DSDE73A Campaign Loans Report ItemizedDS-DE 73A (Rev. 08/03)
CAMPAIGN LOANS REPORT ITEMIZED
Page _________ of _________
(PLEASE TYPE)
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________
FULL NAME AND ADDRESS OF LENDER:
________________________________________
________________________________________
________________________________________
OCCUPATION: _________________________
AMOUNT OF LOAN: ____________________
DATE RECEIVED: ______________________