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SCHEDULE A: RECEIPTS (continued) <br />Date Received <br />Name and Residential Address <br />(alphabetical listing required) <br />Amount <br />Occupation Sr Employer <br />(for contributions of $200 or more) <br />Line 9: Total Receipts over $50 (or listed above) <br />F Enter on page 1, line 2 <br />Line 10: Total Receipts $50 and under* (not listed above) <br />Line 11: TOTAL RECEIPTS IN THE PERIOD <br />* If you have itemized receipts of $50 and under, include them in line 9. Line 10 should include only those receipts not itemized above. <br />Page 3 <br />