Fillable GUIDELINE FOR PRESENTATION IN GOOD ORDER APPENDICES LETTER (Federal Election Commission)

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GUIDELINE FOR PRESENTATION IN GOOD ORDER APPENDICES LETTER (Federal Election Commission)

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GUIDELINE FOR PRESENTATION IN GOOD ORDER
APPENDICES
LETTER FORMATS/FORMS
l Suggested Letter of Candidate Agreements/Certifications
2 Certification from Committee Treasurer
Re: Information Submitted
3 Notices of Threshold Submission Review
4 Contributor File Requirements
5 Notices - Failure to Meet Standards of Good Order
6 Summaries - Results of Review
FORMATS FOR ADDITIONAL DOCUMENTATION LETTERS
7 Contributions Drawn on Employee Participation Plan Account Lacking
Contributor's Signature
8 Loans Forgiven
9 Possible Foreign Contributions
10 Attribution of Unmatched Portion of Written Instrument to Another
Individual
11 Reattribution of an Excessive Contribution to Another Individual
12 Contribution Drawn on Business Account
13 Contribution Drawn on Partnership, Group, or Association Account
14 Contribution Drawn on Trust, Escrow, or Estate Account
GUIDELINE FOR PRESENTATION IN GOOD ORDER
APPENDICES
FORMATS FOR ADDITIONAL DOCUMENTATION LETTERS (Cont.)
15 Listing of Non-Matchable/Matchable Account Designations
16 Contribution Drawn on Individual's Designated Account
17 Signature other than Accountholder (Contributor identified as
accountholder, signed by other)
18 Signature other than Accountholder (signed by contributor not identified
as Accountholder)
19 Signature Discrepancy on Joint Account
20 Written Instrument Omitting Information Regarding Date, Payee, Amount
21 Written Instrument Which Cannot be Associated with Listed Contributor
22 Documentation Required for Initial Submission of Money Orders,
Cashier's Checks or Other Similar Negotiable Written Instruments
Appendix 1
Page 1 of 3
SUGGESTED FORMAT
FOR CANDIDATE AND COMMITTEE AGREEMENTS
AND CERTIFICATIONS
Chairman
Federal Election Commission
999 E Street, N.W.
Washington, D.C. 20463
Dear Mr. Chairman:
As a candidate seeking to become eligible to receive Presidential primary matching
funds, I certify and agree to the following provisions as prescribed at 11 CFR §9033.1 and 11
CFR §9033.2.
I. In accordance with 11 CFR §9033.2(b)(1) and 11 CFR §9033.2(b)(3), I certify that
I am seeking the nomination of the (name of political party) for election to the
Office of President in more than one State. I and/or my authorized committee(s)
have received matchable contributions, which in the aggregate exceed $5,000 from
residents of each of at least twenty States, which with respect to any one person do
not exceed $250.00.
II. Pursuant to 11 CFR §9033.2(b)(2), I and/or my authorized committee(s) have not
incurred and will not incur qualified campaign expenses in excess of the
expenditure limitations prescribed by 26 U.S.C. §9035 and 11 CFR §9035.
III. In accordance with 11 CFR §9033.1(b)(1), I acknowledge that I have the burden of
proving that disbursements made by me, and any of my authorized committee(s) or
agents are qualified campaign expenses as defined at 11 CFR §9032.9.
IV. Pursuant to 11 CFR §9033.1(b)(2), I and my authorized committee(s) will comply
with the documentation requirements set forth in 11 CFR §9033.11.
V. Upon the request of the Commission, I and my authorized committee(s) will supply
an explanation of the connection between any disbursement made by me or my
authorized committee(s) and the campaign as prescribed by 11 CFR §9033.1(b)(3).
VI. In accordance with 11 CFR §9033.1(b)(4), I and my authorized committee(s) agree
to keep and furnish to the Commission all documentation for matching fund
submissions, any books, records (including bank records for all accounts) and
supporting documentation and other information that the Commission may request.
VII. As provided at 11 CFR §9033.1(b)(5), I and my authorized committee(s) agree to
keep and furnish to the Commission all documentation relating to disbursements
Appendix 1
Page 2 of 3
and receipts including any books, records (including bank records for all accounts),
all documentation required by this section (including those required to be
maintained under 11 CFR §9033.11), and other information that the Commission
may request. If I or my authorized committee(s) maintains or uses computerized
information containing any of the categories of data listed in 11 CFR §9033.12(a),
the committee will provide computerized magnetic media, such as magnetic tapes
or magnetic diskettes, containing the computerized information at the times
specified in 11 CFR §9038.1(b)(1) that meet the requirements of 11 CFR
§9033.12(b). Upon request, documentation explaining the computer system's
software capabilities shall be provided and such personnel as are necessary to
explain the operation of the computer system's software and the computerized
information prepared or maintained by the committee(s) shall be made available.
VIII. As prescribed at 11 CFR §9033.1(b)(6), I and my authorized committee(s) will
obtain and furnish to the Commission upon request all documentation relating to
funds received and disbursements made on my behalf by other political committees
and organizations associated with me.
IX. In accordance with 26 U.S.C. §9038 and 11 CFR §9033.1(b)(7), I and my
authorized committee(s) shall permit an audit and examination pursuant to 11 CFR
§9038 of all receipts and disbursements, including those made by me, all authorized
committee(s) and any agent or person authorized to make expenditures on my
behalf or on behalf of my authorized committee(s). I and my authorized
committee(s) shall also provide any material required in connection with an audit,
investigation, or examination conducted pursuant to 11 CFR §9039. I and my
authorized committee(s) shall facilitate the audit by making available in one central
location, office space, records and such personnel as are necessary to conduct the
audit and examination, and shall pay any amounts required to be repaid under 11
CFR §9038 and 11 CFR §9039.
X. Pursuant to 11 CFR §9033.1(b)(8), the person listed below is entitled to receive
matching fund payments on my behalf, which will be deposited into the listed
depository, which I have designated as the campaign depository. Any change in the
information required by this paragraph shall not be effective until submitted to the
Commission in a letter signed by me or the Treasurer of my authorized principal
campaign committee.
Name of Person: _________________________________________
Mailing Address: _________________________________________
_________________________________________
Designated
Depository: ______________________________________________
Appendix 1
Page 3 of 3
Address: ________________________________________________
________________________________________________
XI. Pursuant to 11 CFR §9033.1(b)(9), 11 CFR §9033.1(b)(10), and 11 CFR
§9033.1(b)(11), I and my authorized committee(s) will: (A) prepare matching fund
submissions in accordance with the Federal Election Commission's Guideline for
Presentation in Good Order, including the provision of any magnetic media
pertaining to the matching fund submissions and which conforms to the
requirements specified at 11 CFR §9033.12; (B) comply with the applicable
requirements of 2 U.S.C. §431 et seq. 26 U.S.C. §9031 et seq. and the
Commission's regulations at 11 CFR Parts 100-300, and 9031-9039; (C) pay any
civil penalties included in a conciliation agreement or otherwise imposed under 2
U.S.C. §437g against myself, any of my authorized committee(s) or any agent
thereof.
XII. Pursuant to 11 CFR §9033.1(b)(12), any television commercial prepared or
distributed by me or my authorized committee(s) will be prepared in a manner
which ensures that the commercial contains or is accompanied by closed captioning
of the oral content of the commercial to be broadcast in line 21 of the vertical
blanking interval, or is capable of being viewed by deaf and hearing impaired
individuals via any comparable successor technology to line 21 of the vertical
blanking interval.
Signed: ________________________________________________
Candidate Signature*
* 11 CFR §9033.2(a)(1) requires the Candidate and Committee Agreements and Certifications
to be signed by the Candidate.
Appendix 2
TO ACCOMPANY ANY THRESHOLD SUBMISSION,
NON-THRESHOLD SUBMISSION AND RESUBMISSION
(11 CFR §104.14)
Chairman
Federal Election Commission
999 E Street, NW
Washington, D.C. 20463
Dear Mr. Chairman:
I, (Name of Treasurer), as Treasurer of (Name of Committee), certify that the
information contained in the Committee's (Threshold Submission, Matching Fund
Submission No. ___, or Resubmission No. ___) is complete and accurate. This
submission lists contributions deposited from ____________ to ____________. (Note:
For a Matching Fund Submission also listing contributions that were withheld from
earlier submissions, the certification shall further state: “and also contributions
deposited in periods covered by earlier submission.”)
CERTIFICATION FROM COMMITTEE TREASURER REQUIRED
I also certify the Submission has been prepared in accordance with the
Commission's Guideline for Presentation in Good Order.
If credit card contributions are included in the submission the following statements
must be included: I further certify that a method of billing address verification is in
place for credit card contributions. Only credit card contributions where the billing
address verification system verifies an exact match with the address information provided
by the contributor have been accepted.
Note: For eligible candidates making submissions/resubmissions prior to the last
submission/resubmission date in the year preceding the presidential election and for
ineligible candidates the following statement must be included:
In the event the Commission's initial review estimates that less than 85% of the
submitted contributions are matchable, I agree to accept its return for corrective action.
(See 11 CFR §9036.2(c))
Appendix 2
Note: For ineligible candidates the following statement must also be included:
I also certify that as of the close of business on (last business day preceding the
date of the submission) the committee’s net outstanding campaign obligations equal or
exceed the amount submitted for matching
Signed,
_________________________
Committee Treasurer
________________________
Appendix 3(a)
Page 1 of 2
SUMMARY RESULTS OF
REVIEW THRESHOLD SUBMISSION
FOR STATE OF
Candidate/Committee:_____________________________________________________
Date Submitted:___________________ Amount Submitted: $__________________
Amount Matchable: $__________________
Amount Non-Matchable: $______________
The portion of the Threshold Submission for the State
identified above has been reviewed in accordance with the
Commission's review procedures. The results of the review,
summarized below, indicate that the threshold requirements
for establishing eligibility in the State have not been met.
Attached to this summary is a listing of the contributions
that were identified as non-matchable, and where
appropriate, copies of the associated written instruments.
For a thorough explanation of the exceptions to matchability noted, see the Commission’s
Guideline for Presentation in Good Order, Chapter V, "Standard Exception Codes for
Review of Matching Fund Submissions." Requirements for resubmission of rejected
contributions are also contained in this chapter.
Exception Subcategory Amount
Code Number Rejected
A ___________ $___________
B ___________ ___________
C ___________ ___________
D ___________ ___________
E ___________ ___________
F ___________ ___________
G ___________ ___________
H ___________ ___________
I ___________ ___________
J ___________ ___________
Other ___________ ___________
Other ___________ ___________
Subtotal $___________
NSF Adjustment ___________
TOTAL $___________
________________________
Appendix 3(a)
Page 2 of 2
SUMMARY RESULTS OF
REVIEW THRESHOLD SUBMISSION
FOR STATE OF
As a result of the 100% review of contributions submitted for the State that found that the
eligibility requirements were not met, the portions of the Threshold Submission
pertaining to the State that require correction or supplemental information are being
returned for remedial action. See also Chapter I, Part P. of the Guideline for Presentation
in Good Order regarding the failure of a candidate/committee to establish eligibility. The
supplemental information, corrections and/or replacement contributions may be
submitted on any business day.
Signed:_____________________________ Signed:_____________________________
for the Assistant Staff Director
Office of General Counsel for Audit
Date:_______________________________ Date:_______________________________
INVENTORY OF RETURNED THRESHOLD SUBMISSION MATERIALS
_____ Contributor List _____Bank Documentation
_____ Written Instruments _____Other:_____________________________
_______________________________________
I acknowledge that, on the date noted above, the above Threshold Submission materials
for the State of __________________________________ were returned to
_____(Name of Candidate/Committee)_____ for review and corrective action. I also
acknowledge that, because of the additional time needed for these actions under 11 CFR
§9033.4(a)(2), the Commission will not be obligated to consider an eligibility
determination until after corrected information has been submitted. I further
acknowledge that such eligibility determination will generally be made within
__________business days of the Commission's receipt of the corrected threshold
submission, provided the corrected threshold submission documents have met the
eligibility requirements.
Received by:______________________________ Date:____________________
Committee Representative
Appendix 3(b)
Page 1 of 2
NOTICE
STATUS OF REVIEW
THRESHOLD SUBMISSION
Candidate/Committee: ____________________________________________________
Date Submitted: _______________________________
Amount Submitted: $___________________________ No. of States: ___________
The Commission's Guideline for Presentation in Good Order, Chapter I.P., provides a
candidate/committee an opportunity to take corrective action where the staff review indicates
that the eligibility requirements in at least 20 States will not be met. The following state listings
are presented for your information in taking the appropriate corrective actions. Attached to this
notice is a summary for each reviewed state where the eligibility requirements have not been
met, together with the identification of the contributions that were identified as non-matchable,
and the reasons.
The provisions in the Guideline for Presentation in Good Order provide for Commission staff to
halt the review of a threshold submission when it reaches a point indicating the eligibility
requirements will not be met. The candidate/committee is afforded a maximum of two
opportunities to take corrective actions with respect to the threshold submission before the
Commission proceeds to an initial determination that the candidate/committee has not met the
eligibility requirements in at least 20 states.
Listed below are the states submitted in the threshold submission, grouped into three categories.
For those states in which non-matchable contributions caused the threshold requirements not to
be met, a summary and a listing of the contributions identified as non-matchable are included.
The submitted contributor list and associated documentation for each unreviewed state is being
returned with this notice for your review and to permit you to make any corrections necessary to
ensure that only matchable contributions totaling in excess of $5,000 are submitted with the
corrected threshold submission.
Appendix 3(b)
Page 2 of 2
NOTICE
STATUS OF REVIEW
THRESHOLD SUBMISSION
Eligibility of Reviewed States States
Established Not Established Not Reviewed
Signed: _______________________________ Signed: _______________________________
for the Assistant Staff Director
Office of General Counsel for Audit
Date: _________________________________ Date: _________________________________
Signed: _______________________________
Committee Representative
Date: ________________________________
Appendix 4
Required Fields for Contributor File
Submission Number
Contributor ID Number
Name Prefix
First Name
Last Name
Name Suffix
Address1 Must be residential for Threshold
Submission
Address2 Must be residential for Threshold
Submission
City
State
Zip Code
Occupation Required for Threshold Submission
Name of Employer Required for Threshold Submission
Contribution Deposit Batch
Number
A series of characters which
uniquely identify a given deposit
batch. Typically, YYMMDD,
followed by three for a
sequential number for multiple
deposits on the same day. i.e.
070102005 = 5th deposit batch on
January 2, 2007), or some other
method which results in a unique
identifier to a specific deposit
batch for contributions.
Batch Sequence Number The location of a given
contribution within the deposit
batch (i.e., 17 = 17
th
check in
the batch).
Contribution Amount
Contribution Deposit Date
Amount Submitted for Matching
Aggregate Amount Submitted this
Submission
Aggregate Amount Submitted all
Submissions
Digital Image Address May be Contribution Deposit Batch
Number plus the Batch Sequence
Number.
______
Appendix 5(a)
Page 1 of 3
NOTICE
FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT
TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER
COMMITTEE: __________________________________________ SUB. NO.:
DATE RECEIVED: ___________________________
The matching fund request identified above has failed to meet the requirements of the
Commission's Guideline for Presentation in Good Order. As provided by 11 CFR
§9036.4(a), the Commission will not accept for review and certification of payment any
matching fund request that has not been prepared or presented in conformance with the
standards of good order as outlined in the Guideline.
The following requirement(s) must be met before a determination of good order can be
made:
1) Contributor Data File
_____ must include all information specified in the Guideline at Chapter III.E.,
_____ other: _________________________________________________
_________________________________________________
2) Supporting Documentation
_____ must submit full-size copies or scanned images of written instruments,
_____ if photocopies, they must be grouped into same order as the contributor list
or by deposit batch,
_____ must be referenced to deposit date,
_____ other: _________________________________________________
_________________________________________________
3) Bank Documentation
_____ must submit either unvalidated deposit slips and copy of bank statement, or
_____ validated deposit slips,
_____ other: _________________________________________________
_________________________________________________
4) NSF Listing
_____ must include all checks returned as NSF regardless of whether submitted,
_____ check copies must have associated debit memos attached,
_____ other: _________________________________________________
_________________________________________________
Appendix 5(a)
Page 2 of 3
NOTICE
FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT
TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER
5) Refunded Contribution Listing
_____ must be in straight alphabetical order and include full name and mailing
address of contributor, date and full amount of check, deposit date, total
amount of contributions received from contributors and amount of refund.
6) Documentation for Joint Fundraising Proceeds
_____ must submit copy of joint fundraising agreement, signed by representative
of each participant,
_____ must include explanation of any allocation different from that specified in
agreement,
_____ other: _________________________________________________
_________________________________________________
7) Documentation for Entertainment Event Proceeds
_____ must submit copy of promotional material,
_____ must submit copy of a ticket at each price,
_____ other: _________________________________________________
_________________________________________________
8) Certification from Committee Treasurer Regarding Accuracy and Completeness
of Information Submitted
_____ must bear signature of responsible official,
_____ other: _________________________________________________
_________________________________________________
9) _____ other: _________________________________________________
_________________________________________________
Appendix 5(a)
Page 3 of 3
NOTICE
FAILURE TO MEET STANDARDS OF GOOD ORDER PURSUANT
TO THE GUIDELINE FOR PRESENTATION IN GOOD ORDER
As also provided at 11 CFR §9036.4(a)(3), if the above requirements can be satisfied by
the close of business on _____________________, the matching fund request will be
accepted for review. A payment for the actual value will be certified (as specified at 11
CFR §9036.2(d)(1) and 11 CFR §9036.2(d)(2)) for the next regular payment date.
Signed:
________________________________Signed:_______________________________
for the Assistant Staff Director
Office of General Counsel for Audit
Date:_____________________________Date:_____________________________
Appendix 5(b)
Page 1 of 2
NOTICE
RESULTS OF INITIAL REVIEW
ERROR RATE IN EXCESS OF 15%
COMMITTEE: __________________________________________ SUB. No.: _______
DATE SUBMITTED: ____________________________
The matching fund submission identified above has been initially reviewed in accordance with
the Commission's review procedures. The results of this review, summarized below, indicate the
matching fund request does not meet the "quality of content" standard of the Commission's
Guideline for Presentation in Good Order. Accordingly, as provided by 11 CFR §9036.2, the
review was suspended in order for the matching fund request to be returned for corrective action.
For a thorough explanation of the Commission's policy on the exceptions noted, see the
Guideline, Chapter V - "Standard Exception Codes for Review of Matching Fund Requests."
Furthermore, requirements for resubmission of rejected contributions are also contained in this
chapter.
Exception Subcategory Error
Code Number Percentage
A __________ __________
B __________ __________
C __________ __________
D __________ __________
E __________ __________
F __________ __________
G __________ __________
H __________ __________
I __________ __________
J __________ __________
TOTAL __________
* * * * * * * * * * * *
Submission No. ________ __________________________________________________
(Signature of Treasurer or Committee Representative)
Date Submission Returned: _______________________
_____________________________________________________
Appendix 5(b)
Page 2 of 2
COMMITTEE: __________________________________________ SUB. No.: _______
DATE SUBMISSION RETURNED: ______________________________
Inventory of Matching Fund Request No. _______
Returned for Corrective
Action Retained by FEC
______ Deposit Batches _______
______ Written Instruments _______
______ Bank Statements _______
______ Deposit Slips _______
______ NSF Listing _______
______ Refund Listing _______
______ Joint Fundraising Documentation _______
______ Entertainment Event Documentation _______
______ Treasurer's Certification _______
______ Electronic Files _______
Other: ____________________________________ _______
______ ____________________________________ _______
I agree the above inventory is correct with respect to documents returned to the Committee for
corrective action and those remaining at the Federal Election Commission.
(Signature of Treasurer or Committee Representative)
Date: ______________________________
__________________________________________________________________________
__________________________________________________________________________
___________________________________________________________________________
Appendix 6
Page 1 of 4
SUMMARY OF SUBMISSION
RESULTS OF REVIEW
COMMITTEE: ________________________________________ SUB. No.: ___________
DATE SUBMITTED: __________________________________ RESUB. No.: ________
SUMMARY OF REVIEW
AMOUNT NSF PREVIOUSLY
REQUESTED: $______________ MATCHED: ($_____________)
(SEE II. BELOW)
REFUNDED
AMOUNT CONTRIBUTIONS
ADJUSTED: $______________ PREVIOUSLY MATCHED: $______________
(SEE I. BELOW) (SEE III BELOW)
AMOUNT CERTIFIABLE
REJECTED: $______________ PER REVIEW: $______________
FINAL AMOUNT CERTIFIED: $______________
I. The original amount requested by this Submission/ Resubmission was adjusted prior to
the review in the amount of $________________________for the following reason(s):
( ) NSF Items included in the Submission/
Resubmission $______________
( ) Mathematical Errors $______________
( ) Other: ________________________________ $______________
_____________________________________ $______________
_____________________________________ $______________
Appendix 6
Page 2 of 4
II. ( ) The NSF Adjustment shown on the Summary was made with respect to
contributions matched in previous submissions. Each NSF item was adjusted in
accordance with the percentage of the amount certified for payment for the
submission. Following is a breakdown of the NSF Adjustment:
Submission Amount Percent Adjusted
Number NSF Items Certified _Amount
III. ( ) The adjustment for refunded contributions matched in previous submission is
calculated in the same manner as the NSF Adjustment above.
Submission Amount Percent Adjusted
Number Refunded Items Certified Amount
Appendix 6
Page 3 of 4
SUMMARY
RESULTS OF REVIEW
COMMITTEE: __________________________________________ SUB. No.: _______
DATE SUBMITTED: _____________________________________ RESUB. No.: _______
The matching fund submission/resubmission identified above has been reviewed in accordance
with the Commission's review procedures. The results of the review are summarized below. For
a thorough explanation of the Commission's policy on the exceptions noted, see the
Commission's Guideline for Presentation in Good Order, Chapter V, "Standard Exception Codes
for Review of Matching Fund Requests." Furthermore, requirements for resubmission of
rejected contributions are also contained in this chapter.
Exception Subcategory Amount Error
Code Number_ Rejected Percentage
A __________ $__________ __________
B __________ __________ __________
C __________ __________ __________
D __________ __________ __________
E __________ __________ __________
F __________ __________ __________
G __________ __________ __________
H __________ __________ __________
I __________ __________ __________
J __________ __________ __________
TOTAL $__________ __________
As a result of this review, the final amount shown on page 1 will be certified to the Secretary of
the Treasury on __________________________.
* * * * * * *
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signature
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Appendix 6
Page 4 of 4
COMMITTEE: __________________________________________ SUB. No.: _______
DATE SUBMITTED: _____________________________________ RESUB. No.: ________
I am requesting the identification of the rejected contributions in the submission/resubmission
noted above. I agree that this precludes the resubmission of the submission/resubmission in its
entirety and limits resubmission by the Committee to only the identified items. Further, payment
is limited to solely the matchable face value of each resubmitted contribution that has been
corrected.
Sub. No.: _________ __________________________________________________
(Signature of Treasurer or Committee Representative)
Resub. No.: _______
Amount Requested: $___________________ Date: ____________________
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Appendix 7
CONTRIBUTION THROUGH AN
EMPLOYEE PARTICIPATION PLAN
CONTRIBUTION LACKING CONTRIBUTOR'S SIGNATURE
Exception Code A-2
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on accounts of
employee participation plans and do not bear the contributor's signature.
Your contribution of $____________, dated _____________________, and drawn on check
#_______ of the account identified as ______________________________________________
will qualify for matching only if the statement below is true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly.
Sincerely,
Committee Representative
This is to verify that I authorized the contribution to the Candidate/Committee through the
account maintained for me by the employee participation plan.
NAME ___________________________________________________________________
ADDRESS ________________________________________________________________
CITY _____________________________________________________________________
STATE _________________________________________ ZIP ______________________
YOUR
SIGNATURE ____________________________________ DATE ____________________
(Please do not Print)
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Appendix 8
LOANS FORGIVEN
Exception Code A-3
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that were initially loans to the
Committee, but subsequently forgiven.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the statement(s) below are true and verified by your signature.
If the statement below is not accurate, please provide a short explanation so the contribution can
be attributed properly (or disposed of, if from an incorporated source).
Sincerely,
Committee Representative
This is to verify that the written instrument described above initially represented a loan from me
to the Committee. However, on _____(provide date)_____ the loan was forgiven, and therefore,
became a contribution from me.
(If drawn on a non-personal account, the following language must be included): The
account on which the written instrument is drawn represents my personal funds. It is not
maintained or controlled by an incorporated entity.
NAME __________________________________________________________________
ADDRESS _______________________________________________________________
CITY ____________________________________________________________________
STATE __________________________________________ ZIP ____________________
YOUR
SIGNATURE _____________________________________ DATE __________________
(Please do not Print)
click to sign
signature
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Appendix 9
POSSIBLE FOREIGN CONTRIBUTION
Exception Code A-6
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are from contributors
having a mailing address outside of the United States or its territories.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the statement below is true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly (or disposed of, if prohibited).
Sincerely,
Committee Representative
This is to verify that I am a citizen of the United States or have been admitted as a permanent
resident.
NAME __________________________________________________________________
ADDRESS _______________________________________________________________
CITY ____________________________________________________________________
STATE _________________________________________ ZIP _____________________
YOUR
SIGNATURE ____________________________________ DATE ___________________
(Please do not Print)
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Appendix 10
ATTRIBUTION OF UNMATCHED PORTION OF WRITTEN
INSTRUMENT TO ANOTHER INDIVIDUAL
Exception Code B-2
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on one check,
but represent contributions from more than one person.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the statement below is true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly.
Sincerely,
Committee Representative
TO BE VERIFIED AND SIGNED BY INDIVIDUAL ASSUMING ALL OR
PORTION OF ORIGINAL CONTRIBUTION
The contribution described above also represents my personal funds. The amount of
$____________ should be attributed to me.
NAME __________________________________________________________________
ADDRESS _______________________________________________________________
CITY ___________________________________________________________________
STATE _________________________________________ ZIP _____________________
YOUR
SIGNATURE ____________________________________ DATE ___________________
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Appendix 11
Page 1 of 2
REATTRIBUTION OF AN EXCESSIVE CONTRIBUTION
TO ANOTHER INDIVIDUAL
Exception Code A-4
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on one check,
but represent contributions from more than one person.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the statement below is true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly.
** If this document is to be used as evidence of a reattribution of an excessive contribution
within 60 days from the date of receipt, it must either be date-stamped as received by the
Candidate/ Committee, accompanied by a copy of the envelope containing the postmark and
other identifying documentation, or be dated by the contributors.
Sincerely,
Committee Representative
____________________________________ ___________________________________
Appendix 11
Page 2 of 2
TO BE VERIFIED AND SIGNED BY INDIVIDUALS ASSUMING ALL OR
PORTION OF ORIGINAL CONTRIBUTION
The contribution described above also represents our personal funds.
NAME_______________________________
ADDRESS___________________________
CITY________________________________
STATE__________ ZIP_________________
YOUR
SIGNATURE_________________________
(Please do not Print)
DATE_________________________
AMOUNT CONTRIBUTED_____________
NAME______________________________
ADDRESS__________________________
CITY_______________________________
STATE__________ ZIP________________
YOUR
SIGNATURE________________________
(Please do not Print)
DATE_________________________
AMOUNT CONTRIBUTED____________
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Appendix 12
APPARENT BUSINESS ACCOUNTS
Exception Code C-1
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on accounts
maintained by a business entity.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the conditions below are true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly (or disposed of, if from an incorporated source).
Sincerely,
Committee Representative
This is to verify that the business maintaining the account identified above is not incorporated.
The contribution represents my personal funds, as I am a member of the unincorporated
business. The full amount as listed above should be attributed to me, as it does not represent
contributions from more than one person.
NAME ____________________________________________________________________
ADDRESS _________________________________________________________________
CITY _____________________________________________________________________
STATE _________________________________________ ZIP _______________________
YOUR
SIGNATURE ____________________________________ DATE _____________________
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Appendix 13
Page 1 of 2
PARTNERSHIP, GROUP, ASSOCIATION ACCOUNTS
OR OTHER NON-PERSONAL ACCOUNTS
Exception Code C-2
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on accounts
maintained by partnerships, groups, or associations, or other types of non-personal accounts.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the following information is provided and verified by your
signature. If you cannot verify the statements below because of they are inaccurate, please
provide a short explanation so the contribution can be attributed properly (or disposed of, if from
prohibited sources).
Sincerely,
Committee Representative
(1) The contribution described above is drawn on an account maintained by:
_____ a partnership, which is non-incorporated.
____ a professional association or professional corporation that is not treated as a
corporation under applicable state laws in the State of
_______________________________________.
____ a limited liability company (LLC) that elects to be treated as a partnership
or a person by the Internal Revenue Code. (11 CFR §110.1(g)).
_____ other group or association (describe).
_______________________________________________________
_______________________________________________________
Appendix 13
Page 2 of 2
(2) _____ the contribution described above represents my personal funds, as I am a
partner in the partnership (or a member of the association). The full amount
as listed above should be attributed to me, as it does not represent
contributions from more than one person.
NAME ____________________________________________________________________
ADDRESS _________________________________________________________________
CITY _____________________________________________________________________
STATE __________________________________________ ZIP ______________________
YOUR
SIGNATURE _____________________________________ DATE ____________________
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Appendix 14
TRUST/ESCROW/ESTATE ACCOUNTS
Exception Code C-3
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on Trust,
Escrow, or Estate Accounts.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the conditions below are true and verified by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly.
Sincerely,
Committee Representative
This is to verify that I have equitable ownership of the account described above. The account on
which the contribution is drawn represents my personal funds.
NAME ___________________________________________________________________
ADDRESS ________________________________________________________________
CITY ____________________________________________________________________
STATE _________________________________________ ZIP ______________________
YOUR
SIGNATURE ____________________________________ DATE ____________________
(Please do not Print)
Appendix 15(a)
MATCHABLE AND NON-MATCHABLE DESIGNATED ACCOUNTS
MATCHABLE
Providing that the personal check
1
is matchable in every other respect, the following types of
designated accounts are considered acceptable for matching purposes without additional
documentation signed by the contributor:
Attorney Account
Beach Account
Campaign Contribution Account
Cash Management Account
Charter Account
Construction Account
Drawing Account
Farm Account
Gift Account
Household Account
Installment Account
Investment Account
Medical Account
Oil Account
Photography Account
Property Account
Rental Account
Special Account
Stock Account
Attorney Fee Account
Building Account
Capital Account
Cattle Account
Condominium Account
Discretionary Account
Expense Account
Gas Account
Hotel Account
Income Account
Insurance Account
Livestock Account
Motel Account
Payment Account
Professional Account
Real Estate Account
Separate Property Account
Special Disbursement Account
Sub-Division Account
Tax Account
See definition of "personal appearance" at Exception Code C-4 (Chapter V) of the Guideline.
1
Appendix 15(b)
MATCHABLE AND NON-MATCHABLE DESIGNATED ACCOUNTS
NON-MATCHABLE
The types of accounts listed below, although maintained by an individual, will require additional
documentation from the contributor that acknowledges the account contains solely personal
funds and is not funded by an incorporated entity:
Business Account
Campaign Account (or Fund)
Collection Account
Commercial Account
D/B/A Account
Firm Account
Office Account
Operating Account
Overhead Account
Store Account
T/A Account
Trade Account
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Appendix 16
INDIVIDUAL'S DESIGNATED PERSONAL ACCOUNTS
(Office Account, Business Account, etc.)
Exception Code C-4
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching that are drawn on certain types
of personal accounts which bear a designation indicating the possibility that the account may
contain funds other than your personal funds.
Your contribution of $____________, dated ______________________, and drawn on check
#_______of the account identified as _______________________________________________
will qualify for matching only if the statements below are true and confirmed by your signature. If
the statement below is not accurate, please provide a short explanation so the contribution can be
attributed properly (or disposed of, if from an incorporated source).
Sincerely,
Committee Representative
This is to verify that the contribution described above is drawn on an account that contains only
my personal funds. The account is not funded for my use on an unreimbursed basis by an
incorporated entity.
NAME __________________________________________________________________
ADDRESS _______________________________________________________________
CITY ____________________________________________________________________
STATE _________________________________________ ZIP ______________________
YOUR
SIGNATURE ____________________________________ DATE ____________________
(Please do not Print)
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Appendix 17
SIGNATURE OTHER THAN ACCOUNTHOLDER
(Written Instrument is signed by other than accountholder and
contribution is to be attributed to accountholder)
Exception Code D-1
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are
entitled to receive federal funds from the Presidential Primary Matching Payment
Account in an amount up to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission
requires additional documentation for contributions submitted for matching that are
signed by someone other than the accountholder identified on the face of the check.
A contribution of $____________, dated _____________________, and drawn on check
#_______ of the account that identifies you as the accountholder, but is signed by
someone other than yourself, will qualify for matching only if the statement below is true
and verified by your signature. If the statement below is not accurate, please provide a
short explanation so the contribution can be attributed properly.
Sincerely,
Committee Representative
This is to verify that the contribution described above represents my personal
contribution and my signature appears below.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE __________________________________________ ZIP ___________________
YOUR
SIGNATURE _____________________________________ DATE ________________
(Please do not Print)
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Appendix 18
SIGNATURE OTHER THAN ACCOUNTHOLDER
(Written Instrument is signed by an individual
not identified as an accountholder and
contribution is to be attributed to signatory)
Exception Code D-1
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are
entitled to receive federal funds from the Presidential Primary Matching Payment
Account in an amount up to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission
requires additional documentation for contributions submitted for matching that are
signed by someone other than the identified accountholder.
A contribution of $____________, dated _____________________, and drawn on check
#_______ of the account identified as ________________________________________,
but bearing your signature, will qualify for matching only if the statement below is true
and verified by your signature. If the statement below is not accurate, please provide a
short explanation so the contribution can be attributed properly.
Sincerely,
Committee Representative
TO BE COMPLETED BY CONTRIBUTOR TO WHOM ATTRIBUTED
(NON-ACCOUNTHOLDER):
This is to verify that the contribution described above is drawn on an account which
contains/represents my personal funds as well as those of the identified accountholder.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE __________________________________________ ZIP ___________________
YOUR
SIGNATURE _____________________________________ DATE ________________
(Please do not Print)
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Appendix 19
JOINT ACCOUNTS
NOT SIGNED BY INDIVIDUAL TO WHOM
CONTRIBUTION IS ATTRIBUTED
Exception Code D-2
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are
entitled to receive federal funds from the Presidential Primary Matching Payment
Account in an amount up to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission
requires additional documentation for contributions submitted for matching that are
drawn on written instruments not bearing the signature of the contributor.
Your contribution of $____________, dated __________________, and drawn on check
#_______ of the joint account identified as _____________________________________
will qualify for matching only if the statement below is true and verified by your
signature. If the statement below is not accurate, please provide a short explanation so
the contribution can be attributed properly.
Sincerely,
Committee Representative
This is to certify that a contribution of $________________, effected on the written
instrument described above, should be attributed to me. The account contains my
personal funds and my signature appears below.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE __________________________________________ ZIP ___________________
YOUR
SIGNATURE _____________________________________ DATE ________________
(Please do not Print)
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Appendix 20
OMITTED INFORMATION ON WRITTEN INSTRUMENT
(Date, Payee, Amount)
Exception Code E
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are
entitled to receive federal funds from the Presidential Primary Matching Payment
Account in an amount up to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission
requires additional documentation for contributions submitted for matching that do not
fully contain the contributor's signature, the amount, the date, or identify the Committee
as the payee.
Your contribution of $____________, dated __________________, and drawn on check
#_______ of the account identified as _________________________________________
will qualify for matching only if the information below is provided and verified by your
signature. If the statement below is not accurate, please provide a short explanation so
the contribution can be attributed properly.
Sincerely,
Committee Representative
This is to verify that the full date of contribution described above is (day, month, year).
The written instrument described above was intended to be my personal contribution of
$___________ to the Candidate/Committee.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE __________________________________________ ZIP ___________________
YOUR
SIGNATURE _____________________________________ DATE ________________
(Please do not Print)
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Appendix 21
WRITTEN INSTRUMENT APPEARS TO HAVE NO ASSOCIATION
WITH LISTED CONTRIBUTOR
Exception Code G-3
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
additional documentation for contributions submitted for matching for individuals who are not
identified on the written instrument, as accountholders, remitters/ purchasers, or signatories.
Your contribution of $____________, dated __________________, and drawn on check
#_______ of the account (or, if a money order or similar written instrument, the issuer and
remitter/purchaser must be acknowledged) identified as ______________________
___________________________ will qualify for matching only if the conditions below are true
and verified by your signature. If the statement below is not accurate, please provide a short
explanation so the contribution can be attributed properly.
Sincerely,
Committee Representative
TO BE COMPLETED BY INDIVIDUAL TO WHOM CONTRIBUTION IS ATTRIBUTED
This is to verify that the written instrument described above represents a joint contribution to
the Candidate/Committee from me and___________________________. The account contains
(or written instrument was purchased with) my personal funds and the amount of
$______________ is my personal contribution.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE __________________________________________ ZIP ___________________
YOUR
SIGNATURE _____________________________________ DATE ________________
(Please do not Print)
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Appendix 22
DOCUMENTATION REQUIRED FOR INITIAL SUBMISSION OF
CONTRIBUTIONS RECEIVED IN THE FORM OF MONEY
ORDERS, CASHIER'S CHECKS OR OTHER
NEGOTIABLE WRITTEN INSTRUMENTS
Exception Code G-4
Dear Contributor:
Under Chapter 96 of Title 26, United States Code, Presidential primary candidates are entitled to
receive federal funds from the Presidential Primary Matching Payment Account in an amount up
to $250 from an individual contributor.
To ensure only contributions that qualify are matched, the Federal Election Commission requires
contributions received in the form of money orders or cashiers' checks to be accompanied by a
signed statement from the contributor before they can be submitted for matching.
Your contribution of $____________, dated __________________, and drawn on a (identify
whether money order or cashier's check), issued by (name of issuer), serial
#_______________________, will qualify for matching only if the contribution is confirmed by
the statement below and by your signature. If the statement below is not accurate, please provide
a short explanation so the contribution can be attributed properly.
Sincerely,
Committee Representative
This is to confirm that the written instrument described above was obtained by me and was
purchased solely with my personal funds. It represents my personal contribution to the
Candidate/ Committee.
NAME _________________________________________________________________
ADDRESS ______________________________________________________________
CITY __________________________________________________________________
STATE ___________________________________________ ZIP __________________
YOUR
SIGNATURE ______________________________________ DATE _______________
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GUIDELINE FOR PRESENTATION IN GOOD ORDER APPENDICES LETTER (Federal Election Commission)

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Completed 26 January 2021

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