HomeMy Public PortalAboutForm 490 (Jan 17 - Feb 13, 1999)C~~f;e-enc~~der, Carldldater Type or printlnlnk.
and Controlled Committee
Campaign Statement -Long Form
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Cfseck one of the following poxes to Indlute the type of statement being {led:
Preselection Statement
Supplemental Pre~ledion Statement (Attach a completed Form 4° ~ to this statement.)
Special Odd-Year Campaign Report
Semi-annual Statement
Termination Statement (Attach a completed Form 41 S to this states ~ ent.)
is o er an i ate, an on roe omr ~lttee
Inclu~ed in this Statement '
NAME Of OFFKEtiOLDER OR CANDDATE
S ~e+~. IM a.r k le.~(~
area sofrGNT.oa NEID taKiUOt lOGT10N AIID TIIKT NUMasa M A/PLKAaIE)
~-~~~ b e ~ ~ ~= ~' I a rte. iAn.n n ~ ' . ~ ; ~ I~L.~I~I c r - I
asslDENruu oEl WSINESS Aooasss (NO. AND fTa[tT)
yG~ 1!x.1. 1 Z~ ~ ~+
CETY STATE ZI-COOE 411EA CODENAYTIME PE10NE
C jul^evv~~ ~ Cam, ~ Ri 7 l ((_c~~i) ~l yU -~ `'t 6 ~
COMMITT~"-E/E~~NAME I /' rD.NUMaEa
COAEMnIE I-DDIIESS MO. AND STIIEET)
DATE
1.0. NUMlf A
CITY
C ~Gl!"Cwt.Ln '~ , STATE
~4 ZI-COOE
X171 / 411EA CODE/DAYiDM[MrOME
C _xr~ (, Z y- 9.Y3F ~ MAME Or TaEAwREa CONTIIOIIED COMMli7[E1
^ r[s ^ ND
NAME OF TREASURER COM1WrtEE ADDIIESS (NO. ANO siliEET)
PEIWANENT ADOIIES OE TaEAwaEa STaEET)
INO. AND crtr STATE ZIP CODS AREA cOD[/DAriIME -HON[
S~~ ~D ~ r/~ /
/' s t' S f
CITY STATt ZI-CODE 111EACODEipAYTWE
PEIONE
~(~.r'C~On ~ ~ C~. a (~7 ! ~ `
( ~OyJ G Z ~'p ~Z 7 Attach additlonalln/ormatlon on appropriately labeled contlnwtlon sheets.
eriTication
Ihave used all reasonable diligence in preparing this statement. Ihave -eviewed the statement and to the best of my k Howie ge t
true and complete. 1 certiyouyn~der penalty of per ufY under the lawjj o~ ! ht State of California that the foregoing Is true co
Executedon o2 -~ s -"/ / ~ At ~~WI"f/Ij1G~1~f'~ ~' By
DATI CRY A rATE
An ofilcehoWer or urNilldate who controls • committee must also verl. y the campaign statement. I have used all reasonable diligE
reasonable diligence In preparing this statement. Ihave reviewed the ?atement and to the best of my knowledge the information
complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and co/
Executed on ~ ~S ' G ~ At C (~"r`a/1 ~, ( , gy
DAiE CRY ANO .ATE
Executedon At
OATS
Executedon
}
CRY AND ~ 4Tf
At
CRY ANO ' 'ATE
Statement covers period
from r-~7-c~`/
thrDUgh Z-- ~ 3 ~ 9 9
Date of election M applicable:
(MorTth, Day, Year)
Date Stamp
FEB 1 7 1999
QrOTtf OF CCLARE~MONH'
PAGE-LONG FORM
Pape-~- of ~-~
For Official Use Onlv
ether Committees Not Included in this Statement: Itrstanyod-er
committees notlrrcludedln this coruolidatedstatement that are controlled by you and any
committees of which you have knowledge that an primarily /ormed to receive contrlbut/ons
or to make expenditures on behaf/ of your candJdacy.
COMMffTIE NAME
LO. NUMtifA
NAME Oi TIIEASUIIER CONTlloll[D COMMIIT[f T
^ rES ^ NO
CONMITTfE ADDIIESS (NO. AND sTREET)
OTY STATE II-CODf A11EA CODFIDAYIIME -HONf
NAMI
By
SIGNATURE OI CANDIOAIE/OIrIC(HOL DER
i0a 1NfoM1ATION EIEODUIED 10 aE PIIOVIDID i0 YOU PU1lfUAN1 TO 1HE TNT OIIMATN711 P'~~CTKES ACT Oi 1577. SEE INiOMAAIION MANUAI QN CAMPAIGN DISCIOSUAE P110vISIONS OI tHE PQllll(A~ 11f10Rr~i
tlal. n/ P•II/.....1. r.l. n..ll, I..1 e. ..,I.-. r...-..«1..1...,
By
contained herein and in the attsched schedules is
OTTAEASUAEA
E~to the best of my knowledge the treasurer has used sll
fined herein and in the attached schedules is true and
OI CANDIDATE/OIrICEHOIDIfi
SIGNATURE OI CANDIDAIE/OFTICEHOlO[R
'Allocation Page - Part I Type orpr)ntlnlnk. ALLOCATION -PART I
t Amounts maybe rounded Statement covers period
Contributions and Independent Expenditl. res to wholedona-~.
Made from Campaign Funds ,r,m I - 17- ~ y
SEE INSTRUCTIONS ON REVERSE through ~ -~~' ~ / Page Z of Z
NAME OF O~nF/nF~ICEHOLDER OR CANDID(A~TE AND C/O~NTROLLED CO/MMITTEE 1.D. NUMBER
I F I li.(' ~ C ~~ , i tU t- (~ ~ L ~ c~~ c,
list each contribution and independent expenditur or more made from campaign funds to other committees or
to support or oppose other candidates or ballot measures.
CHECK ONE
DATE NAME Of OFFICEHOLDER, CANDIDATE, COMMITT ~ , OR MEASURE IND~ CUMULATIVE TO DATE CUMULATIVE TO DATE
EXP AMOUNT LENDAR YEAR OTHER
Support O JAN.1-DEC. 31) (IF APPLICABLE)
•
SUBTOTAL S
ALLOCATION -PART 1 SUMMARY Attach addit-onal Jn/omtation on appropriately labeled continuation sheets.
•See reverse regarding independent expenditures.
1. Contributions and independent expenditures of 5100 or m ~re made this period from campaign funds.
(Include all Allocation Page - Part 1 subtotals.) ........... ......................................... .
.................... ....... s
2. Contributions and independent expenditures under S 100 r• ade this period from campaign funds.
(Do notitemize.) ............................................... ................................................................. S
3. Total contributions and independent expenditures made tP is period from campaign funds.
(Do not carry this total to the Summary Page.) .............. .......................... TOTAL S
,.
Allocation Page -Part II Type orprlntlnlnk. ALLOCATION-PART II
Amounts may be rounded Statement covers period
Contributions and Independent Expendity ~°es to wholedollan.
Made From Personal Funds from ~ -I?_c~~1
SEE INSTRUCTIONS ON REVERSE through Z _ ~ J ~- `1 `'~ Peye ~ of
NAME OF OFFICEHOLDER~O/R CANDIDATE /~ /'
l~U 1 li.tr ~ L ~Q ~ / ~~-c7 r ( ! 1"Z,/ [~cv-•e .
list each contribution and independent expenditure of f 10G or more made from the officeholder or candidate's personal funds to support or oppose
other officeholder:, candidates and committees.
DATE
NAME OF OFFICEHOLDER, CANDIDATE, COMMITI :E, OR MEASURE CHECK ONE
Support O IND.
Exp•
AMOUNT CUMULATIVE TO DATE
CALENDAR YEAR
IAN
1 • DEC
31 CUMULATIVE TO DATE
OTHER
IF APPLICABLE
.
.
•See revere rcyardiny independent expenditures. SUBTOTAL S
ALLOCATION -PARTII SUMMARY
Attach additional information on appropriately labeled continuation sheets.
1. Contributions and independent expenditures of S 100 or m ~~re made this period from personal funds.
(Include all Allocation Page -Part II subtotals.) ........... s
.....................................................................
2. Contributions and independent expenditures under;100 r jade this period from personal funds.
(Do not itemise.) ............................................
............... ..................... S
3. Total contributions and independent expenditures made t' is period from personal funds.
(Do not carry this total to the Summary Page.) ............. .............................................. TOTAL S
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMNIITTE k
Contributions Received
1. Monetary Contributions ............................... :.-heduk a, tine 3
2. Loans Received ......................................... chedule a, Une ~
SUBTOTAL CASH CONTRIBUTIONS ...................... Add un.s t + s
4. Non-monetary Contributions ......................... ~ cheduk C, Une 3
S. SUBTOTAL CONTRIBUTIONS (Exciadie Enfbncta6le Promists)
6. Enforceable Promises
(ExEiude Loan Gwr~ntet:, Une /d below) .................. .
7. TOTAL CONTRIBUTIONS RECEIVED .....................
Ex enditures Made
Add Unes 3 + 1
heduN D, Une 7
AddUnesS + 6
Type or print In Ink.
Amounts a+ay be rounded
to whole dollars.
j(~(.~) C i /l
Statement cover(s~pe]riod
from I ' (~ ~ 1 1
through Z ' ~ ~ ~ ~~
TOTAL THIS RI000
FROM ATTACHED fOtEDUIES)
s Z3Dc.j aw
~~~
s ~- 3c,~y
I ~ ~ °"
S Z. ~ ~~ 9
s Z~18`( ~-~
Column B•
iOTAI MIEVNNIS rEI110D
(SEE NOTE ~EIOVIQ
s Z 5 D ~`=
s ZS D""
'~ 30''v
DO
: S 8~ ~-
s SR c;°`'
SUMMARY PAGE
Page ~ of
I.D. NUMBER
Column C
TOTAL TO DATE
(ADD COLUMNS A • !)
s ZS".S ~/ ~-~
s ~ S ~ j 9~
~ ~lS ~<~
(.~
`~ `i
s 3oG2
P
8. Cash Payments (Other than Loans Made)
............ chedult E, Urrt s
f 1 C~ ~ 7 3H z
s z~ t( ~ s ~ Z ~ ~ ~ 3
9. Loans Made ................................ ............. ~ s heElsrlle H, une ~ ~ ~" (h'
10. SUBTOTAL CASH PAYMENTS ............ .............:.. Addunesa + 9 t l U 77 3<~ s 2.D~( Zy s / Z ~( 63
11. Accrued Expenses (Unpaid Bills) ......... ............... cheduM F, une S ~ ~ `"~ rv _
12. TOTAL EXPENDITURES MADE . ............ ............. i ad UrTes to + t f f ~ S ~ l • ~ ~ f ~~~ s / 7 ~ 6 s -
rent Cash Statement 1
Be~inninq Cash Bslance .................. Prtvlous sumr ,ry Page, Une /7 s 'Z S
~
• `~ •• From previous Statement Summary Pege, Cdumn C. However, i1
..............................
14. Cesh Receipts
...
..... Colun .I A, Une 3 about ~
/
23 ~ 1 ~ ~( this is the first report filed for the calendar year, Column a should be
bl k f
1 S. Miscellaneous Increases to Cash ........................ `:chedlule ~ une ~ O~
16. Cash Payments .................................... column ~, tlrre ro above l 0 ~17 , 3 y
17. ENDING CASH BALANCE ..... Addtlnes r3 + re + rs, tlTe subtract Une 16 S f ~~6 , 2 3
M this b • terminadon statement, Une I7 opal be zero. ENaNC usH sAEANCE sHOUED
NOT aE A NEGATIVE AMOUIrT
18. LOAN GUARANTEES RECEIVED .............. Schedule s, ' 4rt ~ column (b) s
Cash Equ6dabenta and ®utstandin~ ®ebts
19. Cash Equlvalen4 .... ............ .............. Ste IrvvT -tlorTS on rtwnt S
an t~cept or Losns Received (Line 2), Enlorceeble Promises (Line
6), Loans Made (line 91. end Aurued E>tpenses (Line 11).
Summary for Candidates in Both tune and
November Elections
21. ~ontEibLltions
ecelve ... s
1l1 through 6130 7i1 to Date
22. €-xpenditures
MAde ...... s
20. Outstanding Debts ................. AddtMrtl . tlrre ltl~ ~olumntabove S
r '
Sch ed u le A Type or print In Ink.
Amounts maybe rounded
Monetary Contributions Received to wholedoller:.
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTf ~,
c 1 ~ -~or ~ ! ~ un~. /
FULL NAME AND ADDRESS OF CONTRIBs ~O OCCUPATION AND EMPLOYER
DATE (K+ COMMITTEE, III ADOrt10N TO COMMITTEI'S NAME AND ADDIIE ~ . ENTf111.0. NUMeEl1 pF SEII•[M7lOYED, EMfll
RECEIVED Oil Sf MO1.0. MUM~EII IIAS BEEN ASSIGNED, ENTEII i11EASUlIt~'S ~ ' ME AND ADDIIESS) NAME Of BUSINESS)
Statement covers period
from ~'~7" K~
through Z r (~ - K
SCHEDULE A
Page ~ of Z /
I.O. NUMBER
AMOUNT CU~MAULATIVE TO DATE CUMULATIVE TO DATE
RECPEREOD HIS (lAN ND DEC. 31) (IF APPLICABLE)
air.-~y ~~~k~~.~ ~~.,~:wt ~,~P„~ /` ~ ~~~~,~
~~~1 ~1~ 7o Z t~J~.cl.~~ fe;~ Dr,. Mi s~..~ ~aw~o,-~~ I~~P;~. `7 ~~
C lUre.,,~,,, ~~ <<, g c 7 c ~
R lz ~,.~ oX ~ee r ~
C' (wr,,~ o n lj ~~, Q/ 7/ /
C~~~p~.i~, Pr~~,~,,,,,~,-
~13U~~~~ /'~ S 7 ~w~c~o r S F / 0~ o,~ ~~L ~',
/ ~~~ ~_i d~,.~,,. ~~ << 9/ 706 P Pe ~
Jatin ~ ~OSe~.IU,,re l,,.J, ll~hlti ~ ~,s~~~ ~<~
113o%y .3~ o . ~ o~~
G ~ (/c -.-~.e. ~ <~. ~/ 7J O lie ~~~c r . ~-~ ~•. L'~ ~~
SUBTOTAL S
Monetary Contributions Summary
1. Amount received this period - contributions of S 100 or ~ yore. ~ pv
(Include all Schedule A subtotals.) .......................... ...................................................................... s r' ~ y(~
2. Amount received this period - contributions of less than ~ 100. ~~
(Do not itemize.) .............................................. ..................................................................... s ~U~
3. Total monetary contributions received this period. ~ ~ ~ ~i
(Add Lines 1 and 2. Enter here and on the Summary Page. Column A, Line 1.) ......................................... TOTAL f ~ /
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTE
~- ~. r C~
DATE
RECEIVED full NAME AND ADDRESS OF CONTRIBU
MCq'AMRTEE,INADDRN7Mi000MMITTE['SNAMEANDADDIIES°
Oq q NO I.D. NUM~EII IIAS LIEN ASSNiNED, ENTEII i11EASUAEII'S N'
^,
!moo b ¢r ~ a 12o b V rc Cti9~ ~ c~,wl-~P
~a~~y ~a ~o ,~~~ ~,=.
~1~~~.~ ~ l4 ~i~//
~ ~30~~4 ~ ~ ~~ ~~~. ~.- bw~ I ~ ~
Type or print In Ink.
Amounts msy be rounded
to whole dollars.
~/
~L/ ~unf/
SCHEDULE A (cont.)
Statement covers
from (~ 1~?~ ` "/GG (
through ~ - ~ > ~ "1 Pew . (~ o} Z
I.D. NUMBER
OR
`.NTERI.D.NUM~ER
AE ANDADDIIESS) OCCUPATION AND EMPLOYER
(liSEli•EMKOYED.ENTER
NAME q BUSINESS) AMOUNT
RECEIVED THIS
PERIOD CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31) CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
~..C.ln,c r
~u,~,u.,,.~.~,~.,q ~, .s ~. o i~
10~ ~
~ Q(~~~
~-tL.-G ~,c i
c~~~~~~. s. ~
lDo ~
m~
~~~
,SUBTOTAL s Zy~~J
' Schedule B - Part I Type orprlntlnlnk. SCHEDULE B -Part I
Loans Received Aril°~nts may be rDUnded Statement covers period
to whole dollar.
G
from ~' (7~ ~7
SEE INSTRUCTIONS ON REVER
E 2~ (~ ~~~
~
S through
Pege
of
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMIT-
E
. I.D. NUMBE R
DATE
RECEIVED LENDER OR GUARANTOR'S FULL NAME AND ADI ftESS
IEf COMMRTEl, INTER r1Al NAM[, ADOII[fS AND I.O. NUMBER. NO I.D. LENDER /GUARANTOR'S
OCCUTATION AND [MftOT[R
S TEN DER INFORMATI ON GUARANTOR I NFORMATION
MUM~[R /Mf tt[NASSNiNID, ENTER M TA[ASUQII'f NAM[ ANt 4ppt[ff) [li•
M
EMPIOYED,lN1ER BUSINESS NAME I
DUE DATE/
AMOUNT
CUMUtATNt
A
MOUNT
CUMUtATN[
INTERESiMIE OrIOAN IODATE GUAMNfE[D 10 DAI[
DUE DATE CAl[NDAR TEAR UIENDAt rEAR
f
INTEREST MTE S
OTNER OIHIR
^ Lender ^ Guatrentor ~
x
~
s
DUE GATE CAItMDAR YEAR
CALENDAR r[AR
INTEIIESi MTE f S
OTN[R O1N[R
^ lender ^ Guarantor ~
w s
s
OUE DATE Gl[NOAR YEAR
CALENDARrEAR
MiTEIIEfT MTE
f
f
OTHER ~ DTNTR
^ lender ^ Gwrentor ~
K
s s
'See important instructions on reverse. SUBTOTAL i trl S ~~ E""' jD' °"
fumm~ry hQe,
ns Received - Part I Summary lIM It OnIE.
1. loans of S 100 or more received this period. (Include all I. -ans Received - Part I (a) subtotals.) . ......... S
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 6100 or more repaid, forgiven, or paid by a thin party this period. (Include all Part II (c)
subtotals. If forgiven or paid by a third party, also itemia the transaction on Schedule A.) ..... ......... S
5. Loans under 5100 repaid, forgiven, or paid by a third par' ~a. (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 I ~riod. ........
(Add lines 4 + 5.) .................................. ..........
.......... TOTAL S ~ )
...............
7. Net change this period. (Subtract Line 6 from Line 3.) .
Enter the net here and on the Summary Page, Column A. ne 2. ... NET s _
Schedule B - Part I (Continuation Sheet)
Loans Received
Type or print In Ink.
Amounts maybe rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTf
DATE LENDER OR GUARANTOR'S FULL NAME AND ADDR SS LENDER /GUARANTOR'S
RECEIVED M COMMRTEE. INTER FUII NAME, ADDetfS Ala) I.D. NUMaER. IF O I.D. OCCU-ATION AND EMPIOr[R (Ir SEIf
NUMa[a MAS aE[N ASSIGIIID, IMTtR TNt TaEASURER'S NAME AMD P CRESS) EMROYED, ENTER aUSIMESS NAMf )
•
^
Lender
^
Guarantor•
^ Under ^ Gwrantor e
^ Lender ^ Guarantors
•
^
lender
^
Guarantore
^ Lender ^ Guarantor •
•See important instructions on reverse o/page i o/ Sc edule B, Part 1.
SCHEDULE B - Part I (cont.)
Statement covers peCr~io/,d
from ~ ~ I ~ ~ 1
through ~~ ~~ . I I page ~ of ~~
I.D. NUMBER
LENDER INFORMATION
DUE OAiE/ AMOUNT - CUMULATIVE
IMERESi MTE Or IOAN TOOATE
OUF DATE CALENDAR 11[AR
s
INTEREST MTE
OTHER
x ~
DUE DATE CALENDAR YEAR
f
INT[RIST MTE
OTHER
% t
DUE DATE CALENDAR Y[AR
s
IrrtEREST MTE
OTHER
x t
DUE DATE CAl[NDAR YEAH
S
INTERIfi MTE
OTHER
x t
OUf DATE CAIE NDAR r l AR
S
INTEREST MTE
OTHER
w s
SUBTOTAL S
,~
GUARANTOR INFORMATION
AMOUNT CUMUlA1NE
GUAMNi[ED iODATF
CALENDAR YEAR
s
OTHER
t
CALENDAR r[AR
1
OTHER
s
CALENDAR YEAR
s
OTHER
s
CALENDAR YEAR
S
DTH(R
t
CAl[NDAR rEA~
S
OIHIR
~s
s ~) Tn~e, rol On
Summ~iy P~y~.
line Id only
Schedule B -Part II Type orprlntinink. SCHEDULE 8 -Part II
amounts may tre rounded
Repayments Made on Loans Received, Loa Is towhot.dotlan.
Forgiven, and Loans Repaid by a Third Park ~
SEE INSTRUCTIONS ON REVERSE Statement covers period
from (-I ?~~~~(
through ~ ~ ~~ ~yr
~
Pepe ~ ~ ~~
NAME OFOFfICEHOIDERORCANDIDATEANDCONTROLIEDCOMMITTEE /
G-, ~ ~ ~ ~G ~ fl / / I.D.NUMBER
DATE OF
REPAYMENT
OR
FORGIVENESS
DATE OF
ORIGINAL LOAN
fULLNAMEOfIEM 'ER
INTEREST
RATE
Ur arArwEO)
AMOUNT REPAID OR *
FORGIVEN ON PRINCIPAL
(EKCWDE ~AVMEM Or INIERESn
OUTSTANDING
PRINCIPAL
INTEREST
PAID
Attach additional infformation on appropriately labeled co- (inuation sheets. SUBTOTAL S 1c) TOTAL INTEREST
PAID TNIS PERIOD 1d1
S
•IA~IPOATANT: Nary-part of • loan K ffw~piwn or repaid by a 4hird party, also itemize the transaction on Schedule A,
Including the narrK and address of the parwn /orgiving the -an or the third party making the payment, and the amount
lorgiven or paid. Enter the amountlnco~umn (d) in the
summary section of Schedule E, L free 3 Do
not carry thH total to the summary secnon of
schedule e.
Schedule B -Part III
Annual Report of Outstanding Loans Rec
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITT~
Attach additional in/ormation on appropriately labeled cor
Type or print in Ink.
NOTE: Thls total should be
the same amount as entered
on the Summary Paye,
Column C, L Ine 2.
SCHEDULE B -Part III
t
S[fledUie C Typewprtnttnlnk. SCHEDULE C
Amounts mey be rounded
Non-Monetary Contributions: Received towhotedou,r,. Statement covers period
/,
1 ' ~ ~ ' ~'7
from
SEE INSTRUCTIONS ON REVERSE through ~ • 1 ~ ~~ ~~ Pape ~ of 2
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER
'
•/
~~
~
u ~
~
GATE
RECEIVED ,
FUII NAME AND ADDRESS OF CONTRIBUTOR
prCOMM(TTEE.INADDRIOMTOCOMMfRE!'SNAMEANpADt111ESS, OCCUPATION AND EMPLOYER
11rsEEr•[MilortD,ENTERNAMEOr
DESCRIPTION OF
FAIR MARKET CUMULATIVE TO
NDAR
CUMUTATIVE TO
DATE OTHER
[NTE111.[1,NUM~ERDR.urN)1.D.NUM~ERNASetENASSIGNEO,
' ~us1N[fSl GOODS OR SERVICES VALUE CALE
YEAR
(JAN
1 •DEC
31) (IF APPLICABLE)
ENTER TREASURER
S NAM[ AND ADDRESS) .
.
=
o~~y ~s~ ~~ .
3~,Tc~ Su:~ J~
~ ~
I ~ J
~ Z~
l_.ii11 ~.o `~ 17l U (
~ ll~d-t;%~r~ ~~. %bl~ Cl~,. ~,
Attach additional information on appropriately labeled cor ~inuation sheets. SUBTOTAL s
Non-Monetary Contributions Summary
1. Amount received this period- non-monetary contributio +s of 5100 or more. ~~,
(Include all Schedule C subtotals.) ........................... ....................................................... S _ ~ Z.S -
2. Amount received this period -non-monetary contributio s of less than S 100. ~~
(Do not itemize.) ............................................... ...................................................... s ~ ~ U
3. Total non-monetary contributions received this period. ~~ f0 ~- `~='
(Add lines 1 and 2. Enter here and on the Summary Page, :olumn A, line 4.) ........................ TOTAL S I
Schedule D type orprlntlnlnk. SCHEDULE D
• Amounts maybe rounded
Enforceable Promises Received (Other tha n Loan to whole dollars.
Guarantees, Loan Endorsements, and Loa ~ Security Statement covers period
tram (-t7~~?~9
NOTE: Loan guarantees, loan endorsements and loan secu +ty are "enforceable promises' that must
be reported on Schedule 8 - NOT Schedule D. SEE INSTRUCTIr. NS ON REVERSE throw h Z'~ ~ ' 7 7
9 i Z. Z~
Pape or
NAME OF OfFICEHOLDER OR CANDIDATE AND CONTR'OLIILED COMMITTE / ` /`
~.C~c~ ~ C.O /~' C~^s / I.D. NUMBER
• DATE
RECEIVED FULL NAME AND ADDRESS OF CONTRIBUTOR
(1i CDMMRTEI,MADOEENINTOCEMNMnT[['>•NAMIANDADDIIES!
[NTEAI.D.NUMaEA01~ON01.D.NUMe[AMASeEENASSIfiNED,
tIR[A TQASl111EA'f MANE AND ADDAEfS) OCCUPATION AND EMPLOYER
~ulr-EMrIUSINISf~E~NAMEOF
AMOUNT PROMISED
THtSPERIOD AMOUNT PAID
THIS PERIOD
(ALfOENTEIION
tCHEDUIE A) CUMULATIVE TO DATE
CALENDAR YEAR
(lAN.1-DEC.31) CUMULATIVE TO
DATE OTHER
(IF APPLICABLE)
ach additional information on appropriately labeled cc ltinuation SUBTOTALS f
s eats.
Enforceable Promises Received Summary
1. Promises received off 100 or more this period (Column (a
2. Promises received under 6100 this period.
(Do notitemi:e.) ..................................
3. Total promises received this period.
(Add Lines 1 and 2.) ............................... .
...................... s
.........................s
................ TOTAL s
4. Payments received on promises of S 100 or more this perk =1.
(Column(b)) . ..................... ................ ............................................s
5. Payments received on promises under:100 this period.
(Do not itemize. Also Include on Schedule A Summary, lr •e 2.) ...................................... S
6. Total payments received.
(Add Lines 4 and 5.) ................................ . ................................... TOTAL s ~ )
7. Net change this period. (Subtract Line 6 from Line 3. Ent r the difference here and on
the Summary Page, Column A, line 6.) ............... .....................................NET s
Mey be ~ neq•tlve number
Schedule E
'Payments and Contributions
(Other Than loans) Made
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts maybe rounded
to whole dollars.
NAME OF OF,F/~IC~EHOLDER( O_ R C~ AND(I'DATE A/N~D CONTROL/LED COMMITTEE
1 v ~ lJ~( ~ vck-t `tom ~ l ~ ~~ [ 4'-(,c/~ C ! ,
CC DES FOR CLASSIFYING EXPENDITURES
I.D. NUMBER
If one of the following codes accurately describes the expe ~diture, you may enter the code and leave the "Description of Payment' column blank. Refer to the
back ofSchedule E-Continuation Sheet for detailed explan ~tions of each category.
'C' - MONETARY AND IN-KIND (NON-MONETARY) •B' - BROA "CAST ADVERTISING ~G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES
AND COMMITTEES •N' -
•O' - NEVIrS 'APER AND PERIODICAL ADVERTISING
OUTS' ?E ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS ANO MEALS
(HUSTLE DESCRIlED)
•I' - INDEPENbENT EXPENDITURES 'S' - SURVi rS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS ~P' - PROFESSIONAL MANAGEMENT AND CONSULTING
'L' - LITERATURE •F' - FUND' 4151NG EVENTS SERVICES
NAME AND ADDRESS Of PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBU ON
IM CDYMRTtl, w ADDrrN111 TO CDMMrtT[Cf NAM[ AND ADOIIESf, lrfr[II1.0. NUMeEII Oil' NO I.D.
Nuwta -IAS MtN Asslcwo, trrrea retwsuaaY NAwt AND ADOetss)
DESCRIPTION Of PAYMENT
AMOUNT PAID
~~o~~ a~~.: ~~ ~o z ~ ~
Lc. To ~ tCC c.. n
JC~r~c~ ~~ ~~~ /'~. r rti
3Z , ~~~5~ r ;~~
u~s~. , C~. 9i ~o Z
-lA
cc
v/I ~ C C k li ~Doc~( 4 13 r./c . ~~ r i~ ~
i
Jc-
•
.
.
L n/1 ~ 3 SY, .
lv~~,~ct~~~ , C~. ~(7 ~3
Impo-tant: Contributions and expenditures made out o/car lpaign funds to or on behall o/other
officeholder:, candidates, committees, or ballot measures n: ~rst also be entered on the Allocation Page, Part 1. SUBTOTAL S
s ~~ ~ G~
Paymentsand Contributions Made Summary 1 f 6 ~-
I. Payments made this period of:100 or more. (Include all Sr ~edule E subtotals.) ....... ........... .............. S 7 3 D .~3~
2. Payments made this period of under S 100. (Do not itemize 1 ......................................................... .............. s 3 ~/ ~~ ~? ~
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. s rater amount from Schedule F, Line 4.) ....................... .............. s1~~~~ ~'
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 ~~__
Statement cover/s~period
from ~ - ~ 7~'r
SCHEDULE E
through ~" ~ ~ ~ ~ % I Page -~ ar
IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
REPORT ONLY THE LUMP SUM Of SUCH PAYMENTS ON LINE 1 OF THE SUMMARY SECTION BELOW.
'Schedule E
(Continuation Sheet)
Payments and Contributions
(Other Than Loans) Made
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Home yr vrn~env~ven uN ~AIYDIDA7E AND C/O~NTROLLED C/O~MMITTEE
//4 LCD C l_et.,~ ~ Le ~ ~~ _ ,
COE
Statement covers period
from ('~1 ~/~
through ~ "~ ~~ ~~
FOR CLASSIFYING EXPENDITURES
'C' - MONETARY AND IN-KIND (NON-MONETARY) •B' - BROA CAST ADVERTISING
CONTRIBUTIONS TO OTHER CANDIDATES 'N' - NEWS APER AND PERIODICAL ADVERTISING
AND COMMITTEES 'O' - OUTS 'E ADVERTISING
- INDEPENDENT EXPENDITURES 'S' - SURVI: 'S, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS
- LITERATURE 'F' - FUND+ <>ISING EVENTS
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUz
ar COMMRTtf, M ADOrt10N TO COMMII7EI'i NAM[ AND ADDRESS, tNTEa I.D. NUMaEa Oa. ~'
NllYa[a HAf BEEN ASSIGNED, ENTEa TAEAfU11EA'S NAI~fE ANO ADDIIEff)
M~..~` c~~ow cl S
4`~v A-~- 14e~~~ {4~.
~z~u :.~, Cam. - ~r / ? o Z
SCHEDULE E (cont.)
Page ' ~ of ~ /
LD. NUMBER ~
SUBTOTAL S ~ S-~ 7 r
- - - ~ ,'.
~ T-
'G' - GENERAL OPERATIONS ANDOVERHEAD
'T' - TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIlED)
'P' - PROFESSIONAL MANAGEMENT AND CONSULTING ~
SERVICES
t,
Schedule F
Accrued Expenses (Unpaid Bills)
Type or print In Ink.
Amount: maybe rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COM/M'ITTE
~ ODES FOR CLASSIFYING EXPENDITURES
If one of the following codes accurately describes the expo nditure, you may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explal ations of each category.
MONETARYANDIN-KIND(NON-MONETARY) •B' - BRO< iaCASTADVERTISING 'G' - GENERAL OPERATIONS AND OVERHEAD
CONTRIBUTIONS TO OTHER CANDIDATES •N' - NEW` °APER AND PERIODICAL ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
AND COMMITTEES 'O' - OUTS DE ADVERTISING (MUST 0E DESCRIBED)
'I' - INDEPENDENT EXPENDITURES 'S' - SURV :YS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS P' - PROFESSIONAL MANAGEMENT AND CONSULTING
'L' - LITERATURE 'F' - FUN[:-tAISINGEVENTS
SERVICES
NAME AND ADDRESS Of PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBI TION IYhDaTANr: DO NDT REMIZE THE ~A~YEIIT Or ACCRUED EIt~ENSES ON SCHEDUIEf E OII E. AE-OIIt ONIr THI IUM~ SUM Or rArMENif
Qt CDMYnIEE. M ADDRION TO CEIMMITTEE'f NAY[ AMD AOOIII><t, ENTEII1.p. NUMaEA 0r ff NO I.D. ON fCHEDUIE r, LE1N 1 AND ON SCHEDULE l.lalE ~. 00 N01 IIE-nEMIZE ACCRUED Ex-ENSES REPOIITED IN A PI1EV10US -EAIOD.
NUMaIII HAS a[[N ASSIGNED, [NTEII iAEASURII'S NAYE AND ADDIIESSI _ CODE OR DESCRIPTION OF OUTSTANDING PAYMENT AMOUNT ACCRUE D
C l~ew.dn ~ I v
Attach additional in/ormation on appropriately labeled con inuation sheets. SUB rOTAI s
Accrued Expenses Summary
1. AccruRd expenses this period of S 100 or more. (Include al Schedule F subtotals.) ..................................................... S ~/1'~~• TO
2. Accrued expenses this period of under S 100. (Do not item xe.) ..................................................................... S l/~
3. Total accrued expenses incurred this period. (Add Lines 1 end 2.) ................................................. INCURRED TOTAL s ~/~~/•.Tv
4. Total accrued expenses paid this period. (Do not itemize. ~~nter here and on Schedule E Summary, Line 4.) ................. PAID TOTAL S ~ _ ~
S. Net change this period. (Subtract Line 4 from Line 3. Entc the difference here and on the Summary Page, Column A, Line 11.) ...... NET S
Statement covers period
from f ~~ 7- ~~
SCHEDULE F
through ~'~ ~~ `7 ~ I Page ~ of Z
I.D. NUMBER
Mir M ~ nr~.i~.. n,,.nM~
Schedule G
'Payments Made by an Agent or Independ ant
Contractor (on Behalf of an Officeholder ~: ~r
Candidate)
SEE INSTRUCTIONS ON REVERSE
Type w print fn Ink.
Amounts maybe rounded
to whole dollar.
Statement covers period
from ~ ~ ~ 7 ~~7~~(,
through 2 ' ~J ~ 7
SCHEDULE G
Page ~_ of ~_I__-
NAME OF OFFICEHOLDER OR 1CnAnND.IDA'TE AND CONTR~O`LLED CO/MMI/TTE I.D. NUMBER
NAME Of AGENT OR INDEPENDENT CONTRACT R
_ODES FOR CLASSIFYING EXPENDITURES
If one of the following codes accurately describes the expo ~~diture, you may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explal ations of each category.
• 'L' - LITERATURE
'B' - BROADCAST ADVERTISING
'N' - NEWSPAPER AND PERIODICAL ADVERTISINC-
'O' - OUTSIDE ADVERTISING
NAME AND ADDRESS OF PAYEE OR CREDITOR
(If CDMMn7EE, Nr ADDITION i0 CENiMn7tCS NAM[ AND ADDIIESf, ENT[R I.D. NUN '
NO I.D. NUMtEa HAS aEEN AfSIf.NED, ENTEII TAEASWIEII'f NAME AND ADDRI
•
Attach additional information on appropriately labeled con inua'ion sheets. TOTAL• S
~DorwttrarohrtoanyotMrschel>wAortotheSummaryoage. TAlstota~ -IavnoteoualtheamountDaldtothsaoentorindPDendentrontrarrnr,~.one.re.l....c,tiva„~.cti„~tie,.iir,.,-.,,~,+,..~,.,,a;a„e
'S' - SURVEYS, SIGNATURE GATHERING,DOOR-TO-DOORSOLICITATIONS
'F' - FUNDRAISING EVENTS
'T' - TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIBED)
Schedule H - Part I Type orprlntlnlnk. SCHEDULE H -Part I
~~~VY~~\) ~f~0' ue ~YYf10lO
oans a e O erS to wholedollart. Statement covers
period
'7
from ~' ~ l '~`7
SEE INSTRUCTIONS ON REVERSE through - G y ~/ ~~ ~ Page ~~ of C./'
NAME OF OFfICEHOLOER OR CANDIDATE AND CONTROLLED COMMITTE ~ I.D. NUMBER
~~ -~~ CCU
DATE OF LOAN FULL NAME ANO ADDRE ` :~ OF RECIVIENT
to cOMMmtE, aY ADDITION iOCOMMm[E'f N/ sE AND ADDRESS, [NrEl1I.D. NUMaEII
INTEREST RATE
DUE DATE
AMOUNT
OA, M NOI.D. NUMaEII HAS aEEN ASSIGNED, ENTI ' TIIEASUIlI11'S NAME AND ADDIIESS)
•
SUBTOTAL s
~ns Made to Others -Part I Summary
1. Loans of S 100 or more made this period.
(Include all Loans Made - Part I subtotals.) ........... ....................... ...................... . f
2. Loans under S 100 made this period.
(Do notitemize.) ... .......................... ................................................ S
3. Total loans made this period.
(Add Lines 1 and 2.) ................................. ........................................ TOTAL s `/~,
Loans Repayments Received - Part II Summary
4. Payments received on loans of S 100 or more. (Include all ',an payments received and all loans of S 100 or more
which have been forgiven by this officeholder, candidate, or committee -Part II (a) subtotals.
If forgiven, also itemize on Schedule E.) ............... ............................................... .
S. Payments received on loans under f 100.
(Including a forgiveness. Do not itemize.) ............. ............................................... .
6. Total loan payments received this period.
(Add Lines 4 and S.) .... ........................................ TOTAL
7. Net change this period. (Subtract Line 6 from Line 3.
Enter the net here and on the Summary Page, Column A, I ne 9.) .................................... NET
i
S~ ~
Schedule H -Part I
Loans Made to Others
(Continuation Sheet)
NAME OF OFfICEHOIDER OR CANDIDATE AND CONTROLLED COMMITTEE
Type or prlM in Ink.
SCHEDULE H - Pari I (cont.)
SUBTOTAL S
~~~
Schedule H -Part II Type orprlntinink. SCHEDULE H-Partll
Loan Re a ments Received on Loans Mad ""'°""" ""' °` `°""°'°
P ~ to whole dollars.
to Others Including Payments Received
from Third Parties) and loans Forgiven
SEE INSTRUCTIONS ON REVERSE
Statement covers period
/rom ~ _~~ ~y
G
through 2 ~ (~ ~ ~ 7 Pape ~~ of Z
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D: NUMBER
DATE OF
REPAYMENT OR
FORGIVENESS DATE OF
ORIGINAL
LOAN
FULL NAME OF RF.:IPIENT OF LOAN INTEREST
RATE
Ilr CHANGED) AMOUNT REPAID OR
FORGIVEN ON PRINCIPAL'
(E>tCIUDE RECEI-r OF INTEREST)
OUTSTANDING
PRINCIPAL
INTEREST
RECEIVED
i
•
~
Attach additional information on appropriately labeled cl Ttinuation sheets. SUBTOTAL s TOTAL INTEREST Ie)
S
RECEIVED THIS PERIOD
'IMPORTANT: If an art of a loan is for iven, also itemize -'-e for iveness on Schedule E. If a re a ment is received from a
y p 9 9 p y
third party, !ntlr th! name and addrrss Of thud party IA the FULL NAME OF RECIPIENT OF LOAN' column above, along Wl th the
nam! O/ th! Ilc/pllflf O/ th! loan. Enter the amount In column (b) In the
summary sectlon of Schedule 1, Line 3. Do
not terry this total to the summary section
o/Schedule H.
Schedule H -Part III
Annual Report of Outstanding
SEE INSTRUCTIONSON REVERSE
NAME OF OFfICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Type or print In Ink.
NOTE: Thls total shouts be
the same amount as entered
on the Summary P~ye,
Column C, Llne 9.
SCHEDULE H -Part III
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Type a pant In Ink.
SCHEDULE I
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 ~ thers. (Schedule H, Part II (b).) .................... 3
4. Total miscellaneous increases to cash this period. (Add Lir ~s 1, 2, and 3. Enter here and on thg
Summary Paye, Line 1 S.) ............................. .......................................... TOTAL s
Attach additional information on appropriately labeled ~ ~ntinuation sheets. ~ SUBTOTAL s