Form 8872                                               Political Organization                                                        OMB No. 1545-0123
(Rev. October 2014)             Report of Contributions and Expenditures
                             ▶
Department of the Treasury     Information about Form 8872 and its instructions is available at www.irs.gov/form8872.                 Open to Public 
Internal Revenue Service   ▶ Do not enter social security numbers on this form or any attachments to it as they may be made public.       Inspection
A    For the period beginning                                        , 20             and ending                                               , 20

B    Check applicable boxes:             Initial report Change of address                       Amended report                     Final report
1    Name of organization                                                                                 Employer identification number 

2    Mailing address (P.O. Box or number, street, and room or suite number)

     City or town, state or province, country, and ZIP or foreign postal code

3    Email address of organization                                                                        4  Date organization was formed

5a   Name of custodian of records                                    5b  Custodian's address

6a   Name of contact person                                          6b  Contact person's address

7    Business address of organization (if different from mailing address shown above). Number, street, and room or suite number

     City or town, state or province, country, and ZIP or foreign postal code

8    Type of report (check only one box)

a       First quarterly report (due by April 15)                     f          Monthly report for the month of: 
                                                                                (due by the 20th day following the month shown above, except the 
b       Second quarterly report (due by July 15)                                December report, which is due by January 31)

c       Third quarterly report (due by October 15)                   g          Pre-election report (due by the 12th or 15th day before the 
                                                                                election)
d       Year-end report (due by January 31)                                       (1) Type of election:
                                                                                  (2) Date of election:
e       Mid-year report (Non-election year only–due by July 31)                   (3) For the state of:

                                                                     h          Post-general election report (due by the 30th day after general 
                                                                                election)
                                                                                  (1) Date of election:
                                                                                  (2) For the state of:

9    Total amount of reported contributions (total from all attached Schedules A) .   .  .      . . .  . .   .   . .                9

10   Total amount of reported expenditures (total from all attached Schedules B)  .   .  .      . . .  . .   .   . .                10
      Under penalties of perjury, I declare that I have examined this report, including accompanying schedules and statements, and to the best of my knowledge and 
      belief, it is true, correct, and complete. 
Sign  
      ▲                                                                                                  ▲
Here 
        Signature of authorized official                                                                       Date 
For Paperwork Reduction Act Notice, see separate instructions.                        Cat. No. 30406G                               Form  8872 (Rev. 10-2014) 

Form 8872 (Rev. 10-2014)
Schedule A    Itemized Contributions (DO NOT enter social security numbers on this schedule.)    Schedule A page                         of 
Name of organization                                                                             Employer identification number 

Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .    ▶   $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Contributor's name, mailing address and ZIP code     Name of contributor's employer                                          Amount of contribution

                                                     Contributor's occupation
                                                                                                                             $
                                                     Aggregate contributions                                                 Date of contribution
                                                     year-to-date . . . .    .     ▶  $
Subtotal of contributions reported on this page only. Enter here and also include this amount in the total on line 9 of   
Form 8872 . . .         . . . . . . . . .        . . . . . . .      . . .    . .    .  . . . . . .                        ▶  $
Open to Public Inspection                                                                                                     Form 8872 (Rev. 10-2014)

Form 8872 (Rev. 10-2014)
Schedule B    Itemized Expenditures (DO NOT enter social security numbers on this schedule.)   Schedule B page                        of 
Name of organization                                                                           Employer identification number 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Recipient's name, mailing address and ZIP code       Name of recipient's employer                                         Amount of expenditure

                                                                                                                          $
                                                     Recipient's occupation                                               Date of expenditure

Purpose of expenditure 

Subtotal of expenditures reported on this page only. Enter here and also include this amount in the total on line 10 of   
Form 8872 . . .         . . . . . . . .        . . . . . . . . . . .        . .   . . . . .  . . ▶                        $
Open to Public Inspection                                                                                                  Form 8872 (Rev. 10-2014)