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| (to be filed by a candidate or his principal campaign committee) |
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| 1.Qualifying Name and Address of Candidate |
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| 2. Office Sought (Include title of office as well |
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| as parish, city, town and/or election district.) |
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| Report Includes Schedules: |
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| 180th day prior to primary |
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| 90th day prior to primary |
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| Annual (future election) |
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| 30th day prior to primary |
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| Supplemental (past election) |
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| 10th day prior to primary |
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| 10th day prior to general |
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| Filed after the election AND all loans and debts paid |
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| 6. Name and Address of Financial Institution |
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| (You are required by law to use one or more |
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| banks, savings and loan associations, or money |
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| market mutual fund as the depository of all |
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| 7. Full Name and Address of Treasurer |
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| 9. Name of Person Preparing Report |
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| 10. WE HEREBY CERTIFY that the information contained in this report and the attached |
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| schedules is true and correct to the best of our knowledge, information and belief, and that no |
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| expenditures have been made nor contributions received that have not been reported herein, |
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| and that no information required to be reported by the Louisiana Campaign Finance Disclosure |
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| Act has been deliberately omitted. |
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| 8. FOR PRINCIPAL CAMPAIGN COMMITTEES ONLY |
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| a. Name and address of principal campaign committee, |
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| committee’s chairperson, and subsidiary committees, if |
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| any (use additional sheets if necessary). |
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| Signature of Candidate/Chairperson |
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| (To be signed by Chairperson only if report by |
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| principal campaign committee) |
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| Form 102, Rev. 1/98, Page Rev. 3/00 |
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