HomeMy Public PortalAboutForm 490O.f~~ceholder, Candidate,
and Controlled Committee
Type or print In Ink.
Campaign Statement -Long Form
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Check one of the followlrTq boxes to Indlute the type of statement being filed:
Pre-election Statement
Supplemental Pre-election Ststement (Attach • completed Form 495 to this statement.)
Special Odd-Year Campaign Report
Semi-annual Statement
Termination Statement (Attach a completed form 115 to this statement.)
crTTlc notaer ~.if'laladie, ana concroiiea committee
Inclu ed in t~iis Statement
NAME OF OFFICEHOLDER OR CANDDATE
OR HELD
Date of election M appllcabh: ~ Page of
(Month, Day, Year) JAN 2 1 1999. ~ FDr Official Use only
~~
CITY CLERK
CITY OF CLAREMONT
t er ommittees o nc u e in t is tatement: ustanyDtl-e-
committees notlncluded In this coroolldstedstatement that •-e controlled by you and any
commkteet o/which you have knowledge that are prlmarfly formed to receive contrlbutlons
a to make expenditures on beha// of your candklaq.
COMMRTEE NAME
NAME Or TREASURE
1 D. NUMaER
CONTROII[D COMMITT[E 1
^ r[S ^ No
COMMITTEE ADDRESS (N0. ANO STREET)
from
Statement covers period
Date Stamp
CEIVED
through
/- • G' - ~~y~ ~ ~ 7
c7rr STAT~ET ZI-COOE AREA COD[1DA11TIME MIONE
~ L.Ia-/°~1~']~i'~t/ ! GM- f/ 71l t~/"~J~ny '~71-~G
NAME OF TREASURER
l~ ~ ~ t~r~=r ~ z~ u~- ~k
r'ERMANENT AODIIESS 0/ TREASURER (NO. AND STREET)
33-: z. Gc~GGI~~T
fTATE ZI-cOOE AREA COOE/DAIITIM[ MEONE
CR1f STATE ZI~COD[ AREA COOE/DAr11M[ -HONf
01 TREASURER
I.D. NUMaER
cONTROI LED COMMITTEE 1
^ r[s ^ ND
COMMITTEE ADDRESS (NO. AND STREET)
f7T11 STATE ZI~CODE AREA COD[/DAVTIME rF10NT
Attach addltlonallnlwmatlon on appropriately labeled contlnuaNon sheets.
eri ice ion
1 have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the Information
true and complete. I certify unde~r~penahy of perjury undo^r the~lyaws of the State of C,~allifornia that the foregoing Is true and correct.
Executed on / ' --~+ ~ r y / At -~'y~I~'/`I~~ l ~r/ i ~ G' l r B ~// /~.~
r
herein and in the attached schedules is
DATE ~ CRY AND ST TE SK:HATURE Or TREASURER
An offlctholder or urTdldate who controls a committee mutt also verify the campaign statement. I have used all reasonable diligence and to the best of my knowledge the treasurer hss used ell
reasonable diligence In preparing this statement. I have reviewed the statement and to the best of my knowledge the information contsined herein snd in the attached schedules is true snd
complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
OAT[
Executed On
DAT!
At
CRY AND STAY
At
CRY AND STATE
ey
By
Executed on At By
OAiE CRY AND STALE
SIGNAIUR[ OI CANDIDATE/OIIICEHOI DER
SIGNAIURI OI (ANDIDAIf/OI-IC[1101 DFR
SIGNA TURT OI C ANDID4IE COI t 1C (HOl DI R
TOR INrORMATN2rI IItOU1RlD TO aE iROV10ED TO TOU fURSUANi 10 THE INrORMATN)11-MCTKEf ACt OE 1977, SEE INIORMAt10N MANUAL ON CAMiAIGN DI~ClQS~1M VIIOVISIONS 01 I11T. iQl IIiCAI 1117ORM A(~
SIsIa of Calllnrnla f all PDlllltal plarllt~l f nnlmltllnn
RISIDENTIAL 011 WSIN[Sf ADORIfS IND. AND STIIEET)
3 .~ ~ . ~'4L LF 6F
CIT1f STATE Zl-COOE AREA CODE/DAYTIME MTONE
Allocation Page -Part I
Contributions and Independent Expenditures
Made From Campaign Funds
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from
through
~~ 1 ~ h`I~-~ ~~ ~ ~t N c: It _ ~r r r iv L' .5 ~ ~ 1~ i'c' l `. I f~l~ ,Z' ~ u ry L J~
list each contribution and independent a nditure of f 100 or more made from campaign funds to other committees or
to support or oppose other candidates or ballot measures.
ALLOCATION -PART I
P~qe of
I.D. NUMBER
DATE
NAME Of OFFICEHOLDER, CANDIDATE, COMMITTEE, OR MEASURE CHECK ONE
Support O
IND;
EXP
AMOUNT
CUMULATIVE TO DATE
LENDARYEAR
IAN. 1 - DEC. 31)
CUMULATIVE TO DATE
OTHER
(IF APPUCABIE)
•See reverse regarding independent expenditures. SUBTOTAL S
.....~....... ~. __. _... __ _ _ _.. Attach additional i n/o-mation en aenmeriarely lahp/~ rnnf:n..~~;nn ~tiee~~
1. Contributions and independent expenditures of s 100 or more made this period from campaign funds.
(Include all Allocation Page - Part I subtotals.) ............................................................................... ... ... s
2. Contributions and independent expenditures under i 100 made this period from campaign funds.
(Do notitemi:e.) ............................................................................................. ................ ... ... .. S
3. Total contributions and independent expenditures made this period from campaign funds.
(Do not carry this total to the Summary Page.) ........................................................ .... .......... .......... TOTAL Z
~-
Allocation Page -Part II Type orprlntlnlnk.
Amounts maybe rounded
Contributions and Independent Expenditures to wholedollan.
Made From Personal Funds
SEE INSTRUCTIONS ON REVERSE
NAME Of OFFICEHOLDER OR CANDIDATE
ALLOCATION -PART It
element covers
from
through
Peye of
List each contribution and independent ex~ienditure o/f 100 or more made /rom the officeholder or candidate's personal funds to support or oppose
other officeholder:, candidates and committees.
DATE
NAME OF OFFKEHOLDER, CANDIDATE, COMMITTEE, OR MEASURE CHECK ONE
Support O e IND.
Exp•
AMOUNT CUMULATIVE TO DATE
CALENDAR YEAR
IAN. 1 - DEC. 31 CUMULATIVE TO DATE
OTHE R
IF APPLICABLE
'See reverse royardiny independent expenditures. SUBTOTAL f
ALLOCATION - PART II SUMMARY
Attach additional information on appropriately labeled continuation sheets.
1. Contributions and independent expenditures of S 100 or more made this period from personal funds.
(Include all Allocation Page - Part II subtotals.) .................................................................................. s
2. Contributions and independent expenditures under S 100 made this period from personal funds.
(Do not itemize.) ................................
........................................................................... _ S
3. Total contributions and independent expenditures made this period from personal funds.
(Do not carry this total to the Summary Page.) .............................................................. .. TOTAL S
,~_
~-
Campaign Disclosure Statement Type orprlntlnlnk. SUMMARY PAGE
Summary Page Amounts maybe rounded
towhoktdollars. Statement covers perbd
1
from
SEE INSTRUCTIONS ON REVERSE through Pape d
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBE R
Contributions Received Column A Column B' Column C
TOTAL THIS riIUOD TOTAI N1EV10Uf -EIIrOD TOTAL TO OATf
~110M ATTACHED SCHEDULES) (SEE NOT[ tElOVlI) (AOD COLUMNS A • t)
1. Monetary Contributions ............................... schedule A, line 3 S jot s s
2 oans Received ......................................... schedule e, une ~ '~`"'
3. UBTOTAL CASH CONTRIBUTIONS ...........:.......... nddw»t t + ~ S ~ ,~.~ s i
4. Non-monetary Contributions ......................... schedule c une 3 ~'
5. SUBTOTAL CONTRIBUTIONS (Exciudr Enro-seabk Promises) Addunes3 + t S ~ L ~ _ S S
6. Enforceable Promises -~-
(Exclude loan Gwr~nteet, Une fA below) ................... ScheduN D, fJne 7
7. TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnetS + 6 _
S ~ ~'~
S S
Expenditures Made
8. Cash Payments (Other than Loans Made) ............ sclreduN E; un. s `~ J
s ~ / ~
s ~ s
9. loans Made ............................................. ScheduN ff, une ~ '$
10. SUBTOTAL CASH PAYMENTS ............................ Addunete + 9 s ~ ~~ s s
11. Accrued Expenses (Unpaid Bills) ........................ schedur. F, une s ~~~ ~
12. TOTAL EXPENDITURES MADE ......................... addun.t to + tt f ~, ~ t s
ent Cash Statement
13. Beyinniny Cash Balance .................. P-evlousSummaryPaQe, line t7 f ~ • From previous Statement Summary Page, Column C. However, if
14. Cesh ReCllptS ..... CdumnA, Une 3 above
"""""'""""""""""" j this Istha first report flied for the calendar year, Column B should be
blank exupt for Loans Received (Line I), Enforceable Promises (Line
15. Miscellaneous Increases to Cash ........................ Schedule ~ Line t ~ 6), loans Made (Line 91, and Aurued Expenses (Line 11).
16. Cash Payments .................................... column a, une t o above /
~ ~ (o
17. ENDING CASH 9ALANCE ..... Adldclrres 13 + tt + ts, thensubdadune t6 s /l, ~ Summary for Candidates in Both June and
Hthlslsaterminatlonstatement; Wre 17mustbe:ero. fW01NGC/lsrstALANCE sHOUto November Elections
NOT tE A NEGATIVE AMOUNT
tit through 6x30 711 to Date
18. LOAN GUARANTEES RECEIVED .............. Schedule e, Part -, Column fb1 S ~~ 21. Cont~ibUtions
RR
s
eceivecdl ..
Cash Equivaltnts and Outstandln~ Debts
19. Cash Equivalen4 ... . ............ .............. See kErerTrcTloru on reverse
S ~ 22. ExPenditures
MAde ....... S ~ --
20. Outstendin~ Debts ................. AddLMTe 2 + Une I I In Column C above S ~.~ o~ ~~ '
Schedule A Tvoeororlntlnlnk. SCHEDULE A
Amounts maybe rounded
Monetary Contributions Received to whole dollars.
SEE INSTRUCTIONS ON REVERSE Statement covers period
from
through
age of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
c. c /' ~iv,~.s ~ 1c' c cl I.D. NUMBE R
DATE
RECEIVED FULL NAME ANDADORESS OF CONTRIBUTOR
(MCOMMm1lE,INAO[Nr10NT000MMn'IEE'SNAMEANOAD[MEfS.EN1E111.D NUMlEI1
o1~rMO1.D.MUMtiEIINAlQEMAfSIGNEO,EIR[Ri1lEASUllIl1'fNAMfANDADDIIESS) OCCUPATION AND EMPLOYER
(~rSEIE•EMVl011E0,eNrEe
NAM[or~usE+rESS) AMOUNT
RECEIVED THIS
PERIOD CUMULATIVE TO DAZE
CALENDAR YEAR
l1AN.1-DEC. 31) CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
l / ~~j !'/o ~~ T f
~- ~ ~ ~ h ,nr t ~ /~- ~ -, , C N n/ TJ~ /~' ~~vr
SUBTOTAL S /~0 --
nnonetary contr~butlons Summary
1. Amount received this period - contributions of S 100 or more.
(Include all Schedule A subtotals.) s /~~~
2. Amount received this period - contributions of less than S 100.
(Do not itemize.) ........................................:.............................................................. ......... ; E~
3. Total monetary contributions received this period. .,
(Add lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ........ ...................... ... .. ... TOTAL s -~ ~~
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type or print In Ink.
Amounts may be rounded
to whole dollars.
!nt tovlrs
from
SCHEDULE A (cont.)
through ~ Pr,ge . of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
_ .e! ~=~~t~~? r t.~ nOC1 t Fig ~ e:~f_> 5- - ~ T /c' f ~- ~-~-~-~E'_» ~' ~n/ c: J~
DATE
RECEIVED, FULL NAME AND DDRESS OF CONTRIBUTOR
MCp~,rMRTfF.INADOn1pNTOCl1MMlfifF'SNAMfANDADD11tSS.fNTfR1.D.NUMlfl1
pR,gND~.D.NUMtfIINAStrFFNASSwNfD,[NTFR111EASUIIf11'SNAMEANDADDIIfSS)
«CUPATIONANDEMPLOYER
~ (~rsj+AMEOf~USNFSS-if~ AMOUNT
RECEIVED THIS
PERIOD CUMULATIVE TO DATE
CAIENDARYEAR
(lAN.1-DEC. 31) CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
•
SUBTOTAL S -~---
Schedule e - Part I Type orprlntlnlnk. SCHEDULE B -Part I
LOariS KECeIVed AmoumsmayDerounaaa StstementcoverEperlod
to whole dollar!.
from
SEE INSTRUCTIONS ON REVERSE through Pagt of
NAME OF OFFICEHOLDER
OR CANDIDATE AND CONTROLLED COMMITTEE
I.D. NUMBER
GATE LENDER OR GUARANTOR'S FULL NAME AND ADDRESS
LENDER /GUARANTOR'S LENDER INFORMATION GUARANTOR INFORMATION
RECEIVED Ir tOMMrTtEE, INTEa iUll NAME, ADDa[ff AND 1.0. NUMa[a
A NOI
D OCCUPATION AND
N~
.
.
.
MVMa[a/Mfa[EMAS1NiN[D,IM[a1H[TatAtAME11YNAMEANOADDIIIfS) I
IOr[a pr EEIi•
lMKOYED,lNTEAaUSINESSNAME)
DUEDAIE/
AMOUNT
CUMUTATNE
AMOUNT
INTEIIESTMIE
OrIOAN
IODATE
GUAMNIEED CUMULAINE
1O0A1r
• DUE DATE CAIENDAII rEAA CAIENDAII rTAll
f
INTEREST MTE [
OTHE11 OTHER
^ Lender ^ Guarantor ~
~
N t
DUE DATE GIENOAA r[AII
CAIENDAA r[AA
INTE11ESi MTE
1
1
OTHE11 OI HEII
^ Lender ^ Guarantor ~ ,<
1 1
DUE DATE Gl[NDA11 rEM
CAIENDAII rr All
f
Mii[11EfT MTE
t
OTHER - 01HEA
^ Lender ^ Guanntor a
w
t s
~e important instructions on reverse. SUBTOTAL s 1^~ Z
E""' jDj °"
~
TVTT•fr ~^1!.
^ _ - ~` - - - • ^ lln^ 11 only.
wona nC~CIT/CU - r1[re [ summary
1. Loans of 6100 or more received this period. (Include all Loans Received - Part I (a) subtotals.) .......... f
2. Loans under 5100 received this period. (Do not itemize.) ........................................... s ~~
3. Total loans received this period. (Add Lines 1 and 2.) ..................................... • • TOTAL S ~~
loans Received - Part II Summary
4. loans of f 100 or more repaid, forgiven, or paid by a third party this period. (Include all Part II (c)
subtotals. If forgiven or paid by a third party, also itemize the transaction on Schedule A.) .............. f
5. loans under 5100 repaid, forgiven, or paid by a third party. (Do no itemize.) If forgiven Or ~,
paid by a third party, include this amount on Schedule A Summary, Line 2 . ........................... S -
6. Total loans repaid, forgiven, or paid by a third party this period. ~_
(Add lines 4 + S.) .................................. TOTAL S ~
7. Net change this period. (Subtract Line 6 from Line 3.) _~_.
Enter the net here and on the Summary Page, Column A, Line 2 . .......................... ... NET s __ _
Schedule B -Part I (Continuation Sheetl Type orprlntlnink.
SCHEDULE 8 - Part I (cont.)
' Amounts may lTe rounded
Loans Received - Statement covers period
towhDledouer:.
from
through peQe of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
,~ ~ ~,/~
DATE
LENDER OR GUARANTOR'S ULL NAME AND ADDRESS
LENDER /GUARANTOR'S
LENDER INFORMATION
GUARANTOR INFORMATION
RECEIVED OfCCMdMnTIE,ENTERfUEENAM[,ADOIItSfAND1.DNUM~ER.IfNO1.D OCCUPAl10NANDEMVLOYERtIfSElf•
NUMEiERIrAfeE[NASSIGNED,ENflRTHETIIEAfU11ER'SNAMEANDADDRESS) EMKOYfD,ENTERIUSIN[S3NAM[) OUEDAIF/ AMOUNT CUMULATIVE AMOUNT CVMUU~INE
IMEREST MIE Of LOAN 10 DATE GUAMNTIED i0 DAif
• DUE DATE ~ CALENDAR r[AR CAL[NDAR r[AR
f f
tNTER[Si MTE
OTH[R OTNlR
^ lender ^ Guarantor • x s s
DUE DATE CALENDAR YEAR
CAl[NOAR YfAR
S
Mff[R[fT MIE f
OTHER OTHER
^ under ^ Gwrentor• x s s
DUF GATE CALENDAR YEAR CALENDAR YEAR
f
IMEREST MT[ S
O1HlR OIHFR
^ Lender ^ Gwrentor~ x s s
• DUE DATE CAIINDAR YEAR CALENDAR r[AR
S f
INTEREST MTE
O1NTR Of H(R
^ lender ^ Guerentor~ x 1 s
OUEDATE CAIENDARrEAR (AllNDARVfAR
t
f
INlfllEfl MIE
OIIIf R OI11(11
^ lender ^ Guerentor~ x s f
•)
'See important instructions on reveRe o/page 1 0/Schedule B, Part 1. SUBTOTAL S (E) ~ 1 nler MI on
S S~mm.~, I~. ~.
lint 1! only
Schedules -Paftll Type orprlntlnlnk. SCHEDULER-Partll
Amounts may De rounded
Repayments Made on Loans Received, Loans towhol.dollers.
Forgiven, and Loans Repaid by a Third Party
SEE INSTRUCTIONS ON REVERSE Statement covers period
rrom
ihrouph
ape of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
DATE OF
REPAYMENT
OR
FORGIVENESS
DATE OF
ORIGINAL LOAN
FULL NAME Of LENDER
INTEREST
RATE
pr cw,-rccol
AMOUNT REPAID OR +
FORGIVEN ON PRINCIPAL
(cxnuot r~rracrn a untusr- -
OUTSTANDING
PRINCIPAL
INTEREST
PAID
Attath additional inl~rmation on appropriate/y labeled continuation sheets. SUBTOTAL s (`I
- TOTAL INTEREST
PAID THIS PERIOD (d'
s--~-
'ILVIPORTANT: Narypart of • loan if /orpiven or repaid by a third party, also itemize the transaction on Schedule A,
Indudinp t11e nanw •ndaddnss of the person /or~yivinQ the loan or the third party making the payment, and the amount
/Or~Illen O! paid Enter the amount in column (d) in the
summary section of Schedule F, l ins 3 Oo
not carry this total to the rummary sec rron of
Schedule B.
Schedule B -Part III Type or printlnink. SCHEDULE B -Part III
amounts may oe rounaea
nnua eport o Outstanding loans Received to wholedollers.
SEE INSTRUCTIONS ON RE VERSE Statement covers period
from
through
eye of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLIEO COMMITTEE
1 c- ~ It N - ,E ~i a S ~ t" G c: l LD, NUMBE R
FULL NAME OF LENDER ORIGINAL DATE OF LOAN AMOUNT OF ORIGINAL LOAN UNPAID PRINCIPAL UNPAID INTEREST
Attach additional in/ormation on appropriately labeled continuation sheets. TOTAL s .~ ---
NOTE: Thls total thould be
the same smount as entered
on the Summary Page,
Column C, line 7.
Schedule C Type orprlntlnlnk. SCHEDULE C
Amounts may be rounded
Non-Monetary Contributions Received to whoa dollars.
SEE INSTRUCTIONS ON REVERSE Statement covers period
from
ihrouph
ape of
NAME Of OFFKEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
/C' j~ ~ ~l.ti - I.D. NUMBER
DATE
RECEIVED FUII NAME A ADDRESS OF CONTRIBUTOR
(li(OMMnTEE,INADDn10NT000MMITTE!'SNAMEANDADDIIESS,
ENTEa ~ D NUM~EII01l. U NOI.D. NUM~EI1 HAS rrEEN ASSIGNED.
ENTEII TIIEAIUIIEII's NAM[ AND ADDalSS)
OCCUPATION AND EMPLOYER
(fir sElr-EMPLaUSINESS)T[11 NAME Or
DESCRIPTION OF
GOODS OR SERVICES
FAIR MARKET
VALUE
CUMULATIVE TO
CALENDAR YEAR
(IAN. 1 - DEC. 31)
CUMULATIVE i0
DATE OTHER
(IF APPLICAFIIE)
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL S ~~-~
Non-Monetary Contributions Summary
1. Amount received this period-.non-monetary contributions of S 100 or more.
(Include all Schedule C subtotals.) .................................................................................... S
Amount received this period- non-monetary contributions of less than S 100.
(Do not itemize.) ......................................................................................................... s
~-
3. Total non-monetary contributions received this period. .~-~
(Add lines 1 and 2. Enter here and on the Summary Page, Column A, Line 4.) ....................... TOTAL S
Schedule D Type orprlntlnlnk. SCHEDULE D
• nmountf maybe rounded
En orcea a Promises Received (Other than Loan to wholedollart.
Guarantees, Loan Endorsements, and Loan Security) Statement covert period
from
NOTE: Loan guarantees, loan endorsements and loan security are "enforceable promises' that`must
be reported On Schedule B -NOT Schedule D. SEE INSTRUCTIONS ON REVERSE
through
Pape of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
~1 `~ - /~IcrlT J~/~'1 F_n~~s mF G ~/~ ~!
DATE
RECEIVED FULL NAME AND ADDRESS OF CONTRIBUTOR
llrcoMMmEE.nrAaortwNrocoMMmtrsNAMEANOADDUSS.
lNTtI11.D.NUMIEIIOII,/NOI.D.NUM~tRNAfttENASfIGNED,
tNTlll TIItASU11ta'f MAM[ ANO ADOIIEff)
OCCUPATION AND EMPLOYER
llrsur-EMnortD,tNiEI1NAMt0r
BUSINESS)
AMOUNT PROMISED
THIS PERIOD AMOUNT PAID
THIS PERIOD
(ALSOEMTE110N
fCNEDUIE ~) CUMULATIVE TO DATE
CALENDAR YEAR
(lAN.1-DEC.31) CUMULATIVE TO
DATE OTHER
(IF APPLICABLE)
s eels. additional information on appropriately labeled continuation SUBTOTALS s ~ ~_
Enforceable Promises Received Summary
1. Promises received of 5100 or more this period (Column (a)) . ...................... S '~-
2. Promises received under 5100 this period. ~_
(Do notitemi:e.) ............................................................s
3. Total promises received this period. TOTAL `~
(Add Linesland 2.) .................................................. s
4. Payments received on promises of S 100 or more this period. s
S: Payments received on promises under:100 this period.
(Do not itemi:e. Also Include on Schedule A Summary, Line 2.) ...................................... S -~~----
6. Total payments received.
(Add Lines 4 and 5.) ..................................................................... TOTAL ; ( -~'- )
7. Net change this period. (Subtract Line 6 from line 3. Enter the difference here and on
the Summary Page, Column A, Line 6.) ......................................................NET ; '~"~
M•y br ~ n~q•tlve numWr
S+ch ed u I e E Type or print In Ink.
Pay~llerlt5 and COrltrlbUtlOr1S Amountsm~yfxrounded
to whole dollars.
(Other Than Loans) Made
SEE INSTRUCTIONSON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
CODES FOR CLASSIFYING EXPENDITURES
Statement covers period
SCHEDULE E
from
through
Page
I.D. NUMBER
of
If one of the following codes accurately describes the expenditure, you may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations of each category.
MONETARYANDIN-KIND(NON-MONETARY) •B• - BROADCAST ADVERTISING 'G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES 'N' - NEWSPAPER AND PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
AND COMMITTEES 'O' - OUTSIDE ADVERTISING (MUST aE DESCRIBED)
'I' - INDEPENDENT EXPENDITURES 'S' - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS ~P' - PROFESSIONAL MANAGEMENT AND CONSULTING
'L' - LITERATURE 'F' - FUNDRAISING EVENTS
SERVICES
NAME AND ADDRESS Of PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E-.
pf COYYrrT[[, W ADDrT10N TOCOYMn7[['f MAY[ AND ADDII[SS,lNr[II I.D. NUM~EII Oil, M NO rD. REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON LINE ~ OF THE SUMMARY SECTION BELOW.
MUYe[A/MfM[NAfWi1t/D;IIRIAttt[AfURIA'sNAY[AMOAD011t[S) [ODE OR DESCRIPTION OFPAI'MENT AMOUNT PAID
Important: Contributions and exPenditurts made out of campaign funds to or on behalf of other SUBTOTAL S
officeholders, candidates, committees, or ballot measures must also be entered on the Allocation Page, Part 1. ~-~`
Payments and Contributions Made Summary
1. Payments made this period of s 100 or more. (Include all Schedule E subtotals.) ............................:......................... S ~
2. Payments made this period of under S 100. (Do not itemize.) • ....................................................................... s ~ ~~
3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part II, Column (d).) .............................. s -~
4. Total accrued expenses paid this period. (Do not itemize. Enter amount Irom Schedule F, Line 4.) ....................... ~..:........... s ~~
5. Total payments made this period. (Add Lines 1, 2, 3, and 4. Enter here and on the Summary Page, Column A, Line 8.) .......... ~ TOTAL S J ~~
Schedule E Type or printlnink. SCHEDULE E (cont.)
(COntlnuatlon Sheet) Amounts mey be rounded
towhokdollers.
Stetementcoversperlod
Payments and Contributions
t`°m
(Other Than Loans) Made
SEE INSTRUCTIONS ON REVERSE through ~ Pe
e of
g
NAME OfOFfICEHOLDERORCANDIDATEANDCONTROLLEDCOMMITTEE I.D.NUMBER ~
l ~!~ .~ N'c:lT l~~tl~iv'BS ~~ J'' ~-,~,"~, ..~ chi
CODES FOR CLASSIFYING EXPENDITURES
'C' - MONETARY AND IN•KIND (NON-MONETARY) 'B' - BROADCAST ADVERTISING 'G" - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES 'N' - NEWSPAPER ANO PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODA110N5 AND MEALS
ANO COMMITTEES 'O' - OUTSIDE ADVERTISING (MUST BE DESCRIBED)
INDEPENDENT EXPENDITURES 'S' - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS 'P - PROFESSIONAL MANAGEMENT AND CONSULTING ~
- LITERATURE 'F' - FUNDRAISING EVENTS SERVICES II
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
p COOEMRTEE, M ADDITION TO COMMnTEE'f NAME AMD ADDRESS, ENTEII I.O. NUMel11 OA, Ii NO I.D.
NUMBER IIAS eIEN ASSIGNED, ENTER TAEASU11Ee'S NAME ANO ADDRESS)
I
' ' ~ ~
CODE OR DESCRIPTION OF PA>~MENT +
I 'I
1
~ i
AMOUNT PAID ~+~
• ~
~f `g
i~
++
I
SUBTOTAL S
schedule F Type orprlntlnlnk. SCHEDULE F
Amounts may be rounded Statement covers period
Accrued Expenses (Unpaid Bills) tDwhDledonar[.
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
N
CODES FOR CLASSIFYING EXPENDITURES
from
through
Pape
I.D. NUMBER
of
If one of the following codes accurately describes the expenditure, you may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations of each category.
~' - MONETARY AND IN-KIND(NON-MONETARY) 'B' - BROADCAST ADVERTISING 'G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES •N' - NEWSPAPER AND PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
AND COMMITTEES •O' - OUTSIDE ADVERTISING (MUSTlE DESCRIBED)
'1' - INDEPENDENT EXPENDITURES •S' - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS •P - PROFESSIONAL MANAGEMENT AND CONSULTING
'L' - LITERATURE •F' - FUNDRAISING EVENTS
SERVICES
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
h- COMMRTEl, M AOORION TO COMMITTE['f IIAM[ AND ADOIIISf, IM[II I.O. NUMaE11 OR p MO1.0. IMMtTAMT: DO NOT R[MIZ[ THE ~A~MENT Or ACCRUED Elt-ENS[S ON fCHEDUIES [ OII I. IIE-OIII ONI~ 1H[ lUM- SUM OI ~AVM[NI S
ON SCHEDUL! 1, llrrE ~ ANOON fCH[DUIE !, llrE 1. 00 NOl IIE•Il[MIEE ACCRUtD [xPENSEi IIEPOIITED IN A -IIEVN)US -EIIIOD
NUMa[eHAf1E[NAfSN:MED.[NTEIITIIEA[UII[A'SNAM[ANOADD11ESf) CODE OR DESCRIPTION OF OUTSTANDING PAYMENT AMOUNT ACCRUED
/~-67~S Pea ~~ ~ r~ c s ~ 1~,
~ ~ ~O ~ GU'l L -~'lo~i~~L~. 13 L ~/~' . ~u r 1~ -=l •~~
G ~ •l~ ~
~
~ ~ ~ ~~
I
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL s 102 `~--
Accrued Expenses Summary
t. Accrugd expenses this period of s 100 or more. (Include all Schedule F subtotals.) ........................................ .
............ s /~.~-
2. Accrued ex enses this eriod of under 5100. (Do not itemize.) S ~
P P .....................................................................
3. Total accrued expenses incurred this period. (Add Lines 1 and 2.) ........ INCURRED TOTAL s /fir ~~
4. Total accrued expenses paid this period. (Do not itemize. Enter here and on Schedule E Summary, Line 4.) ................. PAID TOTAL S ~ _ ~_.___ ~
S. Net change this period. (Subtract Line 4 from Line 3. Enter the difference here and on the Summary Page, Column A, Line 1 1.) .. NET S ___..__
M.r !r. • nr~.~i.• ...,..,I v,
Schedule G Type or print in ink. SCHEDULE G
Amounts maybe rounded Statement covers rl
Payments Ma a by an Agent or Independent to wholedollan. ~ ~
Contractor (on Behalf of an Officeholder or ~ ~'~
from
Candidate
SEE INSTRUCTIONS ON REVERSE through Page of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBE R
/ ~l~--I~c`al' a~ U/`l~:tT . cF~lF_~/1~5 l1,•~ I~lr'1~~1~ 1_"it,/.~~ G/c
NAME OF AGENT OR INDEPENDENT CONTRACTOR
CODES FOR CLASSIFYING EXPENDITURES
If one of the following codes accurately describes the expenditure, you may enter the code and leave the "Description of Payment' column blank. Refer to the
~ck of Schedule E-Continuation Sheet for detailed explanations of each category.
'L' - LITERATURE S - SURVEYS, SIGNATUREGATNERING,DOOR-TO-DOORSOLICITATIONS
'B' - BROADCAST ADVERTISING 'F' - FUNDRAISING EVENTS
'N' - NEWSPAPER AND PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
'O' - OUTSIDE ADVERTISING (MUST BE DESCRIBED)
NAME AND ADDRESS OF PAYEE OR CREDITOR
M COMMRTEE, IN ADDITION TO COMMmEE'f NAME AND ADDIIESS, ENTER I.D. NUMaEII OR it
NOI.D.NUMaE11MAfaEENAfSIGNED,ENTEaiIIEASUIIEe'fNAMEANDADDII[fi) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Attach additional in/ormation on appropriately labeledcontinua'ion sheets. TOTAL* S ,~_.
~ Donot trarES/e-to any otM-sthedirk o- t0 the Summary Pape. Thls total may not equal the amount paid t0 the agent Or independent contractor as reported on Schedule E by the ollic eholderic and~dale
Schedule H - Part I Type orprlntlnlnk. SCHEDULE H -Part I
.. _ _r . ^ e... .... . ~ . _~_~
•.. ' Yr ~ VY~IY~Y
erS to whole dollars.
Statement covers period
from
SEE INSTRUCTIONS ONREVERSE through Page of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROL
L
ED COMMIT
T
EE I.D. NUMBE R
~n
,
~
I
n ys ,/~J ~,,/~
DATE OF LOAN FUII NAME AND ADDRESS OF RECIPIENT
pTCOMMRTEE,aIADDITNlN10COMMITTEE'fNAMEANDADD11EfS,ENT[III.D.NUMlEII INTEREST RATE DUE DATE AMOUNT
- OIL, I NO1.0. NUMata NAf aEEN ASSIGNED. ENTEa iREASUR[II'S NAMf AND ADDIIEff)
•
SU9TOTAL s ~-
l~s Made to Others - Part I Summary
1. oans of t 100 or more made this period. ~
'(Include all loans Made - Part Isubtotals.) ............................................................ Z
2. Loans under s 100 made this period.
(Do notitemize.) ............................................................... ................. S
3. Total loans made this period.
(Add Linesland 2.) ...........................................................:.............. TOTAL f '~~
Loans Repayments Received - Part II Summary
4. Payments received on loans of S 100 or more. (Include all loan payments received and all loans of S 100 or more
which have been forgiven by this officeholder, candidate, or committee -Part II (a) subtotals. s
If forgiven, also iteml:e on Schedule E.) ............................................................... .
S. Payments received on loans under f 100. ~-
(Including aforgiveness. Do not itemize.) .............................................................. S
6. Total loan payments received this period.
(Add Lines4 and S.) .. .... ... ........ ............................................. TOTALS ( .
7. Net change this period. (Subtract Line 6 from Line 3. ~~
Enter the net here and on the Summary Page, Column A, Line 9.) .................................... NET S
Schedule H - Part I Type orprlrKlnink. SCHEDULE H - Part I (cont.)
/~IIIVY/117111~~ {A IVYI/VfY
Loans Ma a to Others to wholedollers.
(Continuation Sheet)
Stattamentcovertperlod
from
through
Dpe of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
/L~•T ..._~ f ~Fs ~ _ ~ I.D. NUMBER
DATE OF LOAN FUII NAME ANO ADDRESS OF RECIPIENT
p/COMMm![.MIADDRIONiOCOMMfi?EE'SNAMtANDADDRESS.ENIFRI,D NUMSEII
OIL ri NOI.D. NUMetA NAf BEEN ASSIGNED, ENr[R i11EASVAEII'f NAMF AND ADDRESS)
INTEREST RATE
DUE DATE
AMOUNT
SUBTOTAL s ~_
Schedule H -Part II Type orprlntlnlnk. SCHEDULE H - Part II
Amounts may oe rouna!°
Loan Repa ments Received on Loans Made to whole dollars.
to Others ~ncluding Payments Received
from Thud Parties) and Loans Forgiven
SEE INSTRUCTIONS ON REVERSE Statement covers period
tr°m
through Page of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED//COMMITTEE I.D: NUMBE R
c ~ G~- Lr ~ Gc ~
DATE OF
REPAYMENT OR
FORGIVENESS DATE OF
ORIGINAL
LOAN
FULL NAME OF RECIPIENT OF LOAN
- INTEREST
RATE
(tFCNANGED) AMOUNT REPAID OR
s
FORGIVEN ON PRINCIPAL
tExCIUDE NiCE1VTOf INTE1lESi)
OUTSTANDING
PRINCIPAL
INTEREST
RECEIVED
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL S ~
~` TOTAL INTEREST s roe
RECEIVED THIS PERIOD
~
IMPORTANT: If anypart of a loan is forgiven, also itemize the forgiveness on Schedule E. If a repayment is received from a
third party, enter the name and address of third party in the ~Ff1Ll NAME OF RECIpIENrOF LOAN' column above, along with the
name O/the rlC/p/!At Of the loan. ~ Enter the amount !n column (b) In the
summary sedlon of Schedule 1, Line 3. Do.
not terry this total to the summary section
o/Schedule H.
Schedule H -Part III Type or print inlnk. SCHEDULER-Partlll
Annual Report of Outstanding loans Made ^'~~~to~wholedollarsnaea
EE INSTRUCTIONS ON REVERSE Statement coversperlod
from
throw h
0
~l
Page of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBE R
FULL NAME OF RECIPIENT Of LOAN ORIGINAL DATE OF LOAN AMOUNT OF ORIGINAL LOAN UNPAID PRINCIPAL UNPAID INTEREST
Attach additional information on appropriately labeled continuation sheets. TOTAL S ~_.
NOTE: Thls total should be
the same smount as entered
on the Summary Page,
Column C, Llr-e 9.
Schedule I Type orprlntlnlnk. SCHEDULE I
Miscellaneous Increases to Cash Amountsmeyberounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE Stetementcover:period
from
throu0h
ew of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
G /~-J'C lv~ ~/~ ~/Ir~S ~~ ~ ~~-i'~~ ~. ~ I.D. NUMBER
DATE
RECEIVED FUII E AND ADDRESS OF SOURCE
llrcoMwrtTEE,rJ1A001T1pNT000MMRTEE'SNAMEANDADOIIESS,ENTEIII.O.NUM~EII
q NO 1.0. NUMBER NAS elEN ASSIGNED ENTER TRIASURER'S NAME AND ADDRESS
DESCRIPTION OF RECEIPT AMOUNT OF
INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL s _~_.
Miscellaneous Increases to Cash Summary
1. Increases to cash of s 100 or more this period . ............................................................ s
2. Increases to cash under S 100 this period. (Do not itemize.) ................................................. s
_~---
3. Total of all interest received this period on loans made to others. (Schedule H, Part II (b).) .................... f - ~_.
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the _
Summary Paye,Line 15.) ....................................................................... TOTAL s