...Report...
FE6AN026
FEC FORM 3XRev. 12/2004
Office
Use
Only
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C. §437g.
4. TYPE OF REPORT
(Choose One)
(a) Quarterly Reports:
12-Day Primary (12P) General (12G) Runoff (12R)
PRE-Election
Report for the: Convention (12C) Special (12S)
30-Day
POST-Election General (30G) Runoff (30R) Special (30S)
Report for the:
(b) Monthly
Report
Due On:
Feb 20 (M2) May 20 (M5) Aug 20 (M8)
Mar 20 (M3) Jun 20 (M6) Sep 20 (M9)
Apr 20 (M4) Jul 20 (M7) Oct 20 (M10) Jan 31 (YE)
FEC
FORM 3X
REPORT OF RECEIPTS
AND DISBURSEMENTSFor Other Than An Authorized Committee
1. NAME OF COMMITTEE (in full)
ADDRESS (number and street)
Check if different than previously reported. (ACC)
TYPE OR PRINT
CITY STATE ZIP CODE2. FEC IDENTIFICATION NUMBER
5. Covering Period 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
Signature of Treasurer Date
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) in the
Election on State of
in the
Election on State of
Office Use Only
C 3. IS THIS NEW AMENDED
REPORT (N) OR (A)
(c)
Nov 20 (M11)(Non-Election Year Only)
Dec 20 (M12)(Non-Election Year Only)
Example: If typing, type
over the lines.
(d)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
12FE4M5
15
92704
04
Sarah H. Rollins
Sarah H. Rollins
2016
[Electronically Filed]
C00589879
PAGE 1 / 45
201601
SANTA ANA CA
COMMITTEE TO RESTORE AMERICA'S GREATNESS
3843 SOUTH BRISTOL STREET
SUITE 312
04/15/2016 15 : 04
Image# 201604159012459331
2016
01 3103
FE6AN026
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M M / D D / Y Y Y Y M M / D D / Y Y Y Y
Y Y Y Y
COLUMN B
Calendar Year-to-Date
COLUMN A
This Period
6. (a) Cash on Hand
January 1,
(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. 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) ................
For further information contact:
Federal Election Commission
999 E Street, NW
Washington, DC 20463
Toll Free 800-424-9530
Local 202-694-1100
FEC Form 3X (Rev. 02/2003 ) Page 2
SUMMARY PAGEOF RECEIPTS AND DISBURSEMENTS
This committee has qualified as a multicandidate committee. (see FEC FORM 1M)
Report Covering the Period: From: To:
Write or Type Committee Name
324456.49
2016 13650.40
133393.12
310806.09
0.00
2016
191063.37
201601
13650.40
310806.09
COMMITTEE TO RESTORE AMERICA'S GREATNESS
Image# 201604159012459332
324456.49
133393.12
01 31
191063.37
03
0.00
FE6AN026
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Report Covering the Period: From: To:
COLUMN B
Calendar Year-to-Date
COLUMN A
Total This Period
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) .................
(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) .........
DETAILED SUMMARY PAGEof Receipts
Write or Type Committee Name
I. Receipts
FEC Form 3X (Rev. 06/2004 ) Page 3
308156.73
310806.09
4.81
0.00
0.00
0.00
0.00
0.00
310806.09
2016
0.00
310806.09
0.00
0.00
40106.73
0.00
2016
308156.73
40106.73
01
268050.00
34.55
2610.00
0.00
0.00
4.81
308156.73
COMMITTEE TO RESTORE AMERICA'S GREATNESS
308156.73
0.00
268050.00
310806.09
Image# 201604159012459333
2610.00
34.55
0.00
01 31
0.00
03
0.00
0.00
FE6AN026
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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. Transfers to Affiliated/Other Party
Committees .................................................23. Contributions to Federal Candidates/Committees and Other Political Committees .................
24. Independent Expenditures
(use Schedule E) .......................................25. Coordinated Party Expenditures (2 U.S.C. §441a(d)) (use Schedule F)........................................
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 .................................
30. Federal Election Activity (2 U.S.C. §431(20))
(a) Allocated Federal Election Activity
(from Schedule H6)
(i) Federal Share ................................
(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) ..............................................
COLUMN B
Calendar Year-to-Date
COLUMN A
Total This PeriodII. Disbursements
DETAILED SUMMARY PAGEof Disbursements
FEC Form 3X (Rev. 02/2003 ) Page 4
0.00
185469.50
0.00
0.00
0.00
270.00
0.00
191063.37
0.00
0.00
185469.50
0.00
0.00
0.00
0.00
191063.37
0.00
0.00
270.00
0.00
0.00
0.00
191063.37
5323.87
0.00
270.00
0.00
0.00
0.00
191063.37
185469.50
0.00
0.00
185469.50
5323.87
0.00
Image# 201604159012459334
0.00
0.00
0.00
0.00
0.00
270.00
FE6AN026
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COLUMN B
Calendar Year-to-Date
COLUMN A
Total This Period
DETAILED SUMMARY PAGEof Disbursements
FEC Form 3X (Rev. 02/2003 ) Page 5
III. Net Contributions/Operating Ex-
penditures
33. Total Contributions (other than loans)
(from Line 11(d), page 3) ..........................
34. Total Contribution Refunds
(from Line 28(d)) ........................................
35. Net Contributions (other than loans)
(subtract Line 34 from Line 33) ................
36. Total Federal Operating Expenditures
(add Line 21(a)(i) and Line 21(b)) .........
37. Offsets to Operating Expenditures
(from Line 15, page 3)...............................
38. Net Operating Expenditures
(subtract Line 37 from Line 36) ................
308156.73308156.73
34.55
307886.73
185434.95
307886.73
185469.50
185434.95
34.55
185469.50
Image# 201604159012459335
270.00 270.00
FE6AN026
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Aggregate Year-to-Date
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M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
500.00
300.00
500.00
100.00
250.00
IA
UT
3124 10th Ave N
4230 Fox Meadow Ln
250.00
5346 S Cottonwood Ln
COMMITTEE TO RESTORE AMERICA'S GREATNESS
84117Transaction ID : SA11AI.6225
50501
TXPasadena
Holladay
Fort Dodge
retired
BellMed Resources, LLC
Transaction ID : SA11AI.584777504
Transaction ID : SA11AI.6999
self-employed
26
17
02
850.00
2016
6
2016
2016
Image# 201604159012459336
03
02
02
45
Michael Barkhaus
2016
2016
Tim Bell
2016
Virginia Anderson
retired
sales
Medical Device Sales
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
FE6AN026
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
500.00
1500.00
500.00
1000.00
500.00
NV
NY
9448 Lugo street
9448 Lugo street
500.00
39 Knight Ln
COMMITTEE TO RESTORE AMERICA'S GREATNESS
11754Transaction ID : SA11AI.5568
89123
NVLAS VEGAS
Kings Park
LAS VEGAS
Information Requested
self
Transaction ID : SA11AI.542289123
Transaction ID : SA11AI.5807
Information Requested
22
18
22
2000.00
2016
7
2016
2016
Image# 201604159012459337
01
02
01
45
Marleau Borsack
2016
2016
Sydney Choban
2016
Marleau Borsack
Information Requested
Information Requested
cpa
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
FE6AN026
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M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
, , .
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
500.00
1000.00
500.00
1000.00
5000.00
WA
NJ
11306 NE 179th Circle
P O Box 390
5000.00
15 Oakwood Dr
COMMITTEE TO RESTORE AMERICA'S GREATNESS
07470Transaction ID : SA11AI.7039
98604
NYAkron
Wayne
Battle Gourd
I Squared R Element Co., Inc.
Fin-Tek
Transaction ID : SA11AI.689614001
Transaction ID : SA11AI.6897
Self-employed
31
31
28
6500.00
8
2016
Image# 201604159012459338
02
03
03
45
Jordan Davis
2016
2016
Thomas Finnegan
2016
John R. Davis Jr.
President
Contractor
Sales
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
FE6AN026
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
1000.00
250.00
1000.00
50.00
500.00
NY
TX
4750 rt 145
268 Lombard St
500.00
5523 Harbor Town Dr
COMMITTEE TO RESTORE AMERICA'S GREATNESS
75287Transaction ID : SA11AI.6412
12422
CASan francisco
Dallas
Durham
Rbc
Glazers
Transaction ID : SA11AI.637994133
Transaction ID : SA11AI.7004
ng American trim inc
06
17
06
1550.00
2016
9
2016
2016
Image# 201604159012459339
03
02
03
45
Unit 1
richard gangi
2016
2016
Max Glazer
2016
Marina Galli
Fa
textile mfg
Sales
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
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M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
, , .
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
$1,000 refunded on 4/15/16
1000.00
150000.00
1000.00
150000.00
500.00
CA
CA
c/o Lavely & Singer, PC, Attorneys
53 Wisdom Quest Rd.
500.00
782a jefferson Ave
COMMITTEE TO RESTORE AMERICA'S GREATNESS
91910Transaction ID : SA11AI.6233
90067
IDBonners Ferry
chula vista
Los Angeles
Information Requested
self
Transaction ID : SA11AI.669683805
Transaction ID : SA11AI.6944
05
01
03
151500.00
2016
10
2016
Image# 201604159012459340
03
03
02
45
2049 Century Park E, #2400
John Powers Middleton Companies
2016
2016
marc karetny
2016
Shinji Imoto
Information Requested
self
pbasupally
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
250.00
400.00
250.00
100.00
200.00
SC
CA
1 Market Street Ct
1 Market Street Ct
300.00
14777 Palm Drive
COMMITTEE TO RESTORE AMERICA'S GREATNESS
92240Transaction ID : SA11AI.6899
29520
SCCheraw
Desert Hot Springs
Cheraw
N/A
N/A retired
Transaction ID : SA11AI.625729520
Transaction ID : SA11AI.6484
N/A
05
09
17
550.00
2016
11
2016
Image# 201604159012459341
03
03
02
45
#20
George W. Krauss
2016
2016
Anita Louise LeBarron
2016
George W. Krauss
Retireed
Retireed
Consumer Wellness Advocate Volunteer
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
50000.00
300.00
50000.00
200.00
500.00
NC
CA
11027 Brief Rd
115 estates at the Lks
500.00
c/o Lavely & Singer PC Attorneys
COMMITTEE TO RESTORE AMERICA'S GREATNESS
90067Transaction ID : SA11AI.6943
28227
GAcanton
Los Angeles
Charlotte
retired
self
Transaction ID : SA11AI.629330114
Transaction ID : SA11AI.6695
atr
04
29
09
50700.00
2016
12
2016
Image# 201604159012459342
03
03
03
45
2049 Century Park E, #2400
mike menard
2016
2016
John P. Middleton
2016
darlene p lowry
retired
it
philanthropist
pbasupally
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
500.00
100000.00
500.00
25000.00
25000.00
CA
NY
c/o Lavely & Singer PC Attorneys
c/o Lavely & Singer PC Attorneys
75000.00
3 el retiro Ln
COMMITTEE TO RESTORE AMERICA'S GREATNESS
10017Transaction ID : SA11AI.5359
90067
CALos Angeles
irvington
Los Angeles
self
dematteo monness
Transaction ID : SA11AI.694290067
Transaction ID : SA11AI.6941
self
11
14
05
50500.00
13
2016
Image# 201604159012459343
02
03
03
45
2049 Century Park E, #2400
2049 Century Park E, #2400
John P. Middleton
2016
2016
william monness
2016
John P. Middleton
philanthropist
philanthropist
stockbroker
pbasupally
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
250.00
500.00
250.00
500.00
200.00
CA
CT
2210 Agenda de la Playa
3 el retiro Ln
700.00
5 Oak Hill Dr
COMMITTEE TO RESTORE AMERICA'S GREATNESS
06471Transaction ID : SA11AI.7025
92037
NYirvington
North Branford
La Jolla
dematteo monness
Retired
Transaction ID : SA11AI.699510017
Transaction ID : SA11AI.6560
None
17
05
27
950.00
2016
14
2016
2016
Image# 201604159012459344
02
02
02
45
Myrna Naegle
2016
2016
Paul Rapanault
2016
william monness
stockbroker
Home
Retired Lobbyist
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
500.00
500.00
600.00
500.00
250.00
IA
CA
2352 Festina Rd
5302 Brookeway Dr
250.00
6152 W CHERRY Ct
COMMITTEE TO RESTORE AMERICA'S GREATNESS
93277Transaction ID : SA11AI.6666
52144
MDBethesda
Visalia
Fort Atkinson
retired
US ARMY CORP OF ENGINEERS
Transaction ID : SA11AI.529220816
Transaction ID : SA11AI.6706
self
06
30
25
1250.00
2016
15
2016
2016
Image# 201604159012459345
03
03
02
45
Grant Shimek
2016
2016
Jim Snyder
2016
William Ritchie
retired
broker
PARK RANGER
pbasupally
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
200.00
500.00
210.00
500.00
1000.00
AZ
WI
2473 So. Higley Rd
8632 Ellard Dr
1000.00
300 N 121st St
COMMITTEE TO RESTORE AMERICA'S GREATNESS
268050.00
53226Transaction ID : SA11AI.6528
85295
GAAlpharetta
Wauwatosa
Gilbert
Self employed
Unemployed
Transaction ID : SA11AI.565530022
Transaction ID : SA11AI.6925
RMW Management Co., LLC
22
11
10
1700.00
2016
16
2016
Image# 201604159012459346
03
02
01
45
Ste 104, PMB 311
Robert M Warner
2016
2016
Charles Wilcox
2016
Pat Stephens
Real estate
Owner/Retired
IC
pbasupally
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SCHEDULE A (FEC Form 3X)
ITEMIZED RECEIPTS
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)
SUBTOTAL of Receipts This Page (optional) ............................................................................
TOTAL This Period (last page this line number only) ...............................................................
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
A.
FEC Schedule A (Form 3X) Rev. 12/2015
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
B.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Receipt For:
Primary General
Other (specify)
Amount of Each Receipt this Period
C.
Aggregate Year-to-Date
Date of Receipt
Name of Employer Occupation
FEC ID number of contributing
federal political committee.
PAGE OFFOR LINE NUMBER:
(check only one)Use separate schedule(s)
for each category of the
Detailed Summary Page 11a 11b 11c 12
13 15 14 16 17
loan
2610.00
650 Town Center Drive
2610.00
COMMITTEE TO RESTORE AMERICA'S GREATNESS
2610.00
CACosta MesaTransaction ID : SA13.5202
92626
04
2610.00
17
Image# 201604159012459347
02
45
12th Floor 2016
Jensen & Associates, APC, Trial Lawyers
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Text Box
Memo Item
FE6AN026
SCHEDULE B (FEC Form 3X)
ITEMIZED DISBURSEMENTS
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)
, , .
, , .SUBTOTAL of Disbursements This Page (optional) ..................................................................
TOTAL This Period (last page this line number only) ...............................................................
FEC Schedule B (Form 3X) Rev. 12/2015
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Amount of Each Disbursement this Period
, , .
A. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Amount of Each Disbursement this Period
, , .
B. Date of Disbursement
Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Amount of Each Disbursement this Period
, , .
C. Date of Disbursement
Use separate schedule(s)
for each category of the
Detailed Summary Page
PAGE OFFOR LINE NUMBER: (check only one)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
Purpose of Disbursement
Candidate Name
Office Sought: House
Senate
President
State: District:
Category/Type
Disbursement For:
Primary General
Other (specify)
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
M M / D D / Y Y Y Y
21b 22 23 24 25 26
27 28a 28b 28c 29 30b
650 Town Center Drive
650 Town Center Drive
3843 South Bristol Street
12th Floor
Suite 312
315.00
2398.87
2610.00
12th Floor
COMMITTEE TO RESTORE AMERICA'S GREATNESS
5323.87
Transaction ID : SB26.5204CA
CA
CA
92626
92704
92626
Transaction ID : SB26.5205
Transaction ID : SB26.5203
02
02
loan repayment
01
loan repayment
reimburse expenses
2016
COMMITTEE TO RESTORE AMERICA'S GREATNESS
COMMITTEE TO RESTORE AMERICA'S GREATNESS
5323.87
Tom Fay
COMMITTEE TO RESTORE AMERICA'S GREATNESS
2016
Jensen & Associates, APC, Trial Lawyers
2016
Jensen & Associates, APC, Trial Lawyers
18
2016
2016
2016
Image# 201604159012459348
25
45
10
10
Costa Mesa
Santa Ana
Costa Mesa
001
pbasupally
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Memo Item
pbasupally
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Memo Item
FE6AN026
SCHEDULE C (FEC Form 3X)
LOANSPAGE OFUse separate schedule(s)
for each category of the
Detailed Summary Page
NAME OF COMMITTEE (In Full)
SUBTOTALS This Period This Page (optional) ................................................................
TOTALS This Period (last page in this line only) .............................................................
FEC Schedule C (Form 3X) Rev. 12/2015
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
Name of Employer
Occupation
List All Endorsers or Guarantors (if any) to Loan Source
, , .
, , .
, , . , , . , , .
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
Date Incurred Date Due Interest Rate Secured:
Yes No . % (apr)
Election:
Primary
General
Other (specify)
LOAN SOURCE Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code
1. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
2. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
3. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
4. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
TERMS
FOR LINE 13 OF FORM 3X
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
315.00
Transaction ID : SC/10.4238
Tom Fay
CA
2015
COMMITTEE TO RESTORE AMERICA'S GREATNESS
23
3843 South Bristol StreetSuite 312
0.0010
Santa Ana
315.00
0.00
19
0.00
Image# 201604159012459349
45
01/30/2016
92704
pbasupally
Text Box
Memo Item
pbasupally
Rectangle
FE6AN026
SCHEDULE C (FEC Form 3X)
LOANSPAGE OFUse separate schedule(s)
for each category of the
Detailed Summary Page
NAME OF COMMITTEE (In Full)
SUBTOTALS This Period This Page (optional) ................................................................
TOTALS This Period (last page in this line only) .............................................................
FEC Schedule C (Form 3X) Rev. 12/2015
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
Name of Employer
Occupation
List All Endorsers or Guarantors (if any) to Loan Source
, , .
, , .
, , . , , . , , .
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
Date Incurred Date Due Interest Rate Secured:
Yes No . % (apr)
Election:
Primary
General
Other (specify)
LOAN SOURCE Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code
1. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
2. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
3. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
4. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
TERMS
FOR LINE 13 OF FORM 3X
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
2398.87
Transaction ID : SC/10.4244
Jensen & Associates, APC, Trial Lawyers
CA
2015
COMMITTEE TO RESTORE AMERICA'S GREATNESS
10
650 Town Center Drive12th Floor
0.0011
Costa Mesa
2398.87
0.00
20
0.00
Image# 201604159012459350
45
10/30/2016
92626
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FE6AN026
SCHEDULE C (FEC Form 3X)
LOANSPAGE OFUse separate schedule(s)
for each category of the
Detailed Summary Page
NAME OF COMMITTEE (In Full)
SUBTOTALS This Period This Page (optional) ................................................................
TOTALS This Period (last page in this line only) .............................................................
FEC Schedule C (Form 3X) Rev. 12/2015
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
Name of Employer
Occupation
List All Endorsers or Guarantors (if any) to Loan Source
, , .
, , .
, , . , , . , , .
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
Date Incurred Date Due Interest Rate Secured:
Yes No . % (apr)
Election:
Primary
General
Other (specify)
LOAN SOURCE Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code
1. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
2. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
3. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
Name of Employer
Occupation
4. Full Name (Last, First, Middle Initial)
Mailing Address
City State ZIP Code , , .
Amount
Guaranteed
Outstanding:
TERMS
FOR LINE 13 OF FORM 3X
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
2610.00
Transaction ID : SC/10.5202
Jensen & Associates, APC, Trial Lawyers
CA
2016
COMMITTEE TO RESTORE AMERICA'S GREATNESS
0.00
04
650 Town Center Drive12th Floor
0.000102
Costa Mesa
2610.00
0.00
21
0.00
Image# 201604159012459351
45
12 0003
92626
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FE6AN026
SCHEDULE D (FEC Form 3X)
DEBTS AND OBLIGATIONSExcluding Loans
(Use separate
schedule(s)
for each
numbered line)
NAME OF COMMITTEE (In Full)
, , .
, , .
1) SUBTOTALS This Period This Page (optional) ...................................................................
2) TOTALS This Period (last page this line number only) ......................................................
3) TOTAL OUTSTANDING LOANS from Schedule C (last page only) .................................
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
A. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Mailing Address
City State Zip Code
Payment This Period
, , .
FEC Schedule D (Form 3X) Rev. 02/2003
Outstanding Balance at Close of This Period
, , .
, , .
, , .
Outstanding Balance Beginning This Period
, , .Amount Incurred This Period
, , .
Nature of Debt (Purpose):
B. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Mailing Address
City State Zip Code
Payment This Period
, , .
Outstanding Balance at Close of This Period
, , .
Outstanding Balance Beginning This Period
, , .Amount Incurred This Period
, , .
Nature of Debt (Purpose):
C. Full Name (Last, First, Middle Initial) of Debtor or Creditor
Mailing Address
City State Zip Code
Payment This Period
, , .
Outstanding Balance at Close of This Period
, , .
Outstanding Balance Beginning This Period
, , .Amount Incurred This Period
, , .
Nature of Debt (Purpose):
PAGE OF
FOR LINE NUMBER:
(check only one) 9
10
3843 South Bristol Street
92704
21050
1603 Belvue Drive
0.00
0.00 0.00
0.00
Forest Hill
Santa Ana
0.00
Suite 312
22
Image# 201604159012459352
45
COMMITTEE TO RESTORE AMERICA'S GREATNESS
0.00
3000.00
Enktesis LLC
Tom Fay
3000.00
7626.13
MD
CA
consulting services
website development - amount in dispute
Transaction ID : SD10.4387
Transaction ID : SD10.4388
7626.13
FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
1261.20 0.00
27-01 Queens Plaza North
P O Box 947
27-01 Queens Plaza North
COMMITTEE TO RESTORE AMERICA'S GREATNESS
NY
Transaction ID : H4.7146
UT
NY
11101
11101
84003
Transaction ID : H4.7147
Transaction ID : H4.7148
0.00
0.00
0.00
01
01
01
airline ticket
donation processing fee
airline ticket
25.00
2016
573.10
663.10
Jetblue Airways Corporation
Authorize.Net
2016
Jetblue Airways Corporation
23
2016
573.10
Image# 201604159012459353
04
663.10
25.00
45
688.10
663.10
05
06
1261.20
American Fork
Long Island City
Long Island City
1261.20
Administrative
Administrative
Administrative
002
002
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
3001.52 0.00
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
3843 South Bristol StreetSuite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5166
DC
CA
20009
92704
20009
Transaction ID : H4.5179
Transaction ID : H4.5165
0.00
0.00
0.00
01
01
01
donation processing fee
donation processing fee
consulting fee
1.14
2016
0.38
3000.00
Tom Fay
Democracy Engine
2016
Democracy Engine
24
2016
0.38
Image# 201604159012459354
13
3000.00
1.14
45
4262.34
4261.20
20
20
4262.72
Washington
Santa Ana
Washington
3001.52
Administrative
Administrative
Administrative
003
001
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
2524.78 0.00
P O Box 1627
2125 Fourteenth Street, NW
3843 South Bristol StreetSuite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
OR
Transaction ID : H4.5197
DC
CA
97501
92704
20009
Transaction ID : H4.5180
Transaction ID : H4.5164
0.00
0.00
0.00
01
01
01
list rental
donation processing fee
consulting fees
24.78
2016
2000.00
500.00
Sarah H. Rollins
Democracy Engine
2016
WND.com, Inc.
25
2016
2000.00
Image# 201604159012459355
26
500.00
24.78
45
4787.50
4762.72
27
27
6787.50
Washington
Santa Ana
Medford
2524.78
Administrative
Administrative
Administrative
003
001
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
11076.28 0.00
27134 Paseo Espada
27134 Paseo Espada
1603 Belvue Drive
Suite B
Suite B
COMMITTEE TO RESTORE AMERICA'S GREATNESS
CA
Transaction ID : H4.5201
CA
MD
92675
21050
92675
Transaction ID : H4.5199
Transaction ID : H4.5200
0.00
0.00
0.00
01
01
01
printing
printing
website design, consulting and hosting
1725.00
2016
1725.15
7626.13
Enktesis LLC
Printing OC
2016
Printing OC
26
2016
1725.15
Image# 201604159012459356
28
7626.13
1725.00
45
16138.63
14413.63
29
29
17863.78
San Juan Capistrano
Forest Hill
San Juan Capistrano
11076.28
Administrative
Administrative
Administrative
003
001
001
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
2461.32 0.00
P O Box 6995
750 Park of Commerce Drive
2125 Fourteenth Street, NW
Suite 100
COMMITTEE TO RESTORE AMERICA'S GREATNESS
OR
Transaction ID : H4.5207
FL
DC
97228-6995
20009
33487
Transaction ID : H4.5163
Transaction ID : H4.5206
0.00
0.00
0.00
02
02
02
bank fee
list rental
donation processing fee
2430.00
2016
30.00
1.32
Democracy Engine
Newsmax Media, Inc.
2016
Wells Fargo Bank
27
2016
30.00
Image# 201604159012459357
03
1.32
2430.00
45
20295.10
17865.10
04
04
20325.10
Boca Raton
Washington
Portland
2461.32
Administrative
Administrative
Administrative
001
003
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
1195.86 0.00
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
P O Box 1627
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5176
DC
OR
20009
97501
20009
Transaction ID : H4.5208
Transaction ID : H4.5162
0.00
0.00
0.00
02
02
02
donation processing fee
donation processing fee
list rental
54.86
2016
141.00
1000.00
WND.com, Inc.
Democracy Engine
2016
Democracy Engine
28
2016
141.00
Image# 201604159012459358
04
1000.00
54.86
45
21379.96
21325.10
10
10
21520.96
Washington
Medford
Washington
1195.86
Administrative
Administrative
Administrative
003
001
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
3585.22 0.00
P O Box 1627
3843 South Bristol Street
538 S Flower Street
Suite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
OR
Transaction ID : H4.5214
CA
CA
97501
90071
92704
Transaction ID : H4.5211
Transaction ID : H4.5212
0.00
0.00
0.00
02
02
02
list rental
consulting fees
food and lodging
221.63
2016
2000.00
1363.59
California Club
Sarah H. Rollins
2016
WND.com, Inc.
29
2016
2000.00
Image# 201604159012459359
12
1363.59
221.63
45
23106.18
22884.55
12
12
25106.18
Santa Ana
Los Angeles
Medford
3585.22
Administrative
Administrative
Administrative
003
002
001
pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
24.82 0.00
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5175
DC
DC
20009
20009
20009
Transaction ID : H4.5161
Transaction ID : H4.5174
0.00
0.00
0.00
02
02
02
donation processing fee
donation processing fee
donation processing fee
1.70
2016
9.77
13.35
Democracy Engine
Democracy Engine
2016
Democracy Engine
30
2016
9.77
Image# 201604159012459360
17
13.35
1.70
45
25121.23
25119.53
17
17
25131.00
Washington
Washington
Washington
24.82
Administrative
Administrative
Administrative
003
003
003
pbasupally
Text Box
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pbasupally
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Memo Item
pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
3236.34 0.00
P O Box 1627
27-01 Queens Plaza North
750 Park of Commerce DriveSuite 100
COMMITTEE TO RESTORE AMERICA'S GREATNESS
OR
Transaction ID : H4.5219
NY
FL
97501
33487
11101
Transaction ID : H4.5215
Transaction ID : H4.5218
0.00
0.00
0.00
02
02
02
list rental
airplane ticket
list rental
343.10
2016
93.24
2800.00
Newsmax Media, Inc.
Jetblue Airways Corporation
2016
WND.com, Inc.
31
2016
93.24
Image# 201604159012459361
17
2800.00
343.10
45
28274.10
27931.00
17
17
28367.34
Long Island City
Boca Raton
Medford
3236.34
Administrative
Administrative
Administrative
003
003
002
pbasupally
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
584.19 0.00
3843 South Bristol Street
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
Suite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
CA
Transaction ID : H4.5223
DC
DC
92704
20009
20009
Transaction ID : H4.5160
Transaction ID : H4.5169
0.00
0.00
0.00
02
02
02
consulting fees
donation processing fee
donation processing fee
20.34
2016
500.00
63.85
Democracy Engine
Democracy Engine
2016
Sarah H. Rollins
32
2016
500.00
Image# 201604159012459362
24
63.85
20.34
45
28451.53
28431.19
24
25
28951.53
Washington
Washington
Santa Ana
584.19
Administrative
Administrative
Administrative
001
003
003
pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
358.91 0.00
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
P O Box 6995
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5173
DC
OR
20009
97228-6995
20009
Transaction ID : H4.5224
Transaction ID : H4.5159
0.00
0.00
0.00
03
03
02
donation processing fee
donation processing fee
bank fees
317.78
2016
1.13
40.00
Wells Fargo Bank
Democracy Engine
2016
Democracy Engine
33
2016
1.13
Image# 201604159012459363
29
40.00
317.78
45
29309.31
28991.53
02
02
29310.44
Washington
Portland
Washington
358.91
Administrative
Administrative
Administrative
003
001
003
pbasupally
Text Box
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
10142.50 0.00
3843 S Bristol
1007 North Federal Highway
3843 South Bristol Street
#166
Suite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
CA
Transaction ID : H4.5229
FL
CA
92704
92704
33304
Transaction ID : H4.5228
Transaction ID : H4.6847
0.00
0.00
0.00
03
03
03
rent
voter fraud research and documentation
consluting services
10000.00
2016
100.00
42.50
Sarah H. Rollins
Citroen Associates
2016
The UPS Store
34
2016
100.00
Image# 201604159012459364
03
42.50
10000.00
45
39352.94
29352.94
03
08
39452.94
Ft. Lauderdale
Santa Ana
Santa Ana
10142.50
Administrative
Administrative
Administrative
001
001
001
pbasupally
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
10441.10 0.00
2125 Fourteenth Street, NW
P O Box 6995
29726 Felton Drive
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5158
OR
CA
20009
92677
97228-6995
Transaction ID : H4.5231
Transaction ID : H4.7141
0.00
0.00
0.00
03
03
03
donation processing fee
bank fee
fundraising/media consulting
3.00
2016
438.10
10000.00
Andrew Barnett
Wells Fargo Bank
2016
Democracy Engine
35
2016
438.10
Image# 201604159012459365
08
10000.00
3.00
45
49455.94
49452.94
08
09
49894.04
Portland
Laguna Niguel
Washington
10441.10
Administrative
Administrative
Administrative
003
003
001
pbasupally
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
4537.18 0.00
2237 S 19th Street
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
COMMITTEE TO RESTORE AMERICA'S GREATNESS
WA
Transaction ID : H4.5233
DC
DC
98405
20009
20009
Transaction ID : H4.5168
Transaction ID : H4.5172
0.00
0.00
0.00
03
03
03
office equipment
donation processing fee
donation processing fee
12.05
2016
4524.00
1.13
Democracy Engine
Democracy Engine
2016
Broadcast Supply Worldwide
36
2016
4524.00
Image# 201604159012459366
09
1.13
12.05
45
49907.22
49895.17
09
09
54431.22
Washington
Washington
Tacoma
4537.18
Administrative
Administrative
Administrative
001
003
003
pbasupally
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pbasupally
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pbasupally
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pbasupally
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
12351.86 0.00
1404 East Los Olas Boulevard
650 Town Center Drive
P O Box 6995
12th Floor
#2206
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
Transaction ID : H4.5238
CA
OR
33301
97228-6995
92626
Transaction ID : H4.5234
Transaction ID : H4.5235
0.00
0.00
0.00
03
03
03
database management
legal and accounting fees
bank fee
5321.86
2016
7000.00
30.00
Wells Fargo Bank
Jensen & Associates, APC, Trial Lawyers
2016
Strategic Campaign Concepts
37
2016
7000.00
Image# 201604159012459367
09
30.00
5321.86
45
59783.08
54461.22
09
09
66783.08
Costa Mesa
Portland
Ft. Lauderdale
12351.86
Administrative
Administrative
Administrative
001
001
001
pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
2263.39 0.00
1007 North Federal Highway
500 Staples Drive
P O Box 6995
#166
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
Transaction ID : H4.6848
MA
OR
33304
97228-6995
01702
Transaction ID : H4.7149
Transaction ID : H4.5241
0.00
0.00
0.00
03
03
03
voter fraud research and documentation
office supplies
bank fee
248.39
2016
2000.00
15.00
Wells Fargo Bank
Staples, Inc.
2016
Citroen Associates
38
2016
2000.00
Image# 201604159012459368
09
15.00
248.39
45
67046.47
66798.08
11
11
69046.47
Framingham
Portland
Ft. Lauderdale
2263.39
Administrative
Administrative
Administrative
001
001
001
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
201.00 0.00
2125 Fourteenth Street, NW
P O Box 6995
P O Box 6995
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5157
OR
OR
20009
97228-6995
97228-6995
Transaction ID : H4.7150
Transaction ID : H4.7151
0.00
0.00
0.00
03
03
03
donation processing fee
bank fee
bank fee
15.00
2016
171.00
15.00
Wells Fargo Bank
Wells Fargo Bank
2016
Democracy Engine
39
2016
171.00
Image# 201604159012459369
11
15.00
15.00
45
69076.47
69061.47
14
16
69247.47
Portland
Portland
Washington
201.00
Administrative
Administrative
Administrative
003
001
001
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
3009.96 0.00
4521 PGA Boulevard
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
#115
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
Transaction ID : H4.5245
DC
DC
33418
20009
20009
Transaction ID : H4.5167
Transaction ID : H4.5171
0.00
0.00
0.00
03
03
03
consulting services
donation processing fee
donation processing fee
8.83
2016
3000.00
1.13
Democracy Engine
Democracy Engine
2016
Acer Strategies, Inc.
40
2016
3000.00
Image# 201604159012459370
16
1.13
8.83
45
69257.43
69248.60
16
17
72257.43
Washington
Washington
Palm Beach Gardens
3009.96
Administrative
Administrative
Administrative
001
003
003
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
13551.00 0.00
1007 North Federal Highway
4438 Murietta Avenue
3843 South Bristol StreetSuite 312
#166
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
Transaction ID : H4.6849
CA
CA
33304
92704
91423
Transaction ID : H4.5246
Transaction ID : H4.5249
0.00
0.00
0.00
03
03
03
voter fruad research and documentation
consulting services
mileage reimbursement
1500.00
2016
12000.00
51.00
Sarah H. Rollins
Bryce Chapnick
2016
Citroen Associates
41
2016
12000.00
Image# 201604159012459371
17
51.00
1500.00
45
73808.43
72308.43
17
17
85808.43
Sherman Oaks
Santa Ana
Ft. Lauderdale
13551.00
Administrative
Administrative
Administrative
001
001
001
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
23030.00 0.00
2600 E Cary Street
P O Box 6995
1007 North Federal Highway#166
#4133
COMMITTEE TO RESTORE AMERICA'S GREATNESS
VA
Transaction ID : H4.5253
OR
FL
23223
33304
97228-6995
Transaction ID : H4.6850
Transaction ID : H4.5250
0.00
0.00
0.00
03
03
03
consulting
bank fee
voter fraud research and documentation
30.00
2016
3000.00
20000.00
Citroen Associates
Wells Fargo Bank
2016
C. Josi Company
42
2016
3000.00
Image# 201604159012459372
18
20000.00
30.00
45
105838.43
105808.43
22
22
108838.43
Portland
Ft. Lauderdale
Richmond
23030.00
Administrative
Administrative
Administrative
001
001
001
pbasupally
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pbasupally
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Memo Item
pbasupally
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pbasupally
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pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
6049.13 0.00
P O Box 1123
2125 Fourteenth Street, NW
2125 Fourteenth Street, NW
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
Transaction ID : H4.5256
DC
DC
33443
20009
20009
Transaction ID : H4.5156
Transaction ID : H4.5170
0.00
0.00
0.00
03
03
03
website development and support
donatino processing fee
donation processing fee
3.20
2016
6000.00
45.93
Democracy Engine
Democracy Engine
2016
Z Production Group, Inc.
43
2016
6000.00
Image# 201604159012459373
23
45.93
3.20
45
108887.56
108884.36
23
23
114887.56
Washington
Washington
Deerfioeld beach
6049.13
Administrative
Administrative
Administrative
001
003
003
pbasupally
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
25581.94 0.00
2125 Fourteenth Street, NW
650 Town Center Drive
3843 South Bristol Street
12th Floor
Suite 312
COMMITTEE TO RESTORE AMERICA'S GREATNESS
DC
Transaction ID : H4.5153
CA
CA
20009
92704
92626
Transaction ID : H4.5257
Transaction ID : H4.5225
0.00
0.00
0.00
03
03
03
donation processing fee
legal and accounting fees
consulting services
25000.00
2016
81.94
500.00
Sarah H. Rollins
Jensen & Associates, APC, Trial Lawyers
2016
Democracy Engine
44
2016
81.94
Image# 201604159012459374
25
500.00
25000.00
45
140387.56
115387.56
28
30
140469.50
Costa Mesa
Santa Ana
Washington
25581.94
Administrative
Administrative
Administrative
003
001
001
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FE6AN026
NAME OF COMMITTEE (In Full)
FEC Schedule H4 (Form 3X) Rev. 12/2015
SUBTOTAL of Allocated Federal and NonFederal Activity This Page
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT
TOTAL This Period (last page for each line only)(Federal share to 21(a)(i) and NonFederal share to 21(a)(ii))
, , . , , .
FEDERAL SHARE TOTAL AMOUNT
+ =
, , .
NONFEDERAL SHARE
SCHEDULE H4 (FEC Form 3X)
DISBURSEMENTS FOR ALLOCATED FEDERAL/NONFEDERAL ACTIVITY
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
A. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
PAGE OF
FOR LINE 21a OF FORM 3X
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
B. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
M M / D D / Y Y Y Y
, , .
Allocated Activity or Event:
Administrative Fundraising Exempt
Voter Drive Direct Candidate Support
Public Comm (ref to party only) by PAC
Allocated Activity or Event Year-To-Date
Date
C. Full Name (Last, First, Middle Initial)
Mailing Address
City State Zip Code
Purpose of Disbursement:
Activity or Event Identifier:
, , . , , . , , .
NONFEDERAL SHAREFEDERAL SHARE TOTAL AMOUNT+ =
Category/Type
45000.00
185469.50
0.00
1007 North Federal Highway
650 Town Center Drive
#166
12th Floor
COMMITTEE TO RESTORE AMERICA'S GREATNESS
FL
CA 92626
33304
Transaction ID : H4.5258
Transaction ID : H4.6842
0.00
0.00
03
03
voter fraud research and documentation
legal and accounting services
40000.00
2016
5000.00
Jensen & Associates, APC, Trial Lawyers
Citroen Associates
45
2016
0.00
Image# 201604159012459375
31
5000.00
40000.00
45
185469.50
145469.50
31
Ft. Lauderdale
Costa Mesa
45000.00
185469.50
Administrative
Administrative
001
001
pbasupally
Text Box
Memo Item
pbasupally
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Memo Item
pbasupally
Text Box
Memo Item
pbasupally
Rectangle
pbasupally
Rectangle
pbasupally
Rectangle
