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01/31/2012 19 : 33
Image# 12950394344PAGE 1 / 14REPORT OF RECEIPTS
AND DISBURSEMENTS FEC
FORM 3
1. For An Authorized Committeeman OF
COMMITTEE (in full)Office Use OnlyExample: If typing, type
over
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Page 114 is a form used for reporting income tax information to the IRS.
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Page 114 can be filled out manually or electronically using IRS-approved software.
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The purpose of page 114 is to report income tax information accurately to the IRS.
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Income, deductions, credits, and any other relevant tax information must be reported on page 114.
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