Candidate & Elected OfficialCampaign Finance ReportSummaRy FORm 1a
this area for official use only
Form revised 5.24.2017
Name of Candidate or Elected Official
Telephone Number
As required by the Alabama Fair Campaign Practices Act, i hereby swear or affirm to the best of my knowledge and belief that the attached report(s) and the information contained herein are true and correct and that this information is a full and complete statement of all contributions, expenditures, and other required information during the applicable period of time.
Signature of Candidate or Elected Official
Address
Amended Annual report
date
Check box if reporting new address
City state ZiP Code
Political Party/Ballot Affiliation
Termination report
sworn to and subscribed before me this ____________ day of ____________ of the
year ____________. my commission expires the _________ day of ____________ of
the year ____________.
Print Notary's Name
signature of Notary Public
Please Print in Ink or Type.
Office Sought or Held (include district or circuit number, if applicable)
Calendar Year covered by this report.
Total Pages in Reportinclude this page in your count.
FaiR Campaign pRaCtiCES aCt StatE OF alabama
Cash Contributions
Total itemized receipts from other sources (total from Form 4)
itemized cash contributions (total from Form 2)
Non-itemized cash contributions
Itemized in-kind contributions (total from Form 3)
Total cash contributions (add lines 2a and 2b)
Non-itemized expendituresItemized expenditures (total from Form 5)
Total in-kind contributions (add lines 3a and 3b)Non-itemized in-kind contributions
Total expenditures (add lines 5a and 5b)
ending balance (add lines 1, 2c, & 4c, then subtract line 5c)
Beginning balance (ending balance from previous filing)
In-Kind Contributions
Expenditures
Receipts from Other Sources
ending balance (add lines 8, 9, & 11, then subtract line 12)
Total expenditures for yearTotal receipts from other sources for yearTotal in-kind contributions for yearTotal cash contributions for yearBeginning balance (as of January 1 of reporting year)
SECTION I - Summary of activity from last filed report through December 31 of reporting year
SECTION II - Summary of activity for entire reporting year - January 1st through December 31st
1
2b2a
2c
5b5a
5c
77
5c
5a5b
3c3b3a
2c2b
4a
2a
1
12
14
111098
1213
1110
98
15 Total campaign debt (total debt owed as of december 31) 15
4c4b Total non-itemized receipts from other sources
Total receipts from other sources (add lines 4a and 4b)
3a3b
4a
4c4b
3c
an
nu
al
Non-itemized expendituresItemized expenditures on line of credit (total from Form 6)
Total expenditures on line of credit (add lines 6a and 6b)
Expenditures on Line of Credit
6b6a
6c6c
6a6b
Total expenditures on line of credit for year1314
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCEOF CONTRIBUTION
(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE
Bus
ines
s or
Cor
pora
tion
Indi
vidu
al
PA
C
Ret
urne
d
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCEOF CONTRIBUTION
(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE
Bus
ines
s or
Cor
pora
tion
Indi
vidu
al
PA
C
Ret
urne
d
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCEOF CONTRIBUTION
(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE
Bus
ines
s or
Cor
pora
tion
Indi
vidu
al
PA
C
Ret
urne
d
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCEOF CONTRIBUTION
(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE
Bus
ines
s or
Cor
pora
tion
Indi
vidu
al
PA
C
Ret
urne
d
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 2: CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST in-kind contributions or loans on this form. Use Forms 3 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCEOF CONTRIBUTION
(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL CASH CONTRIBUTIONS THIS PAGE
Bus
ines
s or
Cor
pora
tion
Indi
vidu
al
PA
C
Ret
urne
d
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 3: IN-KIND CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or loans on this form. Use Forms 2 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCE(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL IN-KIND CONTRIBUTIONS THIS PAGE
Bus
ines
s/C
orpo
ratio
n
Indi
vidu
al
PA
C
Oth
er
NATURE OF CONTRIBUTION(CHECK ONE)
Adm
inis
trativ
e
Ren
t
Foo
d
Adv
ertis
ing
Equ
ipm
ent
Tra
nspo
rtat
ion
Con
sulta
nts/
Pol
ling
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 3: IN-KIND CONTRIBUTIONS RECEIVED BY CANDIDATE OR ELECTED OFFICIAL
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or loans on this form. Use Forms 2 and 4 for those listings.
CONTRIBUTOR(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
SOURCE(CHECK ONE)
DATECONTRIBUTION
RECEIVED(mo./day/yr.)
AMOUNTOF
CONTRIBUTION
FORM REVISED 10.29.99TOTAL IN-KIND CONTRIBUTIONS THIS PAGE
Bus
ines
s/C
orpo
ratio
n
Indi
vidu
al
PA
C
Oth
er
NATURE OF CONTRIBUTION(CHECK ONE)
Adm
inis
trativ
e
Ren
t
Foo
d
Adv
ertis
ing
Equ
ipm
ent
Tra
nspo
rtat
ion
Con
sulta
nts/
Pol
ling
Oth
er
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 4: RECEIPTS FROM OTHER SOURCES
The FCPA requires that those contributions greater than $100 be itemized. DO NOT LIST cash or in-kind contributions on this form. Use Forms 2 and 3 for those listings.
SOURCE OF RECEIPT(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX,CITY, STATE, AND ZIP)
RECEIPT SOURCE(CHECK ONE)
DATE RECEIVED(mo./day/yr.)
AMOUNTOF
RECEIPT
FORM REVISED 10.29.99TOTAL RECEIPTS THIS PAGE
PA
C
Indi
vidu
al
Bus
ines
s
Oth
er
COMPLETE THIS BLOCK IF RECEIPTIS A LOAN
GUARANTORS
[FCPA REQUIRES FULL NAME ANDCOMPLETE ADDRESS OF INDIVIDUAL(S)ENDORSING OR GUARANTEEING LOAN]O
ther
Loan
Inte
rest
Lend
ing
Inst
itutio
n
LOANS/INTEREST/OTHER SOURCES OFINCOME TO CANDIDATE OR ELECTED OFFICIAL
FORMOF RECEIPT
NAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
The FCPA requires that expenditures over $100 be itemized.
PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE
(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE
Tra
nspo
rtat
ion
PURPOSE OF EXPENDITURE(CHECK ONE)
Adm
inis
trat
ive
Fun
drai
sing
Foo
d
Adv
ertis
ing
Con
trib
utio
n
Loan
Rep
aym
ent
Con
sulta
nts/
Pol
ling
Lodg
ing
BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES
OTHER
GIVEBRIEF
EXPLANATION
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
The FCPA requires that expenditures over $100 be itemized.
PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE
(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE
Tra
nspo
rtat
ion
PURPOSE OF EXPENDITURE(CHECK ONE)
Adm
inis
trat
ive
Fun
drai
sing
Foo
d
Adv
ertis
ing
Con
trib
utio
n
Loan
Rep
aym
ent
Con
sulta
nts/
Pol
ling
Lodg
ing
BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES
OTHER
GIVEBRIEF
EXPLANATION
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
The FCPA requires that expenditures over $100 be itemized.
PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE
(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE
Tra
nspo
rtat
ion
PURPOSE OF EXPENDITURE(CHECK ONE)
Adm
inis
trat
ive
Fun
drai
sing
Foo
d
Adv
ertis
ing
Con
trib
utio
n
Loan
Rep
aym
ent
Con
sulta
nts/
Pol
ling
Lodg
ing
BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES
OTHER
GIVEBRIEF
EXPLANATION
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
The FCPA requires that expenditures over $100 be itemized.
PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE
(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE
Tra
nspo
rtat
ion
PURPOSE OF EXPENDITURE(CHECK ONE)
Adm
inis
trat
ive
Fun
drai
sing
Foo
d
Adv
ertis
ing
Con
trib
utio
n
Loan
Rep
aym
ent
Con
sulta
nts/
Pol
ling
Lodg
ing
BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES
OTHER
GIVEBRIEF
EXPLANATION
ALABAMA FAIR CAMPAIGN PRACTICES ACT
FORM 5: EXPENDITURESNAME OF CANDIDATE / ELECTED OFFICIAL: ____________________________________________________________________ PAGE _____ OF _____
The FCPA requires that expenditures over $100 be itemized.
PERSON/GROUP/BUSINESSRECEIVING EXPENDITURE
(INCLUDE FULL NAME)
ADDRESS(ADDRESS SHOULD INCLUDE
STREET OR P.O. BOX, CITY, STATE, AND ZIP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
FORM REVISED 10.29.99TOTAL EXPENDITURES THIS PAGE
Tra
nspo
rtat
ion
PURPOSE OF EXPENDITURE(CHECK ONE)
Adm
inis
trat
ive
Fun
drai
sing
Foo
d
Adv
ertis
ing
Con
trib
utio
n
Loan
Rep
aym
ent
Con
sulta
nts/
Pol
ling
Lodg
ing
BY CANDIDATE OR ELECTED OFFICIAL - INCLUDING CONTRIBUTIONS TO OTHERCANDIDATES, POLITICAL PARTIES, AND POLITICAL COMMITTEES
OTHER
GIVEBRIEF
EXPLANATION
AlAbAmA FAir CAmpAign prACtiCes ACt - CAmpAign FinAnCe report For CAndidAte & eleCted oFFiCiAl
Form 6: expenditures on line of Credit by candidate or elected officialnAme oF CAndidAte or eleCted oFFiCiAl:
When total expenditures to a single recipient exceed $100.00, the FCPA requires all expenditures to that recipient be itemized.
PERSON/GROUP/BUSINESS RECEIVING EXPENDITURE
(inClude Full nAme)
ADDRESS(Address should inClude
street or P.o. Box, City, stAte, And ziP)
DATE OFEXPENDITURE
(mo./day/yr.)
AMOUNTOF
EXPENDITURE
Form revised 5.19.2017TOTAL EXPENDITURES THIS PAGE
inte
rest
PURPOSE OF EXPENDITURE(CheCK one)
Adm
inis
trativ
e
Fund
rais
ing
Food
Adv
ertis
ing
Con
tribu
tion
lodg
ing
Con
sulta
nts/
Pol
ling
tran
spor
tatio
n
OThERgive BrieF
exPlAnAtion
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