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SCHEDULE A: RECEIPTS <br />M.G.L. c. 55 requires that the name and residential address be reported, in alphabetical order, for all receipts over $50 in a calendar <br />year. Committees must keep detailed accounts and records of all 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.) <br />Date Received <br />Name and Residential Address <br />(alphabetical listing required) <br />Amount <br />Occupation & Employer <br />(for contributions of $200 or more) <br />12/11/16 <br />Susan Conway & Clifton Jay <br />29 Woodland Rd <br />Lexington, MA 02420 <br />$200 <br />President <br />HealthNEf Systems Consulting Inc. <br />$205 <br />Retired Clinical Laboratory Scientist <br />11/16/16 <br />Judith A Crocker <br />5 Currier Court <br />Lexington, Ma 02420 <br />$250 <br />Business owner <br />Ariex Oil Corp. <br />12/20/16 <br />Kathy and Jack Maloney <br />589 Bedford St <br />PO Box 515 <br />'.j <br />C i <br />L'\ <br />Line 9: Total Rece pts over $50 (or listed above) <br />Line 10: Total Receipts $50 and under* (not listed above) <br />$655.00 <br />F Enter on page 1, line 2 <br />$50 <br />Line 11: TOTAL RECEIPTS P4 THE PERIOD <br />$705 <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 2 <br />