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SCHEDULE A: RECEIPTS <br />11.G.L. a 55 requires that the name and residential address be reported, in alphabetical order, far all receipts over $50 in a calendar <br />year. Committees must keep detailed accounts and records ofall receipts, but need only itemize those receipts over $50. In addition, the <br />occupation and employer must be reported for all persons who contribute $200 or more in a calendar year. <br />(A "Schedule A: Receipts" attachment is available to complete, print and attach to this report, if additional pages are required to <br />report all receipts. Please include your committee name and a page number on each page.) liilh 10P _1 PM ii <br />Name and Residential Address Occupation & Employer <br />Date Received (alphabetical listing required) Amount (for contributions ofl$200hlil. dr1 yl <br />2/24/2014 I Vine Brook <br />MA Road <br />Le <br />96.80 <br />Lexingtonn, MA 02421 <br />Daniel Busa <br />2/24/2014 16 Farm Road 96.80 <br />Lexington, MA 02420 <br />Karen Forienza <br />11 11 2/24/2014 11-ex olomo MA 02420 ce Road NA/At home <br />485.20 <br />(dine Crocker <br />Box 279 <br />Hyannisport, MA 02672 <br />'ence Poor <br />Munroe Road <br />inoton. MA 02421 <br />rd Poor <br />Munroe Road <br />inaton. MA 02421 <br />bridge Urological Associates <br />Mt. Auburn, Suite 519 <br />bridge, MA 02238 <br />Line 9: Total Receipts over $50 (or listed above) <br />Line 10: Total Receipts $50 and under* (not listed above) <br />Line 11: TOTAL RECEIPTS IN THE PERIOD <br />s If you have <br />NA/Retired <br />100.00 <br />NA /Retired <br />100.00 <br />Doctors' office - urologists <br />96.80 <br />n <br />F-1 <br />1 1518.591 <br />446.16 <br />1518.59 F Enter on page 1, line 2 <br />include only those receipts not itemized above. <br />Page 2 <br />