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The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
• Check the "Change of address" box if the organization The organization must list on Schedule A each contributor
changed its address since it last filed Form 8871, Form 8872, from whom it accepted contributions during the calendar year
Form 990 (or 990-EZ), or Form 1120-POL. if:
• Check the "Amended report" box if the organization is filing • The aggregate amount of the contributions accepted from
an amended report. that person during the calendar year as of the end of this
• Check the "Final report" box if the organization won't be reporting period was at least $200, and
required to file Form 8872 in the future. • Any of those contributions were accepted during this
reporting period.
Employer Identification Number (EIN)
Enter the correct EIN in the space provided as shown on the Treat contributions as accepted if the contributor has
Form 8871 the organization filed. contracted or is otherwise obligated to make the contribution.
DO NOT enter social security numbers on Form 8872 In-kind contributions must be included. These
contributions may be identified by including “(In-kind)” in the
CAUTION
! or on any attachments to this form. contributor's name field.
Foreign Address As an entry on the last page of Schedule A, enter the total
amount of all contributions received from contributors whose
Enter the information in the following order: city or town, state
aggregate contributions were less than $200 and aren't
or province, and country. Follow the country's practice for
reported elsewhere. Enter “Aggregate below Threshold”
entering the postal code, if any. Don't abbreviate the country
instead of the contributor's name. Also enter your
name.
organization's address and the last day of the reporting
Lines 5a and 5b period (for example, Jan. 31); and enter “N/A” for employer,
occupation, and date.
Enter the name and address of the person in possession of
the organization's books and records. Name of Contributor's Employer
Lines 6a and 6b If the contributor is an individual, enter the name of the
organization or person by whom the contributor is employed
Enter the name and address of the person whom the public
(and not the name of his or her supervisor). If the individual is
may contact for more information about the organization.
self-employed, enter "Self-employed." If the individual isn't
Lines 8a through 8h employed, enter “Not employed.” If the contributor isn't an
individual, enter “N/A.”
Check only one box. See When To File, earlier, for details on
the types of reports and the periods covered. Contributor's Occupation
Line 8f. If the organization is filing on a monthly basis, enter If the contributor is an individual, enter the principal job title or
the month for which this report is being filed. During position of that contributor. If the individual is self-employed,
even-numbered years, don't check this box to report enter the principal job title or position of that contributor. If the
October, November, or December activity. Instead, file a individual isn't employed, enter a descriptive title to explain
pre-general election report, post-general election report, a the individual's status such as “Retired,” “Student,”
year-end report; and check the appropriate box on line 8d, “Homemaker,” or “Unemployed.” If the contributor isn't an
8g, or 8h. individual, enter “N/A.”
Line 8g. If the organization is filing a pre-election report, also
indicate the type of election (primary, general, convention, Aggregate Year-to-Date Contributions
special, or runoff) on line 8g(1), the date of the election on Enter the total amount of contributions accepted from the
line 8g(2), and the state in which the election is held on contributor during this calendar year as of the end of this
line 8g(3). reporting period.
Line 8h. If the organization is filing a post-general election Amount of Contribution
report, indicate the date of the election on line 8h(1) and the
If a contributor made more than one contribution in a
state in which the election was held on line 8h(2).
reporting period, report each contribution separately. If the
Line 9 contribution is an in-kind contribution, report the fair market
value of the contribution.
If the organization is required to file Schedule(s) A, enter the
total of all subtotals shown on those schedules. If the Non-Disclosed Amounts
organization isn't required to file Schedule A, enter zero.
As the last entry on Schedule A, list the aggregate amount of
Line 10 contributions that are required to be reported on this
If the organization is required to file Schedule(s) B, enter the schedule for which the organization doesn't disclose all of the
total of all subtotals shown on those schedules. If the information required under section 527(j). Enter “Withheld” as
organization isn't required to file Schedule B, enter zero. the contributor's name. Enter the organization's address, the
date of the report, and “N/A” for occupation and employer.
Schedule A—Itemized Contributions This amount is subject to the penalty for the failure to provide
Note. Multiple Schedules A can be filed with any report. all the information required. See Penalty for details, earlier.
Number each schedule in the box in the top right corner of Schedule B—Itemized Expenditures
the schedule. Be sure to include both the number of the
specific page and the total number of Schedules A (for Note. Multiple Schedules B can be filed with any report.
example, "Schedule A, page 2 of 5"). Number each schedule in the box in the top right corner of
the schedule. Be sure to include both the number of the
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