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Date Paid <br />To Whom Paid <br />(alphabetical listing) <br />Address <br />Purpose of Expenditure <br />Amount <br />,�, <br />t_r, <br />r <br />e <br />p.W <br />W—C' <br />Enter on page 1, line 4 -, <br />Line 12: Expenditures over $50 (or listed above) <br />0 <br />Line 13: Expenditures $50 and under* (not listed above) <br />0 <br />Line 14: TOTAL EXPENDITURES IN THE PERIOD <br />* If you have itemized expenditures of $50 and under include them in line 12. Line 13 should include only those expenditures not itemized <br />ahnve <br />