Dec 31 Page 3 Itemized ContributionsClick here to clear form.
SCHEDULE A Page o
ITEMIZED CONTRIBUTIONS 1 1
of more than Fifty Dollars ($50.00) this period
Name of Candidate or Committee: Treg Bernt
Date Received
Full Name, Mailing Address and Zip Code of Contributor
Cash or Check
11 21 / 17
1 Blake Hansen 4035 W. Lost Rapids, Meridian, ID 83646
$ 250.00
$ 250.00
Calendar Year -To -Date
2.
$
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3.
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4.
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5.
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6.
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I /
7.
$
$
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8.
$
$
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I /
9.
$
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I /
10.
$
$
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Total This Page:
$ 250.00
Transfer the combined total of all Schedule A pages to the Detailed Summary on page 2 line 2.