Form 183 Extension of credit to political candidates

U.S. DEPARTMENT OF TRANSPORTATION
					Name of Air Carrier ______________________
BUREAU OF TRANSPORTATION STATISTICS
					Month of _________________________
REPORT OF EXTENSION OF CREDIT TO POLITICAL CANDIDATES
OMB No. 2138-0016 EXPIRATION DATE: 12/31/2021			Paperwork Reduction Act Burden Statement
A federal agency may not cnduct or sponsor, and a person is not required to respond to , nor shall a person be subject to a penalty for failure ot comply with a collectin of information subject to the requirements of the Paperwork Reduction Act unless
that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2138-0016. Public reporting for Form 183, Report of Extension of Credit to Political Candidates, is estimated
to be approximately 1 hour per response, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are mandatory, as authorized by 14 CFR, Part 374a. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Jeff Gorham, OAI/BTS/RITA, RTW-42, Room E34, 1200 New Jersey Avenue SE,
Washington, DC 20590 or email jeff.gorham@dot gov
NAME OF CANDIDATE
	Name of Account	Total Receivable	Credit Limitation	Unpaid Balance	Age of Unpaid Bal.	Security
Line No.	(1)	(2)	(3)	(4)	(5)	(6)
I, the undersigned, (Title) ____________________, of the above-named carrier certify that the above report has been examined
by me and to the best of my knowledge and belief is a true, correct and complete report of the period stated.
(Date):		(Signature):
BTS Form 183