HomeMy Public PortalAboutForm 490 (Jan 17 - Feb 13, 1999)Off~ceh~I,der,, Cand~~d,ate, Type or print In ink.
~an~ Control'led~'~ohim~ittpe
C,~riip~aigri,~Stateme'n~t ,--Long Form
(Governmlent~Code Sections 84200-84216 S)
SEE INSTRUCTIONSpN,REVERSE ~ 'i
Check one of the following boxes to IiWlute the type of statement being filed:
Pre~lectionStatemrint ~i
Supplemental Prp-election Statement (Attach a completed Form 495 to this statement.)
Special Odd~YurCampa~gniReport
semi-annual Statement
Termination statement (Attach • completed fqm 41 S to this statement.)
c o er an f ate, an on roe ommfttee
' Inclu~ed in t~iis~Statement
NAME Oi OFFICEHOLDER 4R CANDIDATE
~D. ;la sDUG-r- oa,HEID txunuos l0(ATION AND psTfaCT NussaEa r APPtKAau-
asloENtuu oe rlrsrNESS Aooa[ss (NO. ANO fTllEt»
COOS Al1EA
ZI- COOE
QTr tTAIE ZIP COOS Al1EA 000E/DAYIIME PHONE
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NAME Of TREASURER
2~ - ~,,~
PEaNiANENI Aooasltsq Tasww
srATE
~ INO. ANO ti
Ir°~l1! 1! F~~
-IIOME
FORM
Statement covers period
l~
from ~1tr / /
~/ r / S
through aAr ILLL/~~~~--~~~~
Date of election M applicable:
(Month, Day, Year)
~ ~ ~
/ /
Stamp
~~V ~~~~®
FEB 1 8' 1999
®1NT• I
~~„ ~, ,
For Official Use Only
utner committees Not Included in this3tatement: Ust any other
committees not Included In this tonsolldatedstatement that are controlled by you and any
committees of which you have knowledge that •n primarily formed to receive contrlbutlons
a to make expenditures on behaf/o/your candidacy.
cOMMRTEE NAME
I D. NUMtEA
NAME q TIIEASUaER CONTAOIIED COMMITIEET
^ YES ^ NO
cOMM1TTEE ADDIIESS (NO. AND STaI[T)
NAA1E
LD. NUMttR
MI PHONE NAME q TatAfUllEa CONTAOIIED COMMIII[[ r
y7,~ ^ rss ^ ND
COMMRTEE ADDaEff (N0. AND iT11EET)
~r ~ sTAiE EIP CODE AREA CODE/DAYTIME -HONI
~,
i i ~ srwre ID CODE AxEA000EA`AYTMIlMIONE
' ~ L'~~ ~~~' G ~ ~~~/~ `/~~ p~~~/ ~~ Attach addttlonallnlamatlon on app-oprlately labeled contlnuaNon sheeb.
,.
en ice ,ion ~ ~ , ~~
1 have used all reawnablt diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the Infor lion contained herein and in the attached schedules is
trust sand iompltt .Ice undQer Welty of perjury under the laws of the State of California that the foregoing Is true and Corr ct.
Executed on f~ ' 7 At -~~~ D ~T ~ ~ ~ ey
'. GATE ~. ~ CRY AN TATS SIGNATUA[ 0/ TAEASUIIEx
An offlcehoWar of undldat• 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 has used all
reasonable diligence In,preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained herein and in the attached schedules is true and
complat~. 1 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
i ~ ,~
Executed on ~ At ey
PATE ~~ CrTY AND STATE
i ~' ~~ ~ i i SIGNAIUNt OI CANDIDAIUOIIICEHOI DEa
Executed on ~~ At gy
OATE CRY AND STATE SIGNAlU11E Oi CANDIDAIIJOIrICtHOl O[A
~~Exacuted on ~ ~ At By
' pAIE CRY AND tTAiE
TIGNAIUIIE OI (ANDIDAIUOI11C11101DI11
i /0111NIOMEATKIN aEQUWD 101E PIIOVIDED f0 YOU PURSUANT TO THE IN/OMIAiION MACTKET ACI OI H7/. TEE INiOM1AtION MANUAI ON CAMPAIGN DISC{gS~ll1[ PROVISIONS Of (MI -gI111CA1 111f0116~!SI
Allocation Page -Part I
Contributions and Independent Expenditures
Made From Campaign Funds
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
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Type or print In Int. ~ ALLOCATION -PART I
Amounts maybe rounded Statement covers period ;, "
to whole dollars. / r
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uy -~ 'Payee of
' I.D. NUMBER
list each contribution and independent expenditure of f 100 or more made from campaign funds to other committees or
to support or oppose other candidates or ballot measures. ~ ~ ~ ~ ~ '
DATE
NAME Of OFFICEHOLDER, CANDIDATE, COMMITTEE, OR MEASURE CHECK ONE
Support O IND
EXP•
AMOUNT CUMULATIVE TO'DATE
~A LENDAR YEAR ~ ,
(IAN. 1 -DEC. 31) CUMULATIVE TO DATE
OTHER
, (IF APPLICABLE)
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es ~ nrsnnu e. eT r ter.......,.. Attach additional i nformation ~s7 w~.,mn~lwrpr~ lahpl..~ ~.,~.;.,..;~:,,,. ~tiee.~
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1. Contributions and independent expenditures of S 100 or more made this period from campaign funds. ~ ~ i ~ I I ~ ~ ~~~~
Include all A ... ..
(location Page - Part I subtotals.); :...... f ,~ ~,~- , , ~
2. Contnbution ....... .....................:........................................ , ,,,. ~ i~ i
s and inde endent ex enditures under S 100 made this enod from cam al n funds. ~ ~ ~
(Do not itemize.) .........
3. Total contributions and independent expenditures made this period from campaign funds. TOTAL S ~ f
(Do not carry this total to the Summary Page.) ....................................................... ....... .... -~-
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A e+OCat10 n ,Pa~e~''= ~ P,a rt iI _.- Type o<pant In Ink. ALLOCATION - PART II
~ Amounts mey De rounded Statement covers period
Contrl6utions'and Independent Expenditures to whole dollars.
~M'ade;~Frorrtw Perso,nal'F~unds from / -/
III , ,
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SEE INSTRUC'fIONSONREVERSE ~ throu0h ~ Peye of '
NAME OF OFFICEHOLDER OR ULND,IDATE
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List each contritwtron and independent expenditure o/f 100 or more made /rom the officeholder or candidate's personal funds to support or oppose
~ other bfficeholders, candidates and committees.
~~
~ DATE
~ NAME OFOFFKEHOLDER, CANDIDATE, COMMITTEE, OR MEASURE
i
I CHECK ONE
Support O e IND.
EXP•
AMOUNT CUMULATIVE TO DATE
lAN ND DEC E3 R CUMULATIVE TO DATE
IF APPiICABLE
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ALLOCATION - PART;II SUMMARY Ae[acn avviuonal lnlormation on appropriately labeled continuation sheets.
1. Contribution: and independent expenditures of S 100 or more made this period from personal funds.
(Inclu
de all Allocation Page - Part II subtotals.) ........................................................ 4 "~-
I
I,butions and in p ~_
2 (Do not iteml:e.) . ~ de' entient expenditures under S 100 made this period from personal funds.
............................... ................................................................. S
3. Total t f, -
(qo not carryitions'and independent expenditures made this period from personal funds.
his total to'the Summary Page.) .................... Tore ~ e
II I I I I~ I ~ III I I ~~~` ` Type or print In Ink. SUMMARY PAGE
~C~nl~al9l'1 ~ISC~OSUr~ Sfd'~@Illerlt Amounts may be rounded
S'U ITl i~78ry'P~g,e ; ' to whole dollars. Statement covers perbd
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ly ' ~ ~ '
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SEE INSTRUCTIONS ON REVERSE ~i ~ through ~.! ' Pa d
NAME OF OFf)CEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE LD. NUMBER
Contributions deceived Column A Column B• ~ Column C
I
I ~ ~ I IOIAI T/aS r[IUOD
oAOM ATTAtIND so+EOUI[s) TOTAL MIEVIOUf t•EIIrOD'
(SEE NOTE a[lOW) ~ IOTAI 10 DATE
(ADD COLUMNS A • ~)
1. I Monetary Contributions ... ..... .. ............... Schedule a, une 3 s ~~~~~" s 5 ~~~ _ s ' ~ ~ ~ /~~
Loans' Received ...... ~ ........... .........
... .,..... ...
' ScMduk e; une 7 `~ -$ -~-
.
SUBTOTA~.CASH CONTRIBUTIONS .........' ............. Addunes I . 2 f _~~~~ ~ f
? ~ ~ - s' ~ ` /
4. Non•monetary'Contribu'tions . ...........................
I ScMduk c, une 3 ~ ~
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S! ,SUBTOTAL CONTRIBUTIONS (ExdE~drl'En/orce•ble Promrses)' Addune:3 + I s `~~~ ~ s ~ ~O ~ - s L ~ /~
6.
Enforceable Promises ' '
(Ewdudr t
on~Gw.•ntees, Une fe 6elotiv) ........:,.:.........
SdtedlrN D, Une 7
.~
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-a~-
7: I
TOTAL CONTRIBUTIONS RECEIVED ..................... AddursatS + 6 s l S~~ ~ t ..~~~ ~ s ~ ~ f
E,xRenditures Made ' ' '
8. Cash Payments (Qther'than loans Made) ............
.. ScheduN E, lhse s s / ~~ ~ S ~~ y~ ~ S ~ l ~
~,
9.~; Loans~Made~~.. .";. . '~ ...........................
scbedr,NH,une7
~-
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10. SUBTOTAL CASH PAYMENTS ............... AoldUnese + 9 S l ~~ ? s ~/ ~d S 7 / ~ j
11 ~. ~Accrtied Expenses (Ulnpal'd Bills) ........................ ScheduN F une s f ~ 02 -~ ~~~~.:~ r,Z, D ~~
'TOTAL EXPENDI7`URES MADE .........................
addunes fo . rf I c.. y .~ Z
s ~ ~~1_~
s oC,' ~ .~ ; ~`s ~~% ~''
~rrent Cash Staterne'nt
13. BeBinnin~ Cash Balance' ' :................. Previous Summary vape, tree n s /
i
14: CashRetlipts ~... ......'' .................. ..... column A,Une3above ~~ /~-J~~~
1 S. Miscellaneou
s Increases to Cash ........................ Scheck,re t une ~ ~
16. Cash Payments ~ ........... . ........................ Column A, Une roabore / 9~,~
17. ENDING CASH BALANCE .: .. Addunes I3 + le • rs, thensuDtradune 16 S . ! / _~
f/ this b a termination'ttatemen~, Wre 17 must be rero. E Narw usN aAUNOi sNOTxo
' ~ ~ ~ ~ , NOT 1E A NEGJITIVE AMOUNT
LOAN GUARANTE
18. ,, ES RECEIVED .............. Schedure e, vent r, Column (b) S "~
Cash E' ulvltlents a _~
Cash E ivalen nd Outstandln~ Debts
19. 4t+ 4 .. ............ .............. See IruT,T,ctlons on nwrse S
20.I Outstanding Debts' .. ,~ ...:.......... AddLUrte? + tine IllnColumnCabove s _-_-~~
• From prcvfous Statement Summary Paye, Column C. However, i1
this b the first report filed for the calendar rear, Column B should be
blank eNgpt for loam Received (line 2), Enforceable Promises (line
6), loans Made (floc 9), and Aurucd ETlpenses (line t t ).
Summary for Candidates in Both June and
November Elections
21. ~ontribl~tions
ecelve ... s
22. ~xpeeditures s
1/1 through 6/30 7/1 to Date
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S~h'e,dule~l~I~ ~ 'I '
Type or print In Ink.
SCHEDULE A
fVlon+et'aryContr'ibu+IOns Received AmountsmeyDeroundt+rJ -St/temenltover~perlod
I I ~ I T, i to whole doll/rt.
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SEE INSTRUCTIONS ON REVE SE through
p~~e; ~
NAMEOF'OfFICEH LDERQRCQNDIDATEAND'CONfROILEDCOMMITTEE ~
LD.,NUMBER
C ~r ~rL S , ~ ,~~
[FATE
,RECEIVED FUII NAME AN ADDRESS Of CONTRIBUTOR
(IrCOMM~n!1,MADOrr10r11000MMn7lI7NAYtANDADDIIlSS.tM1I11L0 NUM/M
orb M NO I.D. NUM/[A NAf /t!N AfS1GNl D, EM[II i11t ASU11E/'1 NAMI AND AD011E Sf)
~ OCCUPATION AND EMPLOYER
plSlll•[M/lOYlD,lNf[II AMOUNT
RECEIVED THIS CUMULATIVE TO DATE
LENDARYEAR
~ CUMULATIVE TO GATE
OTHER
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NAMt Or /usiNttsl
PER100 1
AN. T - DEC. 31) ~ (IF APPLICABLE)
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• I' ' ' ~ SUBTOTAL S 3~~ .--
..rvrrcaarr wna/[uuu~ns ~urnmary
1. Amount received this period - contributions of S 100 or more.
(Include all S
chedule A subtotals.) ...............:................................................................................... ; .~ ~0
2. Amount received this period - contributions of less than S 100.
~~Do not itemise:) ..~..~......' ....:........................................................................... s l~'~
3.,Total monetary contributions received this period. ,
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A. Line t .) ... ....... .......... Tnrel t `r'~.~`7
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Schedule,~A (Co~ntinuatio.n Sheet)
Type orprlntlnlnk.
~
scHEUUIEA(corn.1
Mor~pt~ary Contributions Received Amounttmaytreroundad Ststementcoversperlod
"
to whole dollars.
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paps.,. pf
NAME Of OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
I LD. NUMBER
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J ' ~ ~~ ~~lG'
A
I full I
DATE
RECEIVED N
ME AN ADDRESS OF CONTRIBUTOR
McortMmEt.MADDRIp1110Ct1MMrrTtI7NAMEANOADD11EfS.EMTEIl1.l1NUMtrEl1
OI~NNOID.NUMalIINASaEENASSIGIIED.EMrlII111EASUIIEA'SNAMEANDADDR[ssl
i OCCUPATION AND EMPLOYER
(~rSEl1~tMKOYED.[N1E11
AMOUNT
RECEIVED THIS
CUMUTATIVETODATE
CALENDAR YEAR
CUMUL.ATIVE100ATE
OTHER
~
~~ NAltt a aus~NCSSI PERIOD (IAN. 1 - DEC. 31) ~ (IF APPLICABLE)
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SCFI
ECIIJ~~~ IB ~-' Part ~i ;
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. SCHEDULE B -Part I
LO~It1S ~Reeelved
I Amounts maybe rounded Statement covers perlDd
to whole dollars.
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SEEINST~IUCTIONSONREVERSE ~ ~
through ~I ,
NAME OFOFFICEIffOLDERORCANDIDATEANDCONTROIIEDCOMMITIEE ~
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LD
NUMB
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' GATE (ENDER OR GUARANTO 'S fUIL NAME AND ADDRESS
~ RECEIVED (r COMMRi~l, [Null rUll NAM[, ADDIlas1 AND I
D NUMata
' K NOI
D (ENDER /GUARANTOR'S
O
+ LENDER INFORMA110N 'GUARANTOR INFORMATION
.
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I ~ I NuMalrl HAS aEIM ASiN:MEO, INTt11 ~H[ igAtAMIA'S NAM[ AND ApOllElfl CCUt
AT10N ANO [MROira IK flll•
(MROrED, EN1EA aUANESS NAM[ I
~ DUE OAIE~
AMOUNT CUMUTATNE
~
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INIEl1ESi Ml[
Or LOAN iODAIE AMOUHI
GUAMNIEED CUMUlA1NI
10 DAII
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CAIENDAII rlAA
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INTEIIESi MiE ~ 1
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' ^ L'ender ~ ^ Guarari'tor ~
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I ~ DUE DAi! (71l[NDAII rlAII
CAIINOM riA~
I M, ~ ~ I MYTElltsi MTE ~ 1
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See'important instru~tions
on reverse.
t•l ~) Enter tDl on
l SU6TOTAL ;
~-_ :
~_ Ivmm.ry -.~.
u~. a oolr.
Loans Received - Part~l Summary
0
1. Loans f 6100 or more received this period. (Include all Loans Received -Part I (a) subtotals.) .......... S "~-
nder s 100
2. loans u' received this period. (Do not itemize.) .~ ..............'.....''....................... s ,,~-
a
3. Total loans received this period. (Add Lines 1 and 2.) ......... 1. ~
. ............................ TOTAL..., s . ~'
Loans Received -,.'Partll Summary ~ ~'~ ~~~~
ore re
4 subt fairs I~torgiven or geld, forgiven, or paid by a third party this period. (Include all Part II (c)
paid by a third party, also iteml:e the transaction on Schedule A.) ............. . f -~-~
. Loa
aid by a third pert paid, forgiven, or paid by a third party. (Do no itemize.) If forgiven or
'P
6. y, include this amount on Schedule A Summary, Line 2 . ........................... i -~-
Total loans repaid, forgiven, or paid by a third party this period.
(Add Lines 4 ~ 3.) ............................... TOTAL s ~ ~- )
7. (Net change this period: (Subtract Line 6 from line 3.) ,.,
Enter the net hers a~~ ~^ sh- ~~~^~^^~^~ ~__ _ ,. ..--
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SchQ~dulel'B -Part ('(Continuation Sheet)
Loaris Received ~~ '
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Type or print In Ink.
Amounts maybe rounded
to whole dollars.
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' I NAME OF~OFFICEHOLDER OR tigNDIDATE ANb CONTROLLED COMMITTEE '
I BATE LENDER OR GUARANTOR'S FULL NAME AND ADDRESS LENDER /GUARANTOR'S
RECEIVED p- COMMRTEE, ENilll /Vll NAM!, ADMIESS ANO I.D NUMalA II NOI D OCCU-Al10N AND EM-L OYla Ilf SEIr-
NUMalA ~/Af aEEN ASSIGNID, ENTla TrK IIIEAEUIIEII'1 NAM( AND ADDAEfi) EMrROYlD, INIIII aUSINI6S NAM[ 1
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^ Guarantor ~
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'See important~instru,ctions on reverse of page 1 otSchedule B, Part 1.
SCHEDULE B - Part I (cont.)
Ststement covers period I'
from
~ ~~ ~
through Page' 01
LDS NUMBER
LENDER INFORMATION GUARANTOR INFORMATION
DUI OAIEI AMOUNT CUMULATNE ~ AMOUNi (UMUTAi NE
IME11IS1 Mif Or LOAN lOOATI GUAMNI(ED TOOAIE
DUI DATE CAIENDAII YEAR CAIFNDAA YEAH
E f
INTEIUSi MlE
O1HIA OTHER
N t t
DUE DAIS CAIENDAA YEAR '
(AITNDAII YlAll
s t
arrcasr MrI
OTHE11 OlHlA
x s s
DUE DATE fJ1lENDA11 YEAH
CAl[NDAII YEAH
f t
er1E11Eii MTE
O1~A O1NIA
~ t s
DUE DAIS EJ1lIN0Aa YEAH
CAIINDAA YEAH
~ s
INTE HEST MI!
OTH[A OIHIA
x s t
OUE DAT[ lJ1lINDA11 YEAA CAlIH0A11 YFAI1
{ E
INIIAIfI MIE
OIHIA 0111111
,< s s
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SUBTOTAL s Ibl
s 1 nlel Ibl on
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Type or print In Ink. SCHEDULE B -Part II
~Sc~iedule~~B ~ Part ~II~ ~' ~ '"
i ~moums may oe rounaed
Repayment's Made d~~Loa~ns Received, Loans towhot.rtou.n.
~Forglwe'n, ar~d Lo'ans;Repaid by a.Third Party
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SEE INSTRUCTIONS ON REVERSE ~i' ~ Statement covers period
t,om / - / ~
_
through ~ f ' ~ ~
aye I of
NAME OF OFF~CEHOLOER OR CANDIDATE AND CONTROllEO COMMITTEE LD. NUMBER
,~ i , ~ ~
REPAYMENT INTEREST AMOUNT REPAID OR f OUTSTANDING
'OR ORIGINAL~LOAN FULL NAME OF LENDER RATE fORGIVENON PRINCIPAL INTEREST
FORGIVENESS ~ pr cru-w6to1 (tacwot rarMt-n of untusq ~ PRINCIPAL pAlp
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Attach additional in/o'rmation on appropriately labeled continuation sheets. SUBTOTAL
(`~
s
TOTAL INTEREST
PAID THIS PERIOD
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'IA~IPOATANT: Nang part ti/a loan is /w~piwn or repaid by a third party, also itemi:e the transaction on Schedule A,
JnNudlin~ t111 I1~rM artd'addrsss o/ tM plrwn lor~yierir-~ the loan or the third party making the payment, and the amount
/0f91V1n 0/ plb.' Fnter the amount In column (d) In the
summarysectlon of Schedule F, l ine 3 Do
not carry shit total ro the summary sec tion o/
Schedule B.
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S'ch~dule'B - dart 11,1
Annua Re r "
~ ~ po t of Outstanding Loans Received,.
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SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER ORC{,NDIDATEAN~CONTROLLEDCOMMITTEE '
' ~ '~ ~ - ~ ;,was
~ ~ , FULL NAME Of LENDER ORIGINAL DATE OF LOAN
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Type or print In ink.
' Amounts may t>e rounded
to whole dollars.
AMOUNT OF ORIGINAL LOAN
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Attach additional information on appropriately labeled continuation sheets.
~~
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SCHEDULE 8 -Part III
Sbtement cov/ers period :
from ~ / /~,; ,
throu0h _ ~ '~ ~ Pape of,
LD. NUMBER
UNPAID PRINCIPAL UNPAID INTEREST
i
TOTAL I ~ ®_
NOTE: Thlttotslshouldbe
the same amount at entered
on the Summary P,aQe,
Column C, line 7.
' ,
~ i~~~ ~
~5chedu`e~C ~~ ~ '~ ~ I ~ '~" ~ Type orprlntlnlnk.
Amountf may be rounded
Nori!~Uf oneta~ C~otitributions Received
i y ~i , to whole dollar.
i'
~ ~i ~ I i ~
i
~ '4
SEE~INS~fRUCTIONSONREVERS~E
NAME OF OFFKEHOLD~ROR CANDIDATE AND CONTROLLED COMMITTEE
i i~ ,
i ~ ~~ ~ ~ ,C s ~ eQ~
i
SCHEDULE C
Statement covert period
from ~ ~ -
~ ~ .,
through `r ~~' ~' ' Pape of
I.D. NUMBER
i ~
DATE
RECF~IVED
i
i ~ ~ i iFUll NAME AND ADDRESS F CONTRIBUTOR
IucoMMrint,INAOOrtaNlocoMMmfrsw-MrANOADOUSS.
rNTf4rD.NUMete0l~IrNOLO.MUMereNASe[rNASSIGNED,
fNR11 iRlASUILLII'S NAMr AND ADOAfSS) ~
OCCUPATION AND EMPLOYER
Ur SEU•[MVIOYED,fNr[eNAME01
•USIMtfSI
~
DESCRIPTION OF
GOOOSORSERVICES
FAIR MARKET
VALUE I
CUMULATIVE TO
DATE
CALENDAR YEAR
(IAN. ~ - DEC. 3 t ) - _ v
CUMULATIVE TO
DATE OTHER
(IFAPPUCABIE)
'
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Attach additional information on appropriately labeled continuation sheets. SUBTOTAL s ~
Non-Monetary Contributions Summary
. Amount r
(Include eecelved this pe '' ~- non-monetary contributions of s 100 or more.
II Schedule
C subtotals.) .......... s ~-.
..........................................................................
2. Amount received'this period -non-monetary contributions of less than s 100.
Do'n Itemi„
( of ` ae.) .:... , . ~ . ~ .................................:............................................................. S ~-
3. Total ~_
(Add non-m and 2r E tefnbutions received this period.
Lines
' here and on the Summary Page, COlumn A, Line 4.) ... , TOTAL s
, ~ '
~'
~..
I ~ ~
I' ' i ~ !
~ 1 I I I I ~ i i ~ ~ I ~ '~ I
I i i , I , I I i I I l i I II ,' i I ~ I
I I I I ,e:~ :v . l 1' I I I I I I I I' ' I I 1 1 1 i III ~l,l •i, ~ ,I I I I ~ ~I i i I '
I SchQd u le' ~ I 1 ~1~ III 1 ~ '' ' ' ~ ~Typ~ or print lrilnk: ~~ I I 1 I ' ~ I' , 1 ' ~ SCHEDULE ID
Enfdreeable Promt'ses Received (Other than Load '' Amcunttm.,~be'roonded,' Ststementcovertperlod
I .. I 1 ~ to whgl~ doll~rt; ~ y , " J._ ' . I ~ ~ I , '
I guarantees, login Endors'eme~ts;lland lgan' Secu'nty) , ~, , ' , I , ' 'I from' , 11, r I ,III, ; ' ,
' i i " I, I I I i I , I I ' I I i~1 I
' , NOTE: Loan guarantees, loan endorsements and loan security are "enforceable prohtises' that must ' ' ~ '1 ~ I ' , , I q I
' be reported on Schedul 8 - t~OT Schedule D. SEE INSTRUCTIONS ON REVERSE ; , through Z' ~l ~~ I Pipe I of ~~
I I
I NAME Of OFFICEHOLDER 0~1 CANbIDATE AND CONTPOILED COMMITTEES I I I'1 I i , ; i I ,' ~ I '
i I LDL NUMBERI
i _ I I I, I i I i I i I 1 I ' ~i I I I 11 I I I
' I . I I ~ , ! I '~ ~ I' i
I fULL NAME AND ADDRESS Of ~ NTRIBUTOR ~ I ' ' ~ ' ~ 1 ~ ' ' 'i I~ , 1~ I 1
'I , DATE (N COMMITTEE, MADOIt1pN'T000MMRTEt'S NAME AND ADOIUSS, OCCUPATION AND EMPLOYER '' '~ AMMOUNT PAID ~ CUMULATIVE TO DATE, , CU~IIULATIVE TO '
I ECEIVED lMlstu•tMnoreD,[NrEllw-ME a AMOUNT'PROMISED; ~ TNIS PERIOD ~ CALENDAR YEAR i DATEE OTHER i I
19! I I ENTEIILD.NUMtE^oQwNOI.D.'MUIMQIINAS~EENASSIGNED. I I 7HISPERIOD ~ , u-~sotNTEeoN (IAN.I-D,EC.31) pFAPPUCABLE)
i I ~ I EMf[IIiQASUItEII'SNAMEAND!ADOIIESS) r1USINESS) ~ ' ~ ~ , ' SCNEDUIEIA) i i ~ I ,
I ~ I ~ . 1 1' i I II
I'• I ,
I I , I I' I ' '~ I
I I ,. I II I
i I I I I I ~ I 11 1' I 1 1
I , II I I I I ,1
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I ~ I I .I ~ I ~ ' ' I I I II I I ' I I ' , I 1' Ili I i 'I ' I lil II
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' I I' ~ ~ Ii y I I 11 111 ~~'' I I I~ I I •~ 'i ; dl~li. ~ 1 ' i ~ i II I I I I II
III ' l l ~I I ,I I I I I'' I' I 1'i ' .III, I i ~ 'I I ; I ~I I II I j I, .
I I I ~ ' i ~ I. i i ~ , ~ ~ ,, 1'I ~ ', ~ I I I I iIII
! I I I I ~ ~ I, I• I ' I, I I I ! I 'I I 'I
,III ; I ~ I I I I ~ III I '11 'I ~ ~ I~ II ~ I i I 1' I II i I j ~
I I I~ , ~ i , ' .' 'I
' i,~ I I I I ~ i i ' II 1 ' I ~ ~ I •- ~ I ~ l i I I
I ~ I I I i I 1 ~ I ,, „ I , I I'
I I I '' I '' 1 I ''I i ii ! ~ I ' I
I I I , l i ; 1 I ~ I ~
.b 1 I; I I I I ' I I ~ I' ' 1' ~ ~ I~ '' I I ' ' ~ I I I' I• I I i
I l i I ; I l i~ I V II I ~ I " I I I I I I I
I I , i q, I I I
I
I I tta,ch ad' itional infiormation on appropriate/ylabeled continua'bon' ~ ' I ~ 1
I Ishee,ts. ~ ~ i SUBTOTALS ~ ~I ,~ , -~-T ,
Enforceable Promi'se's Received Summa ~ I '' ~ I I i ; I ' ' ' ' I I
' I ,j '
I I I I I' I11 1 II 1 ~ i'I'Ii 1 I I II~'~'i Ip 11.I '' I' 11 II III I j, I
21 Promises recei've~d ur{5~00 or fnore this pendd (Colum'n (a)). , .L . ~.......,.. J.....1 ....i i I 1, I I ,, ', , 1 I i I I I , I
' I r f ~ 'x100 this period. I! I, II I II I I I I I I I I
I 'I iI(DC1notlterT~ I:e.), ~..L. .... tl•l..I...I.I 1. .I.....'J :i..l....1: ' I ...' .~ .. ~~'' ~' ' I ; 11 II I ',III i ' II I I i~ ' III ii
I
3.'rptallpromifes'receivec~ thllf period ~ '' ~ P , i I 1 I . •'. .'1 .LI•' I ~' ~, '• II ~ I -ice ~ I I I '' 1 I ! 1 I
I
111 ~ (Add L r~e~ 1~ $nd ~.) ! 1 I II' I' . x..:11'''. I ~ . . , I :, ..... ~ I. ii . ' ~11. ~I . TOTAL I';,'I' I I I III ~ ' I I III I' ~ , 1 1 'I I 1 I I
I~ I I II 11 " I I I ~ r •I .. 1 t .j. II i'.,1. .li ~ I '•I • ' I ' •'- I '' ' ~ I I i ',, ~ ~ i l I. II I ~ 'I ~ i I
6 ,. f eyrTl~nts r 'tleG~rl~d o p~ornttes of 5~1 n0 r more this riod. I I , I, ,~ ' I I I ~ ~ ~ I ~ I I III I~,11 li I ''
I ' i t ~ I I i 1 F l i; il" Q I ~ p.~i I I 1 ~ ~ I I I ~ I. I 1' I I
' , I I ' I
I ,' I ~ i I
l (Coli~fn~t, lb)). .. , ,. ~ L . f l..l'... ~ ... r ..I . .. '.. ~., ... '. ..I .I .... ~ I ...., " ~ ~ .I'. .. .I i~ ' I I ~ ' I I ' .I ! I ,
I I 11511 y'mt?ntfF CeiN~d'IQI~1'pflOf~llSeS,!Un~efls~0~thl'4~pe,flO,d. ~ i~ I' II'r I III I' I~'I I, I I, .'.. Ili1 i I ''I' I ~~ ~ I I 1 I I i III II II li
I' I (II~o n t It;~r~ii:e ' I d Include on Sch,gdule'~ SLgmm'ary,ILirie 2.) 1 L .il'., y• M1 ',I °' .. ' II I I ~' ,' I''I, ,; s ' 1 '~' ~' "~?~- '~ I ~ I , I ! II , I
16.TO~~III~~yri; ~Slre~elrefd. 1' I it I I 1~ I r' I' ''1 I11 i ~, i I l l~„.I !.1. I 1 I I I ~ I '
III 0 ~I~1 I~ I G I ,I I, I . Ili II!I I ~I I I,II' i' I i ~i ihl I I I i ii I I I ',r~i'I „ jl 11 11170TA1~ i, 11 I11 '~ I 11 ;~ I II ~ 'Ijl I I Ij 'I
1 II 11~~M, ~I ~ ~~~$.? , 1..,.1...~......''.IL......I.I . ....f.„.........' .......:.........L.. s ~ ) II I t ~ I
II 17 et t;h~ gle ~~Tis'Ipgrgo~.l (Suptract Line 6 t~omllinel3. Enter thg difference here acid on ' ~• ~ I I ' 1 i ,I ' I ' I I I
I i~ th! ISJphinrT ry ~ fin I ) ~' NET -~'~. ~ I 1 ~ ' I I
I ~ 1 ~~f, Cdlu • n~A, line 6. ' ......... L ....I....... -'.. '~:.I. .... f --- - - _ I '' ' I
1 I I I lil 1' II' I p' i' I I I I, I
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I ', JI' , ~ I i ~'I
I$Che~~llle'E I,~ I I ~ + I ~~ , ,< .~ Type orprlntlnlnk. SCHEDULE E
Amount[ mry be rounded Statement covert period
Paymlents ~~hdl Contrybutions to Whol.doll.rt.
(Othe'r Than,loar~s)~ 1lrlade from. ~ -~~
~ I I i r
III -I _~ ' ~ ,
SEEIN57RUCTIONSONREVERSE , ~, through z' p~Qe pf
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE LD. NUMBER
I I ~
' I '' I I ~' ~ CODES FOR CLASSIFYING EXPENDITURES ~ '
I I I
I I If onb 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.
I;
~C' ~ MONETARY AND IN-KING (NON-MONETARY) ~, •a' - BROADCAST ADVERTISING 'G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES 'N' - NEWSPAPER AND PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
ANDCOMMI,TTEES' ~ ~ •O' - OUTSIDE ADVERTISING (MUST 0E DESCRIlED)
'I' - INDEPENDENT EXPENDITURES ~ I 'S" - SURVEYS, SIGNATURE GATHERING. DOOR-TO-DOOR SOLICITATIONS ~p~ - PROFESSIONAL MANAGEMENT AND CONSULTING
"L' - LITERATURE I •F" - FUNDRAISING EVENTS SERVICES
--
- -
NAME AND'ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
pr coYYmit[, r~ ~oorraN rocoMYm[rt NAYe ANO Aooe[ts. [Nr[e ~.o. NuYtte orz r No ro.
' I MU
Mh NAt e!l
NAtt~G
i
lD
i
' IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON LINE 1 Of 7HE SUMMARY SECTION BELOW.
M
Q
~
N
. IN
RLASUIIlII
t MAYI ANO ADOgttl
'
, I
CODE OR DESCRIPTION OF PAf MENT
AMOUNT PAID
~,
,
-
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1
I
,
, G
..r. r[~nl: ~ wnlrrouuvns arw e~rPenurwrrs maoe our o- campalyn tunas to or on behal/ of other 9 , SUBTOTAL sl ~ I O ~ /
o iceholder:, candidates, committees, or ballot measures must also be entered on th'e Allocation Pa a Part 1. /
Payments and ~Co'ntributions Made Summary
1. Payments'rnade this period of 5100 or more. (Include all Schedule E subtotals.) .................. ........:..' ....................... S ~a ~~~
i ,I - ~ . I
2. Pa f `
yments madt3,th`is perioti~of under 5100. (Do not itemize.) ....................................................................... f l0 ~/. ~~
3.'To ~~
tai interest paid this perjod on outstanding loans. (Enter amount from Schedule B, Part II, Column (d).) .............................. s ~--
tai
4. To accrued expenses paid this period. (Do not itemize. Enter amount from Schedule F, Lined.) ...................... .
.............. s $^ -
p, y is made this period. (Add Lines 1, 2, 3, and 4. Enter here and on the Summary Page, Column A, Line fl.) ........... ~~ J ~ -
5. Total amen TnTAI S , s ~ / _
i
' ~ ~
II ~ I I ~ ~I
~Sc~ie~ll~je';E`i,~ ~ i'I'(+ ~ ~ ~ ,<:~ ~,
(Corlt~nUatl~011 Sheet) ~~ ,
Amoumfm yh~.round.d
CHEDULEE(cont.)
Sta
l
d
~Payrr~'erits and Contr'butions ~ towhokdoll.rf. .mMttowrtp.r
o
m ~
(Other Thah Loans) IV~~ade ~ - J 7
IrD
SEE INSTRUCTIONS ON RE VERSE ~
' ~ „
z._lw~,, ,. ,
i through P.O~ ~
NAME OF OFFICEHOLDER OR CANDIDATE'AND CONTROLL
i~ ' i i ; ED COMMITTEE ,, I.D. NUMBER
i '~
t '
•
k.
p~ l D~
~
i
i
~ , ~ , ~ ~
CODES FOR CLASSIFYING EXPENDITURES i;
'
~ ~ 'C' +- MONETARYANDIN-KIND(NON-MONETARY) ,'B' - BROADCAST ADVERTISING 'G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO,OTHER CANDIDATES.
AND COMI~IIITTEES 'N' = NEWSPAPER AND PERIODICAL ADVERTISING 'T' -' TRAVEL, ACCOMMODATIONS AND MEALS
~
' 'O' _ OUTSIDE ADVERTISING (MUST BE DESCRIBED) '
~I
: ~- INDEPENDENT EXPENDITURES ~
L - UTERAITURE ~ 'S' -
' SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS ~P - PROFESSIONAL MANAGEMENT AND CONSULTING ~
'F
= FUNDRAISING EVENTS ,SERVICES ~I
NAME AND ADDRESS~Of PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION ~ ~
p COMMrTTtt, M ADDRgNLT~O CCWMRTIt'f MAMt ANO ADDAtff, [Mt111.D. NUM.t110161f NO LO.
11UM.t11 NAf RtN AffIG11[D,lNTlII IIIIASUR[A'f NAM[ AND ADD1ltff) ~
I
~
~ ~. •.
. ~ ~ ~
I ,1
~ 1
I _
.
CODE OR ; DESCRIPTION OF PAI~MENT
AMOUNT PAID
~j
6 /~S '~~'E`"
6' ~~l- /~~S~~~
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,' SUBTOTAL S ~-~~ ..~-
S4hedNle' F ~ ~ ~ ,~~ ~ ~~ I 1 Type orprlntlnlnk. - SCHEDULE F
' ` Amounts may be rounded
a•`CYV~d E1~Ip~'nfes (Ur~Flald.,.BIIIS~ to whole dollars. - State ~ntcoversperlod
i ~ ~ „ i from
~ I I ~ ' ~ ~,
I ~ j i ~
i ~
SEE INSTRUCTIONS ON'REVERSE ; ~~ through ~' ~ Pape of '
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
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
back of, Schedule E-Continuation Sheet for detailed explanations of each category.
~' - MONETARY AND IN-KIN[1INON-MONETARY) ,•B• - BRbADCAST ADVERTISING "G' - GENERAL OPERATIONS AND OVERHEAp
CONTRIBUTIONS TO OTHER CANDIDATES •N" - NEWSPAPER AND PERIODICAL ADVERTISING 'T" - TRAVEL, ACCOMMODATIONS AND MEALS
AND COMMITTEES _ ~ "O' - OUTSIDE ADVERTISING - (MUST SE DESCRIIED)
'1" - INDEPENDENT EXPENDITURES 'S" - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS "P - PROFESSIONAL MANAGEMENT AND CONSULTING
- SERVICES -
'L' - LITERATURE i •F• - FUNDRAISING EVENTS
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION IwwaTANS: 00 NOT rtEMRE THE MYMENi pi A[CRU[D EIf-ENSES ON fCHEDUIEf [ OII /. RErOItT ONIr THE lUM• SUM Or -ArM[Nli
III COMMRTE[, Irl ADORION TO COMMITTEE'S NAME ANO ADOREtT, ENTER I.D- NUMaER OR, M NO I.D. ON fCHEOUIE f, lM1E 1 AND ON fCHEDUIE E.llIE /. DO NOT RE-RiMI[E ACglUIO EN-ENfES RE/Olli[O IN A IRE VIOUS -ERi00.
NUMEER W1s aIEN,AfSIGNED.lNT[R TAEATIHIEII'f MAME AND AODR[sS) DESCRIPTION OF OUTSTANDING PAYMENT
CODE OR AMOUNt ACCRUED
~~.,,,~'
so
~
~
~
~
~ ~~~
l~~
,,
~
_
,, ,
,,
~~
,,
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',
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~~ ~~
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Attach additional'information qn appropriately labeled continuation sheets. SUBTOTAL ~ -~
Accr
1 Ac es Summary _ `~~ _5 r
ued Ex enest J
p his p od: of S 100 or more. (Include all Schedule F subtotals.) ......................... ...................... S
.......
2. Accrued ex ,ens n
' penses this'penod~of under 6100. (Do not itemize.) ..................................................................... S ~ ~
p incurred this period. (Add Lines 1 and 2.) ................ ~................................. INCURRED TOTAL S ~-=~
3. Total accrued ex enses ~ ~~~ ~
4. Tota ccrued expenses paid this period. (Do not itemize. Enter here and on Schedule E Summary, Line 4.) ..............:.. PAID TOTAL S ~ ~ - ~
l a ~ ~~
S. Net change this period. (Subtract Line 4 from Line 3. Enter the Tlifforon~P hero a.,~+.+-+ the t11R1marV paTTP Cnl~~...., e I ~.,e t t 1 NFT t ~~~''~-
I III' I I I I I~ i 1 1 P I I ~ I I III I I I I
I I I I I I,I I
I I I I I I I' I I I. +~ I I I I ' I~ I ~{..I' I I I I I'I
S~hedt~IpliG ~ I' I' '~ I I ,
I I II ~ le:~ ~I ' I I I ~ ~ I I I Type ~oi pr1n11111nk: I' I ~ I I I ~I I' ~ ~~ I, I I I ~ I' I I SCHEDULEIG I
Payments Made ~ a'n Ag~e'nl'tlor Inde end~n't. ' I ' I ~ amDU~t,;m.y~rDU~aea. statlrBlntE4vlrf~rlOd
' I Contr~cto,r (on Be~alf of an Officeholder 'I r I II ~ I ID whDla dol~.n. I ~ ~ ~ I' '
I O I I a I: ~- I
' I Clandidate) I I I , I I 1I I I I,. rrDm ~I l~
'' SEE INSTRUCTIONSONIR I I 'I I I '' I I I ' I ,' ~ '~ f~ I~ I I I I I .
EVEIRSE I I i
throw h
I I , ' 9 Psde _.t_ Pf
I
NAME OF OFFICEHOID'ER OR CANDIDATE AND CONTROLLED COMMITTEE ~ I I
I
I J%.~ G I I r,,/~ I r I' ~[1 ~/~~~. j! I I, I LD. NUMBER/~~ I/ IJ I I I
JF(i ~ I ~~ ' 'Gi GEC ~ ' I~~ ~`i I I(~ I~ ~ ~/~ C~:1'\ ~' ~ ~' I ~ I I I ~I I ~ I I ~ ~ '!J /C1
NA E OF AGENT R INDEPENDENT CONTRACTOR , I I '
I I I I 11 I ~ ' ~ ~ I. ',' III' I I ~ y l I'~ I I I j
I ' I I ~~ I I I I I I 1111 .II ~ I I I I I ,
I ~ I , I I ~ I I III II
I I I
I I I, I I I CO,DESIFOR CLASSIFYING EXPENDITURES' I 'I i ~ I I I' I' I
I
I ~ I
If one of the, igllovding codes accurately desf~Ibes the expenditure, yI ou may enter the code and le~velthe'"[)escript,ialn of Payment' column blank. IReferllto thel I
I 'back of Schedule E-Continuation Sheet for detailed explanations of each category. ~ I
I h
I ~ '~
I "L" I~ LITERATURE I I I I 'S' - SURVEYS, SIGNATURE GATHERING; DOQR-TO-DOOR SOLICITATIONS I I I III I I I I I
~ I '61' -'BROADCAST-ADVERTISING ~ I I TF" - FUNDRAISING EVENTS I I I I I' I I
I II "N" - NEWSPAPERLR AND PERIODICAL ADVERTISING I' I "T" - TRAVEL, ACCOMMODATIONS AND MEALS. I ~ I I ~ I~:I I II
I 'O" - OUTSIDE ADVERTISING III I I III (MUSTlE OESCRISED) ' I~ I III I I I I r I
I VIII ~I III
t ach a,dc
I
II ~ ' rl~~;'-,I~~
,NAME AND ADDRESS Of PAYEE OIL CREpIT,OR I I
I M COMI~RTEE, IN ADOrr1pN 10 COMMRirE"S NAME AND ApD11ESS, ENTER LD. NUM~ER OIL„ R I I
HOLD.NUMQIIHAS~EENASSIGNED,INiEIITAEASU11E4'SNAMEANDADDAESS)I
I I
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CCIDE I OR I I I I
DESCRIPTION OF.PAYMENTI
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I~ TOTAL' l13' I' I I I I
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S~ched~tle'~F~•- Part I' ~ ~ T
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' Loans Made to Others Am°~ntsmaty~erounded SCHE DU LE H -Part I
1, i ~ ~ , '' to whole dolhrt.
~
' Slstement covert period
4
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from _
SEE INSTRUCtIONSiON REVERSE ~ , i through ~' / r ~ P
t NAME Of OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE t+q! Or
I:D.NUMBER
PATE OF LOAN ~ fUll NAME AND ADDRESS OF RECIWENT
1 ~ ~ N COMMrTTII; M ADDITION TO COMMRI!['S NAME ANO AD011lSS, [N11111 D. NUMA[II INTEREST RATE DUE DATE
_ ~ i ~OILtlNOLD.141MQ11/IAS~[lNASSIGNlD.lN/l11111EASUIIlII'SNAMEANOADDeEfSI
I AMOUNT,
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SUBTOTAL i
..~
ans Made,to Others -,Part 1 Summary
1. Loans of, s 100 re
or.mo
made this period.
ad
............ . ..... • • ......
(Include all Lo
'ans M e - Part I subtotals.) ~
"""""
s ~-
2. Loans underS100madethisperiod. '
"""""" """"
(Do not itemize.) ...
...................................... ..........................
'T
3
all ~~_
:
........
.
ot
oans madethis period .
(Add Lines 1 and 2.) .. .: ....................................... TOTAL s "~_
Loans' Repayments Received - Part II Summary
4. Paymenti, received on loans of i 100 or more. (Include all loan payments received and all loans of S 100 or more
which have been foipiven b this officeholder, candidate, or committee -Part II (a) subtotals.
If
Iven a
lsoitemlze
n Sched
l
E
)
r
S ~-
.
e
u
.
...................
............................: .
a m
ents received,on to
ans under S 100.
y ......
din a for Iveness.
D'o not itemize.) ......... .
9 9
.................
......
.
t
S .~"~
p y
....
.
................
6. ,
otal
loan a ments received Phis period. .......
' (Add~l,ines 4'and 5•) ..................................... ...
7. Net change this period. (Subtract Line 6 from Line 3. TOTAL s ~ -®-'- )
f'.nter the net here and on the Sllmmarv Pan. ~.•.I,,..... A ~ :-- ~ ~ -•
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Type or print In Ink.
SCHEDULE H - Part I (cont.)
oan , a e o er,s
Io wholi dollan.~ ~
(Continuation Shee't)~ ~~ ~
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Statement covert period
_~ 7
l
from
ihrouph ~ ~~ °~
:
aye of
NAME OFOF,fI EHOLDERORCJLNDIDATEANOCONTROIIEDCOMMITTEE
i ~
I LD.NUMBER
'
DATE OF LOAN
i ' ~ i
~ fUll NAME AND ADDRESS Of RECIPIENT
)II (OMMrtTtl. W ADDITION IOCOMMnIt['S NAMI ANO AD011[SS.lNItlll O NUM/[/
~ O0.Y MOI D.I[U61/lANAS/![M ASSIGNIQlNil11111tASUR/"S NAMI ANO ADDRt SS)
INTEREST RATE
DUE DATE
~ ~ AMOUNT
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SUBTOTAL S _~_
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S,t:he'c~ule'~I:-' Pa'~t II ~ .
LoanllRepa menu Received, on Loans Made
to Others ~n,cluding ,Payments Received
from Third Parties) acid Loans Forgiven
SEE INSTRUCT,ONS ON REVERSE
~ NAME OF OFFICEHOtiDFR OIj CANL~IIDATE AND CONTdOLLEO COMMITTEE
I //~~~ ,
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SCHEDULE H - Part II
Statement covers period
Iron _- ~ - 17
-, -> > ,
through Pape of
LD: NUMBER
I
DATE OF
REPAYMENT OR
FORGIVENESS
DATE OF
ORIGINAL '
LOAN,
FULL NAME OF RECIPIENT OF LOAN -~-
INRATEST
Ilf CNANGED) ~ ~..~ ~
FORGIVEN ON PRINCIPAL-
(EMCIUDE IIECEI-T Ci'r INTERfSI)
OUTSTANDING
PRINCIPAL G~ l c' (p
INTEREST
RECEIVED
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Attach additional in/ormation on appropriately labeled continuation sheets. SUBTOTAL s
' ~ lal
TOTAL INTEREST s
RECEIVED THIS PERIOD ~-
•IMPORTANT: If any part of a loan is forgiven, also itemize the forgiveness on Schedule f. 1/a repayment is received from a
thirdparty,'Itrnter'the name'a-1daddress of third party in the ~FULI NAME OF RECIPIENT OF LOAN' column above, along with the
name,o/the recipient. of the'loan.
., Enter the amountlncolumn (b) In the
Wort terry thlsttoal to thesumma'ry sect on
o/Schedule H.
Type or print In Ink.
' Amounts may fie rounded
to whole dollars.
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Schedule H ;~ P~,art III,'
Type or print In Ink.
SCHEDULE H -Part III
Hnnyal, Keport o.T uutstanding Loans Made ~ -tcwhci:dolian:~~`~
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SEE INSTRUQTIONS ON REVERSE ~ Statement/coversperlod
I l
from _
through ~' ~ ~ ~ ~
e9e ~
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTl~OIIED COMMITTEE
~~ ~ I I I ~ ,
C ~ ~ t~ G , LD. NUMBER
~~~~~~
I ~ ,
~ FULL NAME OF RECIPIENT OF LOAN
ORIGINAL DATE OF LOAN
AMOUNT OF ORIGINAL LOAN
UNPAID PRINCIPAL
UNPAID INTEREST
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Attach additionalinforination on appropriatelylabeledcontinuationsheets. TOTAL =
R. ,
More: rnl~ tot.lshou-d ee
the same amount as entered
on the Summary P~ye,
Column C, Llne 9.
I ~ ~ i ~ I II II
I ~ ~ ~ ~I' ~I ~ ~ I
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Slcher~lu,le I' II I ~ ~ ~ Type orprlntlnlnk. SCHEDULE
MiscQllaneo~us Increases to Cash AmountEmayberounded
I I I , ~ to whole dollars.
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SEE INSTRUCTIONSIQN REVERSE ~ ~ ~ Sgtementcoversperlod
~ _~~,
from
throu0h ~ ~ ~ ~
aw Of
NAME OF OFFICEHOLDER;OIf,CANDIDATE AND CONTROLLED COMMITTEE ~ 1.0. NUMBER
BATE
RECEIVED
' ' fULL E AND ADDRESS OF SOURCE
lu cOMMm[[, M ADO/r1pN iOCOnrMmE['S NAME AND ADDRESS. ENi[a 1.D. NUMal11
I ~ ~ I ~ ~ W MO LD. NUMaEa HAS aEEM ASSIGNlD [MT[a iaEASU11Ea'S NAME ANO ADOIIESS
DESCRIPTION OF RECEIPT
' AMOUNT OF
~ ~ INCREASE TO CASH
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Attach additional information on appropriately labeled continuation sheets. SUBTOTAL ; ,~_.
,~
Miscellaneou~s'Ini~eases to Cash Summary
1. Increasei.to dash of;S100~or~ more this period . .....................................................:...... s ~-
,',
2. Increases to caih under S 100 this period. (Do not itemize.) ................... ........................... S - ~-
3.1Total of.all
' interest received this period on loans made to others. (Schedule H, Part II (b)J .......:............ s -~--
4:,Total miscellaneous increases to cash this period. (Add lines 1, 2, and 3. Enter here and on the '
Summary Page, Line ~1 S:) ....................................................................... ,TOTALS '~`