William Childers - 1975/01/21 - 1975/02/20
-
..".~,:",:~
<"-."',' -~:.~
'~~j
F':'Hn1 :120
__~~/~~_~#.LZ>BP.s
"..jA;\.~i-~ OF C()M\~ITTEE
___/J? /-'_"'€~ $/' _.
ADDRE:~5 OF CO~'.~~",~ITTEE
(Itltcrim Fonn)
COMMiTTEE
CAMPAIG~~ STATEMENT
':':";'ORNMErn' CODE SECTION 84200-8.1214)
S:ate:i:ert c:vers period frorn~~~thrOUgh~~;?~
Q~,pA'/LV
r
c;;;-/~ y ~
(cfry)
~-_:
J
I,D. NUMaEn
~.J>-
J>-f"2 -00l.y?
:r~-P.?O
(S TAT E 1
{NO. AND 5TH:::::~-
(ZIP CODE)
(AREA CODE)
(PHOt'.!E NO.,
_4~._~ .#~.L/4RC>/
t'J..\t<.1E OF r RCASUR E i-":(
?:_-2J?st)__~/kR .-4t/~- .-
Q~y ?4
5:. STREET)' (CITY) (STATE)
J:;,;e... ~4;e~,,- ~ '
--' +,Oc:P ~ }?.y.::?-.:2 ~~L-
(At~E.A CODE) (PHONE NO.'
1~4P 6.p~ - .:2~<P/
.9.;."7:>20
3
3D A':~/L",c..t!>
HESIC:ENTIA~ t,D;')hESS OF TREASURER {NO.
..4 V"~L-
(ZIP CODE)
BUSINESS A:")~;r'iES5 OF TREASURER (NO. &. STREET) (CITY) (STATE)
i1:jUNEl Q.:.~NE2 DUNE3 DOTHER
CHECK c;;;;;ZR MAiLING AODR="'r';?;h~P.o.
-;~F ELECTiON (PRIMARY, CEr>JERAL, SPEC!AL\ DATE.OF ELECTION ,MONTH
(ZIP CODE)
(AF-~EA CODE)
(PHONE ~O.)
B,!."<). City, scar and ZiP~_
DAY, YEAR) TOfAL PAGES OFFICIAL U~;E ONLY
lt~tlf ur .."............-0. _
l\LLOCATION OF EXPENDITURES BY CANDIDATES AND MEASURES
(A.llocate the totals of Schedules E and F by Candidates and Measures; Amounts may be rounded off to whole dollars)
OFFICIAL
USE or'H_ Y
NAME 0
ME
&/~4-!:1_
==--j --~-
- - ,_.-
F CANDIDATE AND OFFICE; N(,ME OF BALLOT CHECK AMOUNT OF CUMULATIVE
EXPENDI TU RES
(,sum: AND BI-\LLOT NUMBEFl OR LETTER ONE THIS PERIOD TO DATE
.-
C /f/)' L' l> ER> [~SLJ PPOR T ~.::.s- ~c5~'/3
, ~ OPPOSt~
L.':'
r, SUt:"PORT
r-.: OPf--:JOSE
L
- ~- ~- .---..
[1 SUPPORT
.,
r-J OPPOSE
- -
0 suppon;
-- OPPosE
'--.'
--, --.
[-':J supponT
,-, OPPOSE~
, -,
-- --..-....-.-.
r--1 SUPPOHT
L_j
[-] OPPOSE
----. -
[J SUPPORT
CJ OPPOSE
.-
[:1 SUPPOr~T
r--l OPPOSE
[.,,1
-----.----. -- -_._._--
r::J SUPPOHT
[] OPFJOSE
-.
[J SUPPORT
[-' OF' POSE
.J ,
Attach additloo211 information on appropriately labeled continuation sheets.
VERIFICATION
I declare under penalty of perjury that to the best of my knowledge, this statement and its schedules are true,
correct and CQmpl8te and that I have used all reasonable diligence in their preparatio .
Executed on ~h~h., _,~_ at C?~~ by
f," T' (CITY A!' S,ATE)
C
D
E
A canclio'ate who cont::J''; a committee must also verify the campaign statement.
I declare undc';r pe:o., ",::' :;erjury that to the best of my knowledge this statement and its schedules are true"~
correct and comp!ek '~'." treasurer of this committee has used all reasonable diligence in the prepdratic~
of this statern::nt ?~ = :::; ':"~:;c~du!es.
I
I
1" I
I
I
._---------- j
t:.Y.ecuted ;:.(1 _______..______ at ________ by
.:. :C!:Y AND STATE)
--- 1 -
(5IGNATURE. OF CANDi~::'A.TEl
NO~;1~/t/l1 aL~.$
7;;Y52'U__.
/J SUMMARY PAGE
(' ~pte.~4/~~
,
..
1.0. :<;
(l{ C ,;:--:
COLUMN A
COLUMN 8
COLUMN C
Cumul ati ve
total from
previous period
This period
Cumulativ?-
to dat,?
RECE1vrs
,.
~
$ /61....? s: &19 $ 5?t:J" ~ $ /69~~
(Column A +
Column 8)
(Total at beginning (Net change (Tolal al end
of period) for period} of period}
(Column A +
,/l).;? s-: <?.5! S?G/. c?.J? ~lumn 8)
$ $ $ /675"2
(Column A +
Column B)
(Column A +
Column B)
{Tolal at beginning (Net change (Total at end
of period) for period} of period)
$ /&>,c.s; ~ $ _~ d~ $ /S9.5; ..~
.:::> ,,-
(Column A +
Column B)
$ /3 7~ $ 33~ 3$" $ 2c.Q/,3
(Column A +
Column B)
(Total at beginning (Net change (Totai at end
of period) for period} of period)
$ $ $ 35.:1.. /3
---
(Column A +
Column B)
1. ~,,1onetary contributions (Line 5, P2r! 3 of Schedule A)
2. Unpaid loans (Line 9, Part 3 of Scredule B)
3. Miscol :aneous receipts (attach explanation)
4. Total monetary contributions, Net cash receipts (Lines 1+2+3)
5. !-Jon-monetary contributions (Line 3 of Schedule C)
6. Pledges (Line 7 of Schedule D)
7. Total receipts (Lines 4+5+6)
EXPENDiTURES
8. Payments (Line 6, Part 3 of Schedule E)
9. Accrued expenses (unpaid bills) (Line 5 of Schedule F)
10. Total expenditures (Lines 8+9)
STATEMENT OF CHANGES IN FINANCIAL CONDITION
12. Cash receipts this period (Line 4, column B)
$ /cJ~S: C'O
37&,. dt)
,35.;?,,/3
L.:2 ~..:2 cf 7
11. Cash on hand at the beginning of this period
13. Cash payments this period (Line 8, column B)
14. Cash on hand at closing date (Lines 11+12-13)
15. Liabilities (U',-" 2, column C + Line 9, column C)
16. Surplus (if L ": '" is greater than Line is, subtract
Line 15 frc~ _ -" 14)
$ '/';'<9' -?- ~ 7
17. Defici: ("_ -c; ;:; is greater than Line 14, subtract
Line 1 ~ f- _~'\ :-. ,--.~ 15)
$ (
)
-2-
..
. /~..~.'!:: --.-------..---.----------------------..-..
_____I.D. NU:\'3EP. (If Committee)
(Interim F onn)
SCHEDULE A, FORM 420 or 430
MONETARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
PART 1 _. rlECEIVED FROM COWill TTEES: (See information manual for directions and examples)
~ DATE_L --------
FULL NAME AND AODR::SS OF COMMITTEE I.D. NUMBER OR TREASURER'S AMOUNT ClIMULA TI Vi:
(Street, City, ~tat~\ FULL NAME AND ADDRESS RECEIVED TO DATE
..
--
-- -
..
----.,
..
--- I --
~ .. -----" CONTINUATION
ATTACH ..o\..- C.'''J ~L INFORMATIO;~ Q,< ,:',::::::' :~'.: ";'';;J~~.";- EL Y LABELED SHEETS
SUBTOTAL ' ~ Nfth additional Subtotal s to line 1, part 3, page 4) S
l \....ar-ry
-3-
NAA1E ~/~~~
C~/dfR.r
a/P4/9'.--!- 1.0. i;.J\'8Erl (If ~mmittee) 77/ 6CJ<F1
SCHErfULE A, FORM 420 or 430
(continued)
PART 2 - nECEIVED FROM OTHERS: (See information manual for directions and examples)
FULL NAME AND ADDRESS (Street EMPLOYER (IF CONTRIBUTOR IS AMOUNT CUMULA 7;';;:
DATE , City, Slale) OF CONTRiBUTOR'" OCCUPATION SELF.EMPLOYED LIST STREET RECEIVED AMOUNT
ADDRESS & CITY OF BUSINESS)
,
----- 1----
#L- -
-
-- I---
,
..
--- t-
L
__l .
Attach additional information en appropriately labeled continuation sheets I
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
~he contribution was made by an intermediary provide the information for both the intermediary and the principal
L.?~ltri butor. .
PART 3 - SUMMARY OF MONETAP'- CONTRIBUTIONS (See information manual for directions and examples)
1. nECC-i ::: _ F''OM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. F~E(~:: :::".:. ;:;':2\1 COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3. REC;:-,:,::'-'= ==0';1 OTHERS THIS PERIOD (Part 2) Include all Subtotals
4. Fi:=:C::: .. =~..: =:::C'..~ OTHERS UNDER $50 THIS PERIOD (Not Itemized)
5. Te-:.. ','C'/:::'-\RY CONTRIBUTIONS THIS ?ERIOD (line 1 + 2 + 3 + 4,
E:o-o' '. 3 '.}r;}; en U;:8 :, Column B of SUc;-:ccf' Page)
$
s
- 4 -
N.:'M~
/v/!/~#f
~~-'9/t;) ~ 1.0. NUMBER (If Con'lTlittee}
SCKEDULE A, FORM 420 or 430
(continued)
C$LAEef'
PAnT 2 - RECEIVED FROM OTHERS: (See information manual.for directions and examples)
EMPLOYER (IF CONTRIBUTOR IS
SELF-EMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS)
~A_
~, L'e~/.s
c':" Co ~ 0 ~/~/
Fl'LL NAME AHO ADDRESS (Street
City, Sta,-) OF CONTFlIBUTOR*
OCCUPATION
,/8(I/~ ~-e
779/..? .0.A""t",-(./
~Q~Y' .,
:%/, --,.....
/?.3r
~-
/~s-a?/
AMOUNT
RECEIVED
J>
CUMULATIVE
AMOUNT
'Go.~ ~~_~6..
~ _010
c:::oo."o-
--~~~,....Z~_fZ. <~~..~~~~ ~:~o.
~/~l'
./?Q CA':R~/
~;;ti._o_....
76'1 tf.,. "7~
"...' '-' " ~ /A!I.'
;....'.:.
-.. ......--<....,,_..... -~.~.--_....~.,.._..~_..";;' ._-
Attacn additional information on appropriately labeled continuation Sheets
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
.;Jt:!J~GJ .
.~
L.s;~~__,
.
"---,- ~.. ~.. "-"~'-
5"",
/3'CJ~~
.:2 . t?'.~~ _0 ~_
fr4 ~__~
..
d~~
~. .
. -t!Jd
/.~- ~_._-~
, "f.
..
.,~ "~""'.,"'-' '~-'" ......-..--"""'4oi...,
J/: If the contribution was made by an irnermediary provide the information for both the intermediary and the principal
contributor.
PART 3 - SUMMARY OF MONETARY CON~.~IBUTIONS (See information manual for directions and exa'npJe~)
1. RECEIVED FROM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RECEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3. RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
- 4:. RECEIVED FAaA OTHERS UNDER $50 THIS PERIOD (Not Itemized)
5. TOTAL MONETARY~CONTRI8UTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line 1, Column 8 of Summary Page)
-4-
...:..... ..........~
'.
$ ,;'..n'" .:.-. _ :~
#'" c~-c::t('-..J, "_>~"<:.
c?2~~~__.:;'
$ /5r~~~
. -"~---'-'-"--'~ --, ~ -~..._.......,,__~.___1ItM..,..,.,
C~Lz;ER~' a..~/,4/~,A../' 1.0. NUMBER (If Co,rmittee)
SCHEDULE A, FORM 420 or 430
( continued)
r..'::, ~l::
''', ;1.
-"y.~dL6tt'4
....-. .... ........--.
.
r'..\.:P :.. R::':El\l~[) FROM OTHERS: (See infonnalion manual.for direcHons and e><amples)
i Fl'LL NAME AND ADDRESS (Street
r"~tE I City, State} OF CONTRIBUTOR*
___ _.-J
f:/! E~v~NO <'-I"
_ ~~3D -f"_",4 C~.
!
:f.,r-! ,ij",,,",y- #WNEA/
h5 I 02 ~'1k U$~
OCCUPATION
AY,R/cv/7t~
AVHBZ-/f'
cD.
~l h;,y ~:4rC#il-
- --i'
~~I ~;:7 7;;:~;P;;
~/T7i-A :r ~~#-
~y I d?79? ~cL-("'f) ;:1.ss
- ---j-' -, .
~/ ?7hi?- h~ a/~Er
/7f 7'79/C ~/k,. #VC:-
)1'/ I &..<L t:PA/~"';(//
/61 .:9cf' / ". Sr= ~~ r
-"1-
I/%:' i .E",p~S'rp,,?c:.e-
/.:M '
;if 17751'C ~..,d~'c
~/ I (""~"" I ~~"'D
/;z> 79~3 tuPEU 4t1c-
1S,//./ Z)/"uE ~.2~U
77$ K63~ E.X 4n::,~1!J~
E/pr.M;~
~~c'~
MR~/A;7
a/~~7
~h z:s r
rft a. Fe..-
AtHch ada~tionat intcrmation 00 aiir;ropriatelylabeled conti~uation sheets'
EMPLOVER (IF CONTRIBUTOR IS
SELF-EMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS}
33"'" ..,F. 9 ~~
C;"/~CJ
? :<'dC::> #""~A;Y~~
(7;. /...6/
, . -f/1/. ~,7f'",~
3?/
/:>/ Sr-
G;//tfb
'7 -"Y OCJd/ /
AMOUNT
RECEIVED
/62). ~
~a~
~a~
.I{'( ..sn ~
o?7?":7 PAe"~~&~ 5ZJ".d~.
_c;;,./J6y
'?79/C. A.I~//~~
C,/4
3<1'/ /Sr ,,7'-
C;~~
779/C- 0~~..c./
. G,/~
J
7'3.3 hR~ A.--'
Q~'
~9S- ~ .-4,,;f~
G;'/~
SlIBTOTAL (Carry with additional Subtotals to line 3, part 3) S
~
6ZJ,. ,~
~
Ot/,.$-
~~~
~~
~..~
.
?/ 7" t2 5!!Z.
CUMULATIVE
AMOUNT
6~.;...~
~~
~~ ttJ ~
~..:>~ ~a
T"f. T .::'
~~ ,,~
6 .,.~..
~ cd
o . .
~-z;-~
~a
tit)
-
~-~
~aoO
~
>i: If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
-'
"_ ~tl:'_: '~"""',\"f'."-,.._
PART 3 - SUMMARY OF MONETARY CONTRIBUTIONS (See information manual for directions and examples)
1. RECEIVED FROM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RECEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3, RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
4, RECEIVED FROM OTHEnS UNDEFl $50 THIS PEnlOD (Nolltemized)
5. TOTAL MONETARY CONTRIBUTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this totai on Line 1, Column 8 of Summary Page)
-4-
$
-2$'~:~O-
L/'~a ,",Ii:)
$ ~~;". .= ~"
:"'"""".""'",""=""',~
,-/ -
/ / ~ j/," ~.1 ~ :./, /
"'C.&LLde~ _~4 ~~~~
. . (lnleri For
SCHEDULE B, FORM 420 or 430
LOANS
ID ';UrABEH (If cornmi\tee) U~L
li\rTlour-ts may be rounded off to whole dollars)
PART '1 - LOANS RECEIVED: (see informat;on manual for directions and examples)
- DAT~l~ FULL NAME AND ADDRESS Ot/.,F,',~'R EMPLOYER (If self-employed Int,.r-
OCCUPATION list street address and city est AMOUNT OF CUMULA T\ V::
AND ANY GUARANTORS OR ,-v".ui'LRS of business.) Flate LOAN AMOUNT
--
Attach addi tionill information on appropriately label ed continuation sheets.
SUBTOTAL $
PART 2 -- LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY:
(see information manual for directions and examples)
(a)
(b)
(c)
(d)
DATE
FULL NAME AND ADDRESS
AMOUNT
REPAID
AMOUNT
FORGIVEN
(Enter on
Sched. A)
AMOUNT PAID
BY A THIRD
PARTY (Enter
on Sched. A)
UNPAID
BALANCE
Attach additional infor;nation on dppropriately labeled continuation stleets.
SUBTOTAL $
....... IN' r 1 J ....4.11l't
PART 3 - SUMMARY
1. LOANS OF $50 OR MORE THIS PERIOD (Part 1) Include all Subtotals
2. LO,'\NS UNDER $50 THiS PERIOD (Not Itemized)
3. TOTAL LO,-'\NS RECEIVED (Line 1 -c 2)
4. LOAN[; F~EPAID OF $50 OR MOm::-!lS PERIOD (Part 2, Columna) Include all Subtotals
5. LOANS f~ORGIVEN OF $50 OR ~/C.:.:=- THIS PERIOD (Part 2, Column b) Include all Subtotals
6. LO,AJ-JS PAID BY A THtriD PAR-"':':C' $50 OR MORE THIS PERIOD (Part 2, Column c) Include all
$ ----
$
$
Sutt-o:t::S
7. LOA\;S SEPAID, FOF-lG1VEN. C:': ~c':;i:J BY A THIRD PARTY UNDER $50 THIS PERIOD (Not Itemized)
8. Ti:)Tr\L... '_OANS REP/\ID, FCc~-::;: =~j OR PAID BY A THIRD PARTY THIS PERIOD (Line 4 + 5 + 6 + 7)
9. i'~cT C-:';.JGE THIS F'ER:C):J _ - e :-3, :=nterthis total on line 2, CoL-';: B of Summary Page)
$ _,_____'__'n~
S
-5-
r","':::~/~~
~/ ~~.s a/.;:f/~"'-- I.D. ~.c!\ISER (If Committee)
(Interim Form)
SCHEDULE C, FORM 420 or 430
NON.MONET ARY CONTRIBUTIONS
(.t\:-:10U'1 ts may be rounded off to whol e dollars)
7i'SO&>/
.
See infc1rllation manual for directions and examples
-
DESCRIPTION OF FAIR MARKET CUMULA 7; Vi
FULL NAME AND ADS"=SS AND EMPLOYER*
DATE OCCUPATION CONSIDERATION VALUE AMOli"T
1.0. NUMBER (If Cc,-Git~ee) RECEIVED
-
4.?
\
_.
AH.~~'.1"1 F.ldrJlticnai information on appropriately labeled continuation sheets
SUBTOTAL $
~~~~~I_butor is self-emp 10YC':---~-:- s treel address and ci ty of busi ness I
SUMMARY
1. NON-MONETARY==','C:C 3UTIONS OF $50 OR MORE THIS PERIOD (Include all Subtotals)
2. NON-MONET;'\R/ C',--:-:::i5UTiONS UNDER $50 THIS PERIOD (Not Itemized)
< TOTA,L NON-,'.\i::';;::-:::;Y CONTRIBUTIONS THIS PERIOD (Une 1 + 2, Enter on
$
~_ine 5, CO:1....';;n 2 :,;3_:;-'~2~y P2g~)
$
---_.'---,--"
-.---.-. --_._-~-~--~-- .-..-.
-6-
~ 'dZU'J-
"-,, ~,' ')'.' Qr-- ...
,~, ,'L"ucR(11 COlTITII,tee).,~ '- ..__.___.
(Inte In F m)
SCHEDULE D, FORM 420 or 430
PLEDGES
(r\r:wunts may be rounded off to whole dollars)
See in forrr- Ci ~; on manual for directioi' 3 3nd i nstrtlctions
(a)
(b)
(c)
-I
-....----- --.--'-... , -
I EMPLOYER* AMOUNT AMOUNT CUMULA Tl Y:=
DATE. FULL NAME AND ADO;;:::SS I OCCUPATION PLEDGED PAID {Enter PLEDGE
MJD I.D. NUMBER (II COIH",;:ee) I THIS PEr~IOD on Scne{l. A) UNPAID
---- -- .._.__...._-~+ -- -----,,,--
j
I
i
I
I
,
I
._-
,
--I
-~.'-
i
[- ---
--
.- -_.__._.'--~-
- N/L "
Attach additlona! Information on appropriately labeled continuation sheets
SUBTOTAL $
<"
I * If contributor is self-employed list street address and city of business
SUMMARY
1. PLEDGES OF $50 OF~ MOPE THIS PERIOD (Column a) Include all Subtotals
2. PLEDGES UNDER $50 It-; ;'~ERIOD (Not Itemized)
3. TOTAL PLEDGES FiEC:.= :='J (Line 1 + 2)
4. PLEDGES OF $50 OR "C-::. ;'JAID THIS PERIOD (Column b) Include all Subtotals
5. PLEDGES UNDERSEO ?;:, :) T,..,IS PERIOD (Not Itemized)
o. TOT.AL PLEDGE:', p,:"::': _ ,~':: 4 + 5)
r<EI CHANGE TH ~ C:::=. CD "Line 3 - 6, Enter this total on line 6, Column B of Summary
$ -.---.-.---.--
$
$
P2.ge)
$
-7-
NA''\E~~4''''''
~C:;4Pr a,~#/~~
/(Itlteri~1 Form)
SCHEDULE E, FORM 420 or 430
PAYMENTS
2:~~CJJJI ~
I.D. N'JHBER (If Corrmlttee)
(A;"ounts may be rounded off to whole dollars)
PART I - MADE TO COMMITTE.ES: (See information manual for directions and examples)
---
OFFICIAL
USE ONLY
---.
--
--
-----~
l...tt=;;.-:.i': . - .), 2t 'n~o
FULL NA~~::: 0'" PAYEE COMMITTEE AND 1.0. NUMBER (If the committee has no 1.0. Number, AMOUNT
state full name and address of t'le Treasurer) THIS PERiCO
-
ML- -
..
,
------
-
,
---.-.-
-' w_....,,~_._
<Clalion G' #",. .- J::~i~d continuation sheets
...
- ,.
S0S 10, AL (Carry with additional subtotals to Line 1, part 3, page 9) S L-_____._
- 8 -
c,\',r: __:{II.// ~,f~__~~;&.$' C~f24~~ ~c), ~'-.:~:::;=R lit Committee) __~t:::J.P /
SCHEDULE E, FORM 420 or 430 I
(continued)
PART 2 - 'JADE TO OTHER'" (Sp~ .~,; .
__ .;). .. I!"ormaton manual for directions and examples)
CULL NAME AND ADDR;:::SS OF PAYEE'"
(Street. City. S~31e) DESCRIPTION OF PAYMENT AMOUNT
_._--- THIS PERICCi
~o...v~k --
~47c//
SO nRS'7 r7 ..MiIV -::r;s r ~47'c-bs: 67..79
-'
-
G;,/~y Z>/~~7c'/ --
A'L> p"FA? // ..r ~ /~..F....v r--
'74~6 /~", ~,..~, &;/~r c36, '7"D
--
~..A--A R/("" ,/W;t9 /cff'
r:..a 7)~T .>Y' .G-<- ~s<.= ~A /~-s c::; r C' 0
./
cv- 'r~r r;; ,.~ ..4Z>/'E/?~.s-~~E</ T
7~.;,/.ff /.(.,,~Ek- Au? 0:; /..-sy /9-- C) 0
- J
--
P..l42 A .L~ ;?'v o..e
7/7 h,f5-T- 57 C:/ ~ ~rJ:#ME;(/7S ..y?, /6'
/
G;/~ /),. r"T;.# --
A.z:> y c .e T; 5'E ~E..c, r-
7~~ ~~~"'-;"L 'G::/,.e~ ~3:~o
~/ ~l' Or r'N r'r# C/ 4C>P~/f'/5j.~ ~E.-(/-7-
/'-Y'C 6 ~~7?;-~ /2&..~D
-
tactl add; tlonal information on appropri~tely labeled continuation sheets ~ -
SUBTOTAL (Carry with additional subtotals to Line 3, part 3) sI 332..3.:>
:1 f the er , ,
At
I ~
p s)n prOViding the goods or services was different than the payee, list each person's name and address.
-------
OULK RATE NO.
, r
II
f
1
,)
1
POSTAGE METER NO.
EIl~e: )'our blllf.:. r~t:' and/or postage meter number used in cllmpaign mass
'~.Q1.IIl~gS.. /n a(~lrtLO:l a cr~py of each mass mailing should he sent to the
1 azr I 011 tical I ractlces Commission.
PART 3 - St"'H1ARY 0' .
Ji. I F PA I'MENTS (Se~ Information manual for directions and examples)
1. M~:)~~.: ~OMMITTEES THIS PERIOD (Part 1) Include all Subtotals $
2. ~~:~:~ _ .-,OM~~ITTEES UNDER $50 THIS PERIOD (Not Itemized)
~: '1"~' ~~ ~~, ?THERS THIS PERIOD (Part 2) Include all Subtotals
':;::~ "~ ~~~THERS UNDER $50 THIS PERIOD (Not Itemized)
~. ~'=_~" ~~;~~,~~ED EXP~NS~S PAID THIS PERIOD (Schedule F, Line 4)
'_' : ~,' ;~.~~S THIS PE:F-{IOD (Lines 1 +- 2 + 3 +- 4 + 5, Enter this
:; o. \..-olumn B of Summary Pags" $ 3..:5j? ~
=__.-==:.i~_~
-9-
1-,:""'= ~&(d"'M a~~ER..r ~~A'#""F ~__ :.D NU\\3E:R (II C:{)rr(T1~tte.c) -.Z~sO./?L__.
(Interim f 0 nn)
SCHEDULE F, FORM 420 or 430
ACCRUED EXPENSES (Unpaid Bills)
(Amounts may be rounded off to whole dollars)
See Ink,r::olion manual for directions and examples
----- AMOUNT
FULL Nt""~E.l.ND ADDRESS DESCRIPTION OF
.....,.. State)'" ACCRUED EXPENSES ACCRUro:J
(Street, \,.-: 'J THIS PEP.:::
-- u -<-~.
/!//L" --"
--
Attacrl addi tional inlannatian on appropriately labeled continuation sheets.
SUBTOTAL $
*If the accrued expense is owed to a committee, list the committee's name and 1.0. number (or the full name and address of
the treasurer). If the person providing the goods or services was different from the payee, list each person's full name, stree
address, cit and state.
SUMMARY
1. i\CCRUED EXPENSES OF $Se .' =:, \10RE THIS PERIOD. Include all Subtotals
2. ACCf-'UED EXPENSES OF lit =,= 550 THIS PERIOD. (Not Itemized)
3. TOT}'_ ACCRUED EXPU-;,;'.:.: . ,::;URRED THIS PERIOD (Line 1 + 2)
..:. .\CCG'Jt:::D EXPENSES p;.::-. -- :) PERIOD (Not Itemized, Enter on Line 5, Part 3, Schedule E)
5. "E',' CH;'.J~GE THiS PEP":::-'_ ',,,, 3-4. Enter on Line 9, Column B of the Summary Page,
Th s '~-;J.y b2 a negative 2'7:'':: -
$
$
$
$
- 10 -
-
(Interim Fonn)
CANDIDA TE'S
CAMPAIGN STATEMENT
C:C:'/:'RNi/.ENT (our: SECTiON 8,\200 - 84214
F,'r;:, 4:<0
'3:",,:"':"( cover:.; period from/'-175-througtl.'{-2.~.z.s-
,I' , ,~/ i '
, ."_~_v~~fl:lUt~ _~:~__~!/uL~It~)
",\,~" 0" ~_""__ArE, W ' . ..
:'C~'2~~~C{~ 7:r.o4~ '/4' ;~~
;;,,,,,,;~' ,;~L:, .' , <N~~'~;-~-- ::;c!:,;+--L '~"jb
[J Lins 1 0 Line 2 J Other :I
~J~ .J.-c.~_k_._~~??:.7!J
{7.IP CODE) (ARE! -ODr-:1 "Pr'IONl- r"
fJ?' J- c - L~c: ,J~ - If ~~- .i~~/
(ZIP CODE) (t~nEA CODE! (PHONE ;-...0.)
~c::C~~-;C-.\8L~:.-o-;:;X-FOf~ }:,.iAILlt-lt; ADC:x-;::SS (It-;;r!Jer. [J'[()\"idA n,-;~-;;;t.(O[ P.'(). Box) city, sta'U! a-nd zip code)----
- ~ ~ ---------
_ TY i'~~~RY' G '''ERA L. SP icC I A LJ Q7~~[~/~ TI ~U00N;9~7?~:J~' FI 2~~;Z:C~~~J":_::_:
POL1T:CAL F;t,QTY AND DISTF~ICT NUMBER (If ,Applicahle) TOTAL PAGES THIS F:EPORT OFFICIAL USE O~~LY
LiST i~LL COMMITTEES SUBJECT TO YOUR CONTROL WHICH HAVE RECEIVED CONTRIBUTIONS OR MADE
EXPE~JOI TURES ON BEHALF OF YOUR CANDICACY
(.4 coc,t;olled committee is one which is controlled directly or indirectly ly you:>, which octs iointly ',vith you or one of your cuntrollod
cCH:1rnii"tees. in conn~~ct;on ......:l,h the making of expeflditure~,. You control 0 committee if you, yaur agent or any other committee you
centro' has significant influence 011 the actions or decisions of the committee.)
~I l PHON~
I\DDRf:'SS
- -- ~-_ I '-~U"'~~~~=7C
t,.:e:j l, L/..'-A /0
'-- "-i-'L___'~ .
--=L~ ~~J
CC\'\1I"i TU' NAME CO~j1Mi TTEE
N'D I.D. I'WMBEF! ADURESS
TREASURER
-~!I-r;L! ,? /_-- ---- '
:~~t:; ;:;~~;w .
~____ ~__en__n______~__
)/u..t~2~~~l'/ .
~!.:~.~~~..~,~~~~=~~~j:.ri('ltely labeled COfltinlration sheets.
H LIST /\LL ADD!TlONAL Cm,iMITTEES OF WHICH YOU HAVE KNOWLEDGE WHICH H.4VE RECEIVED
COf\!Ti-llBUT10NS OR MJ.\OE EXPENDITURES ON BEHALF OF YOUR CANDiDACY
CC!\,'.i'i T iT NAME
flJ:U i.D. cJlJ';1l~cR
COMMITTEE
ADUHESS
TREASU FiER
ADDHl::SS
PHONE
r-~Ui"/18LR
, 1
i :1:"""-1'
:--/,h~~-=r~:~---- J - ---
r\it('H~~fl aud: :nfO:-Tl::1tion on :Ji:p(nrnintJ'C)ly 1:lbpled continuation ~~heets.
-C-"-'-'---J'~-----"
i declare under porn"
_~_~=-~~. schedules are true,
,
1=------1
I
l EY.8cuteej
_._----,...,..,...-.__...~.
__----L__...,__
VEFl/F/CATION
o"Hjury that to thi3 best of my Knowledge this statement and its attach,3d
~, and complete and that I have lIsed all reason3ble diliSlence in thle,ir Frep;lr~itioil.
, '." ~.-/)' ~~-; /~7 ,~f ,,/
, " 'c.~"'/ (-), C. /' / . " // ' ,;/ ,,'
".,;(j{j-_ZL",~l{.'i-f{1!.cf. b~ - . ._~ . -. .14/
IC'!., AI'D "PEl ISIGNATU?C' '-'f" CA',DIL'C\.F'
.- 1 -,
- SUMMARY PAGE
N"r"e-al~Jil--~d&h/i~
1.0. ;;'..C:C' .-Z/I07/_~(._
rl f ("
-
-
COLUMN A
COLUMN B
COLUMN C
Cumulative
total from
previ ,Jus period
This period
Cumu(ativ~
to date
RECEIPT:;
1. t\\oiietdry contributions (Line ~
3 of Schedule A)
$ Jt1a-S-dtJ S<!J-7/1c'C3 ~a'-Y4-0l
, I ,- (Column A -f --
Column B)
2. Un~aid ioztns (Line 9, Part 3 of SC:ie::ule B)
-"--'
(Total at beginning
of peri ad)
(Net change
for period)
(Total at end
of period)
3. tl,1issei !;:1I180US receipts (attach explanation)
~-----'
4. Total monetary contributions, Net cash receipts (Lines 1+2+3)
~1'UiM-A+-
Column B)
$ ,/LJ ~~C7 e S~~ c;J & sh"9a'7/0
(Column A +
Column B)
5. Non-monetary contributions (Line 3 of Schedule C)
V'
(Column A +
Column B)
G. PleeJges (L.ine 7 of Schedule D)
.y'"
(Total at beginning (Net change (Total at end
of period) for period) of period)
$ )t:/~~/O $ ~ ,c) e ~~~--3
(Column A +
Column 0)
7. Tot:';! r~'ceipts (Lines '1+5+6)
EXPE;o,JDlTU HES
8. FJajm2i1is (Line G, Part 3 of Schedule E)
s)171
$,~t;{ ~6~~~. /1
(Column A +
Column B)
9. Accrued expenses (unpaid bitls) (Line 5 of Schedule F)
(Total at beginning
of period)
(Net change
for peri od)
(Total at end
of pariod)
10. TOt:11 c/,J:mcJitures (Lirws 8t9)
s
s
~Q:dL
(CoILr;1n A +
Column B)
STATEMENT OF CHANGES IN FINANCIAL CONDITION
12. Cash receipts this period (Line 4, column B)
s /2/ ~5'- ~' (!j
,,--~/I/ C> e~
11. Cash on hand at the beginning of this period
14. Cash nn hand at closing date (Lines 11+12-13)
,/
~2
1:1 45- .
/.1'
r/1
13. Ca~3h payments this period (Line 8, column B)
15. Liabilitj'33 (
.0 2, column C + Line 9, column C)
Lir8
'_ ;'::; 15)
s/~~h
S (, b ~1.:-. J ~7c~_._.._
~~;::r:r=
16. Surplus (if c_ ,,~.~ is greater than Line 15, subtract
Line 15 fi'):"_ -,; 14)
17. Dek: ~ "_ - e '::; ; s greater than Li ne 14, su btract
-2-
. .
(.itlL'-t2~_,L,.ljd~fu.___~.((~0,;cj,/J,~"__
'--7(ii;~~ri.Jl I'(lrm)
SCHEDULE A, FOFUA 420 or 430
MONETAf~Y CONTRI BUllONS
J' '-C Vi
I.D, r,f' ',':P (II Commit'.,,,) _.__/-~--1___ ~2.__. __.__
- .-.- ~-_.._-"t""-.
,';[110",'\S may bio r()unded off to Ivholo dCIllars)
(~r.1VED FFWM COM"\!TTE:ES: (See information manual for directions and eX"Iflples)
-''''''--J--'''''''' --..---.-.-- l'-
-, ,.- ~l...1 - ,....,.......-... . r-.r- ,.....,.",.\~\ - 'r"' . ',\ ,_. c: "- ~
.. T,<: ,,' ,,", ,- UU. NAr,,,, j",O AO:..,.,=,S ,"",'" ~",,",'," ",I rTEe , I.D. NU"~,tkR o,~, fR_.AS
DA .- (Stm"l, Ci:y, S:8''') FULL NAME AND ADD
-..----.1.---..- -.---.------.----- .------ ....-.--------.--
I
--1.--.----
I
I
P:\8T 1 ..
uRi~;;n-T-- AlI10UNT'-- -~.__.-
CUM
HESS I RECeiVED T
-.-...t------- __..n.
,
)1J1_ c...-
----L
,- --.-
~] -- ---
L~ -----
----- ------
--_.-
I -,~._~-
--r~---
-.--.-.,.--- ---.--.---. ----...-
UU\1T,'::
o DATl
ui'
(L_~_._
I
--'-'--r-"
--+
I
----].-.-.----------
I
I
I
I
--------[.--- . "-"--'---"-'-'-------'
I
n~!~-~_=~n~~~~~--~-----[-~"----
I
I
----j-----.
I
I
______L_ .__________
I
I
--- -+~---------- 1
;7" C:-';~""0 :~;~~~;:~;~:,-~~;.:;~ ::~,~;:~::~:t~:~';:',:eC: '-'~::~3-~"ge 4) t______J
'- 3 --
">,,,=(LIi~~2;V (~j;/t~'(:J
I.D\;, "3'=" (Ii Com"lltee)
'7Lf.,S-c:y /
..1._______...___-!...___________
A, FORM 420 or 430
(continued)
~
. .
PART 2 --
'/ED f'flOM OTH:=RS:
(See i:lfonnation manual for directions and examples)
--.------------.--..-- - ---
._-~---- I EMPLOYER (IF CONTAIf:lUTOR IS
"'.ILL NAJ,IE AND 1\00 "'=.S5 (Street AMOUNT CU1viULA,i,::
DAT;.'; CONTR! 3UTORx OCCUPATION SEL.F.EMPLOYED LIST STREET RECEIVED AMOUNT
City, Stilte) OF ADDRESS & CITY OF BUSINESS)
--_.__._,-~- ... ----- ._._---_._~_._._----- ._--- -- ..
1
--- -- "'- -- .. -- ..
-.-- -'
--..--
\
-- _..~---------------- ---.. -
_.__l___.____________ _,__
~J - ---..---.-.,'----.--
------1 .--.--
L_________.____
A1t~lcr, c~(jC1 i t I 0 ~ ;~ : lrlforrnation on "r,proprl ately label ed continuation sheets
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
C;J; jf'the cont'rib'ution was made by an inter'mediary provide the information for both the intermediary and the principal
con tr: D'__:tcr.
---------- --
PART 3 -- SUMt,iARY OF MONETARY ::CNTRIBUTIONS (See information manual for directions and examples)
1. 8E:CE:1 VE.'
2. RE-.CC.l \..' :==.__
s.
; ,~' I ~
;::C~:\1 COMMITTE,ES THIS PERIOD (Part 1) Include all Subtotals
- :::\1 COMMITTEES UNDEF'! $50 THIS PERIOD (Not Itemized)
::: =:',1 OTHEF1S THIS PERIOD (Part 2) Include all Subtotals
. :::~ OTHERS UNDER $50 THIS PERIOD (Not Itemized)
-- .~~FY CONTRIBUTIONS THIS PE;=::'JiJ (line 1 + 2 + 3 + 4)
._:~, :"i~:e 1, Column B of SUf11fTl~'_.", ::=;;8)
$ -
3. nL~(~;f:~'~' -'0
4. F~E~ :.:=:
$ ===-~--=--=
-4-
1,'/:: _..:.L~~t0 rA'/./ Z;ER...>' (' /h.:;4?/J/~/~ I.D. NUMBER (It Con1lTlIttea)
SCHEDUCE A, FORM 420 or 430
(continued)
'7 r.y ,.--. , ./
~- ~-~""'<. ,;,.f.-
;
T'..\.:(~' :: .. Rl:.CEiV[D FRuM OTHERS: (See infonnalion manual.for direcHofls and examples)
I
..-. -. -. --r-_o EMPLOYER (IF CONTRIBlITOR IS
I AMOUNT CUMULATIVE
I Fl'LL NAME AND ADDRESS (Street
r'.~"1E i City. Slate; OF CONTRIBUTOR* OCCUPATION SELF-i:MPLOVEO LIST STREET RECEI VEO AMOUNT
I ADDRESS 8. CITY OF BUSINESSj
_-i_ -
-- I EvL c-d/t~/A/O C~~v> 97'4' r~
i --'0' y.>/r Ay/-;?/cv/ 7';;K~"<" 3.3'<:'-) .c- . '-i-- . ,
,;" '/ I ;r, ~~ :5(..::'/" ~ -.
0.0. -
_~:> I :3/..3.:) --E_ ~"/;{~ C/Av C;,I/P'7 -
I , I
I "A/4' ",p;"r' ~;Y/VE;(} I ~'
I ..L. v H ,BL-;;'/{' d /rY A ......c::>".{' .~/:' (,."\ t''''
% , 17.;,<10,') ~{}. C:'O ! ~o...--~ -, -----
I Us4 co. ~..-
75 I 02 ~nh c:/~} G, /./il /
! ,
- .'. --
It/ ,0:-, ;;p A &>7.;('~- ~:, s:~..~ t;~ y:. ...~?'
% ~4.c:";:;-~ ~a~ / db ,~'~
/75, ~;/4/P h,., C;~;. . . ,. . ,~.y.. ~ .. . . ".
*'l"
! ..J '- ---.,'.--..-
- , .'
:% I ~/ ..c..cEc7A'/c-. .E./.c:CJ;;7 c.. ~'":>'V _'j ~: :::~ ,. ~~.',~ ~
" (,.. #'----
('"a:.,.~,.~ .3 .f?/ /;;/ sT" ..~--,.,(" -fJIIi'''':'~-"''''''_:;;''';-
/5-1 . .>~'/ ~..r- >V;- c:/.. , ' 5-"~c....",;""'~.
G,../ /'fZ:,/
;%T~e~ r ~~r# -
.:T4R..v~;"vf P/K4~~~ ;;r
..:7.- . o?7?:7 .;S2j ....CJ~~ '. ./:. .~
/;r! 0/799 ~C'"~('t.> HJ>.'S' " --::;;'<../. ..
_G.,./AJ;y . -.
----r: ;( , . /,/ ..,
% j";;,,..,,- hZ;'k ,a.'''-'E,,/ /'
tU//Vc--y A,1.. / /~/)... ...:5"1).. ~ .-. L~ (..)
.:~v/c.>- 7' 79/<: ~;t;/k" 4t/~ 779/ c. :.J..:....'..
C,./4/
- -
%1 .2r/~ L t?A/,r>#"v/ E./Ec.~g)("/ 4"'-' r: ,:,-;:'"
~~/ />/ ~: ;/- 7- .:.', C
v" r..37J ~ 6?'. -
/~-! 3 c:f' / /57 .}~r &:, '~
?//?Tty -
I Eh' ~/.:--sr // "?':c ~ /
-"./ i ~d'/ h'ki~ .(V,?'~ ~ 4' 1'-.'.- C
! ? 79/C 0-Z;~ ,~(J :...::;. . .:.:.s..
/ /lj?L~4t/.c- -
/ '.- '} 79/ C G'~/rr:~;/
/:-.>1
.
, /' I ~4/P4 ..E, ~-<-~D ltrrl /;:S ;r- t(h?~' A--'" r //"- C"..:
7.Y3.> ~ c" (:, !J .::;.. -
-:-'-.....>.. -
/ -,,~ I~::-U' c;;~y ""- ,
,""!:....,} ;:---~P3' 3- "'I/C-
_....~
0/ 'l,vc:: .~ ~ I ../
.../ b"'~.:2Z.Z) - ,;(..1' A RJ-k'-,? 7 ,,-,
/-fi,- ~(; Fe- 2f'c,3? ..s:- -<-L ",; '.!5) cY' CO
-/?j' ~ , - St>.
,,'i'l.1 ,;;;0- E..< /l/ ~ L>e)/C 'G //.<-"'2:: .
, , J . .. ... .. .. .....-.-...4.'
I
. . ...--...------..., --.......... -.. '" -- ---..-.-....-,-.......- -...---~.
.ltt~CI1 aoci tional intcrmation on appropriately labeled continuation sheets r
/.
i- ,. /. v;~
SLIBTOTAL (Carry with additional Subtotals to Ime 3, part 3) S
1270
--'
:6
~
~
~
~
:b
~
-
~
/
- ,
.. If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
PART 3 - SUMMARV OF MONETARY CONTRIBUTIONS (See information manual for directions and examples)
1. RECEIVED Ff.10M COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RECEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3, RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
4. ~lECE1VED FROM OTHEJIS UNDEFI $60 THIS PEniOD (Nolllemized)
5. TOTAL MONETARY CONTRIBUTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line 1, Column 8 of Summary Page)
$
-.;.;:;:{:~;, .")()
.L/-YC,.. o<..'.J
$ -'-:::::;:0" "C' C'
( continued)
PAnT 2 - RECEIV~D FROM OTHERS: (See infonnation manual. for directions and examples)
I
I
t'XiE 1
I
I
~_I
I
~:/ I
% I
/?~l
-., ....-
%
~/,'-"""
7?;~
- .......
~(..-
/;7.:;-
17/
//3/
FrLL NAME AND ADDRESS (Sir"'
Cay, Stat.} OF CONTRIBUTOR*
OCCUPATION
EMPLOYER (IF CONTRIBUTOR is
SELF-EMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS)
cr>."t"q-
~;7 Le"~/.s
C"':" C'. ~ . c:;.:/,ey
7 7 9/~' .t';:'" ......:-',c-,,<,../
" . ....--', ;/ ,c. . ,..
. S;>///G.'Y
./ YD C--~.PC~/
a;~i'--'"''
76'1 u.,. 1'7/
,.,. t;;/A3
-.'" .... ._~,_...,~ - .....- -_.......,..._..~...~.
Attach adoltional information on appropriately labeled continuation Sheets
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
;1?' C"'4'"~/eP .f)/~~~4/
';73:/ u- [7 ~(
3~T ~4.;{/';€:2L /
? 77/ .L:--- tA/ ,;i'EA/ _.. .,.
.,
,-/<:=~I/~ ~')<'
Y,p-/) L-
~i'4~
;Ft=-A L.
, ....z;'#.?4r~,.__2~_yL. ,4;.. ..~~~~
C,/A3, .
...,
AMOUNT
RECEIVED
CUMULATiVE
AMOUNT
~~/f~~ -/I/.!>~j
7'79/' ...~' h.K~;C:;--'
&16' ...,.:.-.2l,A/ ff~ JI A/ (/,:'
/Yt:l rL-~i:-'~ .
~.z.EL ~ ~~/Q&y A{.U.IEL
7'6/ /;V. C7~ ..........-.
. '~." ,
~.~7f'^'.Fi:> .
/Y 'Vcr . ,
(~"- 1"- ../" 7'7 r.,"" , ,,~; l
}.r) c:v .~ C-/. _
. G/~ ,:..;.-- ..:._, '. .
d S..:::::- . :::? ,'- ('; L-
I ' ..;;>. -::-::-:-::-:.
I '.~
I .:F> -.
~..€.~ ~:~ k r -_. '~'. -... '._ .
~..z?:,:~-:__:__..I _0.t:.~ 2.~_"
d6~.::.:2- r d'::::~;. ,'(")
'w_~ ......._-....~.- ..,..~...-l --,,~._--. -- ----.._.-
.~
, -
/:~~:_~:).g- ._-
/ ,
" ,-..'J,.
~.- ~
/~ , _... ._. o'
j
t:
."".~
".. ..- -......--.
.
- -~ ..... ... .. ..._...~.,. """'.'--"---'-","
15~ ,!
/ .?7J, c;;.: !
>/: If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
PA AT 3 - SUMMARY OF MONETARY CON~_RI8UTtONS (See information manual for directions and examples)
1. RECEIVED FROM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RE:CEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3. RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
4, RECEIVED FROM OTHERS UNDER $50 THIS PERIOD (Not Itemized)
5. TOTAL MONETARY~CONTRI8UTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line t, Column B of Summary Page)
-4-
','
". -'-..,,--
$ "."..~-,:>,-=
.-?<7::::::' 00
,;..-...,.......,...........-
/ ~~ c>~ ---- /' C" ~
$ <? / ~) I ..'_..-
_-:;.:.::e..;.~ .
:.,\,"1E
.-~il!dl:ti"!!'-' ~~/~__{5'UIC/~:a~,,-, __
(hilI' m For,
SCHEDULE B, FORM 420 or 430
LOANS
; =.} ~-; ~
,'.mEn (II cornrnittee) -.:l..,~)~ S L-
:,C0our:',:; :;'1y be rounded off to) whole dollars)
PAfn 'j -, '..C/\NS RECEIVeD: (:,e" i:1')rmat'on manual for directions and examples)
D~~~T--FUL.:-r~J-<\ME ",ND ADD.,i-:':SS 0= LEi\jO);,:R -'!:CCllPATION"- EVi~!L.~~~~~-'~:Ir~~~~~~g'gi~~d "~;r-I
.__..___I___~~~~~~._GllAR,<\~~'~~~~~.C:~~~~~:~_.L______"-___,~~Si,,~S~.) ___ Ral~-'
I
AMOUNT OF CUMULt,TIV::;
LOAN AMOUNT
'--'-I'---~--
I
~1
SUBTOTAL $
LJ7d;'
flttach additional information on clppropriately labeled continuation sheets.
l'><iI-.'!!I-~~m_ --A~.a...-.J.4,,(1
P/\RT 2 - LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY:
(see informCllion manual for directions and examples)
(a)
(b)
(e)
(d)
--DATf~- FULL NAME
-----r-------.,---..-.,---..,--
~UNT AMOUNT PAID
AND ADDRESS AMOUNT F-ORGIVEN BY A THIRD UNPAID
FlEPAID jEnter on PARTY (Enter BALANCE
"ched. A) on Sched. Ai
------ ..- --_.._-~ -- _..-
--.--
- -.--.--
iy Ic{beled c:ontinut1tion S;-leets~
SU STaTAL $
-- --
~J~~----
;\tt~1ch acjdition(~,1 in;ormntion on RpprGpri;~t8
.J J"_"'II'\IPtl _"iI' ...1..1111....
Pi\.RT 3 -- SU~,iMARY
1. LOf\I';S or' S50 OR MORE THiS PEFllOD (Part 1) Include all Subtotal s
2. LOANS U.',DE.R $50 THiS F~j~riIOD (Not I ternized)
3. TOT/'lL L(j~NS RECEIVED ( Line 1")
4. LOAr--.)S fiFcPAID OF $50 Of1 MORt:' ~ PERIOD (Part 2, Column a) Include all Subtotals
ti. LOf\NS r-:OilC:jIVE['J OF $50 O[{ f/C -HIS F:lECfliOO (Part 2, Column b) Include all Subtotals
3. LJ),c\r-,S F'AID E3Y A THIHD PM"-;" ;50 OF! MOHE THIS PERiOD (Part 2, Column c) Include all
$ -..-.--------
$ -....----.-.--.....
$
c,: ~,."~'" ~ ' .-'
',,;-.J,i< ;.;;"::-
, ~~.; E T~ ~ ( F.-:' t::~
:3Y A THIRD PMHV UNDER $SO THIS F'E.FiIOD (Not Itemized)
F)C,ID f3Y f\ THIHD PARTY THiS F'EFi!OD (Li!le 4 ;. S i 6 17)
:c,c ',' ::';s total on line 2, Cul'c 3:;f SUrnrD'1ry F)il~je\
:;>
::;';::>'\10, FOF1Gi\';.::~,
8. -;,Ji
_ '~~~,\. -:j H EP /\ 1 C,
9. WeT
,..,
::-.
- 5 _..
~.~ _:'<',~ E:
j{J diifi1-rv ~f1,d."tW L {7~r ,o.',n '" C~,"m'''ceJ
(hztcrim Form)
SCHEDULE C, FORM 420 or 430
NON-MONETARY CONTRIBUTIONS
(,':'nOJ~i'S may be rounded off to whole dollars)
S"e i r
J:,Oil manual for cire(~ ej'lS ?nd examples
I
DATE I
__J.
I
I
FULL NAME AND MJ': "':O:SS AND
1.0. NUMBER (Ii COf'T:::eC)
OCCUPATION
EMPLOYER*
DESCRIPTION OF
CONSI DERATION
----1-- ,
+~--
-..-I..~-.--
i
I
---1......-.-----... -....
~~_L
I
I
I
_____-L..,_______.________
Atl.a.::l' :':o~>t'Cj-,,:1 informAtion on (lh~)r~)pri8tely labt~led contlllu8t!OIl sheets
SUBTOTAL $
f-';if-;;')'lt-l;b~Jtor is self-emplcyed--'-'.: -:CJ9t 3ddress and city of busines~
_______.___..___n___n_.o.o -~____...___~_o_.__._.~_~__ __.,,'" _____
SUMMARY
'. ' :mJ-MONET:\~W C':::, - =u iiONS OF $50 OR MORE THIS Pf:::RIOD (Include all Subtotals)
~. ~.JrH,10NET/dW___: '.-'.:~ ::=UTi<JNS UNDER $50 THIS PERIOD (Not Itemized)
'OTt,L NC"H,v",c:--':C'i ~:'C')Tr-:;;3UTIONS THIS PERiOD ('_ :>:; 1 + 2, Enter on
~ n8 5, Cc:l:~ '-...."1 ::_ ~:o';
- 6 -.
/""1 . ~ 9
/ CfJ ( '.I [
- :1---
FAIRMARKET ClJ"'I"--''''''
,~,t~ L,...-. ~.._
VALUE AMCJGNT
RECEIVED
-- ----
,) 7 ~1
$ --.
s
.C., _ ,i/jjt~~~j:~uj/e/~ i~~~:.___ ....
SCHEDULE D, FORM 420 or 430
PLEDGES
,',_ "!'3ER(lr cOlrmittee)____Z!iJ~{i f/l__
'r;;; May be rounded off to whole dollars)
See infow"J,'::on manual for dln~cti,~i'5 2nd in5(r~lctions
(a)
(b)
(c)
------~..-T--...~ -..---.--,-----..-
I
D!\TE lIJ~JLL NAME ;l'-lD,fI;?DP=?,S i OCCUPATION
-"H. 1.0. NU:<'1B~rl (.. _0""'1'11 "e~) I
-----.--:.-..'-..-----.------.-..--------1-----.--
I
_____l___
EMPLO
-----
'!ER* M:'OUNT I AMOUNT CUMULATi\':::
PLEDGED PAID {Enter PLEOG=
THIS PERIOD I o~~:~~~ UNP/,i t:.
,...------..--
-- _.-
-'-------
--
-- ----- :-----
.-. ... .--
.--------- ----- -- --
----- --- -- -----
-- ---- -----
STOTAL $
-. .-
I
----'------
I
--~--
--~----~~--
I
-.'---l-'..----.-.---------------
I
1.__.._------------.--
-f' .---~_..-~~
.1.ttc;Zh" add! ~jn31 jntormation on app.r(~~:;.;t;TyT3i~eled contj~ation sheets
su
r.---------.----------..---------------.----~
-=-~~_~(~l.~ib~t~~~~elf-ernPIOYed liS: str~et address and city of busine~J
SUMMARY
1. [)LEDGES OF $50 em MOii'HIS PERIOD (Column a) Include <lll Subtotals
2. F'LEDGES UNDEH :;;50 r- ;):-:RIOD (Not Itemized)
v. TOTAL Pl_EDGES REC': - - Line 1 + 2)
,~ PL. EDGES OF $50 Op, "::..-:.>:,iO THIS PERIOD (Column b) Include all Subtotals
c: ~~ E~L)GES "J;-."L)L:~_i-<:: ~ M ..;-'.-~;S PERIOD (Not lter11ized)
'-('i-,~L PLECJCL-:0 P,-\ 5)
'c-cT Cri;',:'X>= " ~ 3 -- 6, Enter this total on ,_, ~;, Column B of Summary
s
$ -....-----,.-,-.--
^
:~~~~72;Z:~--:
- ? --
" j' '1<." "IL' d!e. .
,.', / ' ' t. / /", /J '1 / /~."
r,A":: _ii{'_d {fi/}11.r- _~: uP. ,L&-' (fl?.rC'l~~
(1 terim Form)
SCHEDULE E, FORM 420 or 430
PAYMENTS
,.... '1 . I
1.0. ,.~':3E:H (If Cornrnittef:) L'/:i-Ci f__..:.:...___
(i\, O.,lts may be rounded off to whole dollars)
PAHTt '. r,1.I'..DE TO COM:\illTTE::S: (See in;~'rmation manual for directions and examples)
OFFIC!AL
USE ONLY
r\'; ',(,i
--""----- -----
FULL ~L~'/E 0- ;:;':.\1 '.:E COMMITTEE AND 1.0. NUMBER (If the comm I ttee has no I.D. Number, AMOU:H
state full name and address of the Treasurer' THIS PC:A:C':J
- .------
-
,
-_._.----. --
----~--_.----- .-------------- -~._----~
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---------"----
--------" --.
-.---.--------...-----. -~--
------.-.-.-----... ~------
I
.-_._------ ~--~..~ ..-.----- '-'-- .. -- 1--_____ -----
......---.;.. ...'"'
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(Inten: Form)
COMMITTEE
CAMPAIGN STATEMENT
Form 420
;;p H.
(GOVEFlNMJ::NT CODE SC;:C 10 64200-84214) :
Stateme,,' cove.. pedod fcom - thcough_' 0 7.:>-1
.
J.~ -Jr2~ '118'
(AREA CODE) {PHONE NO.;
I ~() K"---r~2..-~
(AREA CODE) (PHONE NO.1
~;r - g--,,~ -~!~
'PHONE NO,)
QG St ;7?' Box), City, Star and Zip Code)
ION 'MONTH, DAY, YFAR' TOTAL PAGES
~.._--~_._~,.._,..._~
OFFICIAL u~c:: ONLY
\..~...I-:J"-.;:~.
ALLO ATION OF EXPENnITURE~ BY CANDIDATES AND MEASURES
(Allocate the totals of Schedules E and F by Candidates and Measures; Amounts may be rounded off to whole dollars)
-~--"'-
AMOUNT OF " T.-
EXPENDITURES CUMULA '';'',Vt:.
~_THIS ~ER10D_ _. TO DATt:
NAME or C~NDIDATE AND OFFICE; NAME OF BALLOT
MEASURE: AND BALLOT UM R OR LETTER
CHECK
ONE
OFFICIAL
USE ONLY
-
C
0
E
F
~.~
OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
o OPPOSE
o SUPPORT
Q-.?~~_OSE
Attach additional infoiTllation 00 ap~ropriately labeled continu~ti.on sheets.
Executed on_
by
STATE)
A candidate IV 0 controls a committee mu also verify the campaign statement.
I declare under penalty of perjury that to tile best of my knowledge this statement and its schedules are true,
correct and complete and the treasurer of this committee has used all reaso able dili ce in he preparation
of this statement andJts sc e I
/
v'
Executed on
, , /J /,1' _ /'#IJ. SUMMAR)' PAGE
'","d'~~~
LD. NUI~ber __ COLUMN A
(;: C ar;lmittee)
,.~..~flF"rs
'. Moretary c.'>ntiibutions (Line 5, Part 3 of Schedule A)
2. Unpaid IOa,'15 (Line 9, Part 3 of Schedule B)
3. Misce:llaneous receipts (attach explanation)
4. Tot:!l monetary contributions, Net cash receipts (Lines 1+2+3)
5. Nor.-('Ilon~tary contributions (Line 3 of Schedule C)
6. Pled~(;s (Uno 7 of Schedule D)
7. Total ieceipts (Lines 4+5+6)
EXPEMCITURES
8. Payments (Line 6, Part 3 of Schedule E)
J. Ac:crued expenses (unpaid bills) (Line 5 of Schedule F)
10. Total expenditures (Lines 8+9)
11. Cash on hand at the beginning of this period
12. Cash receipts this period (Line 4, column B)
13. Cash payments this period (Line 8, column B)
14. Cash on hand at closing date (Lines 11+12-13)
15, Liabilities (Line 2,column C + Line 9, column C)
Cumulative
total from
previous period
$~
(Total at beginning
. of period)
-
-
$
COLUMN B
This period
COLUMN C
Cumulative
to date
$ ~ 0:25: 0 u $ I, 0 ::l5..:-C!. 0
(Column A +
Column B)
(Net change
for period)
-
~
(Total at end--
of period)
iCoiurm A+
Colurm B)
$" ~$!.Q t t'J ~& 0
(CoIUIM A +
Column B)
(Net change
for period)
---
(Column A-':t""~
Column B)
---rrotal at end--
of period)
$ II () ~. 09 $ ,~ () -:2~-. 00
(Colurm A +
Column B)
$13. "7 r
(Total at beginning (Net change
of period) for period)
16. Surplus (if Line 14 is greater than Line 15, subtract
Line 15 from Line 14) ,
-
$
(Total at beginning
:::l
$~
$ $
17. Deficit (if Line 15 is greater than Line 14, subtract
Line 14 from Line 15)
. STATEMENT OF CHANGES IN FINANCIAL CONDITION
$ ~-
jf~ 2~-' "j)
l~"3,78.
;r~
-2-
$ /1 () II. ~ 2
$ ( )
$/',7 $'
(Column A +
Column B)
(Total at end
of period) ~
$ /3.7 fj
.
(Colln1n A +
Column B)
.".dJl;., ~~
~ ~'
~ ~orm) I.D. NUM6ER (if Conmitteei
SCHEDULE At FORM 420 or 430
MONETARY CO~lTRiBUTIONS
(Amounts may be rounded off to whole dollars)
.1 ;'i:" ~ - REGi:.IVED FROM COMMITTEES: (See information manual for directions and examples)
" .-..- .".- -
i FULL NAME A.I\ID ADDRESS OF COMMITTEE I.D, NUMBER OR TREASURER'S AMOUNT CUMULA fiVE
"0' .\' ~'::i I (Street, City, Stats) FULL NAME AND ADDRESS REeEI VED TO DA"![
-, ,-..- ... ~~...........-
I ~
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---L ..
-
-~
ATTACH ACDITiONAL INFORMATION ON APPROPRIATELY LABELED CONTINUATION SHEETS
SUBTOTAL (Carry with additional Subtotals to line 1, part 3, page 4) $
-3-
N~""~~ 6iIf!1& ~ 1.0. NU"8ER (It Conn,....
SCH ULE I FORM 420 or 430
. . (continued)
PMn '2 - REC!:::IVE:O FROM OTHERS: (See infonnation manual.for directions and examples)
EMPLOYER (IF CONTRIBUTOR IS
SELF.EMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS
, /7/7-?
,/7h,
,hp~
l;;;~
1/96'.
,f J6.,
OCCUPATION
AMOUNT
RECEIVED
CUMULATIVE
AMOUNT
l:if 0, D Z) Jf,C)~~) 0 .
,;; _~~, 00 ;;2. ,":>--r D D
j-?',?~.O_Q J;-sc", ~t:.~__
_~r 0 cJ
~ -szr ... CJ <:J
~~ h
. " ;:2.cJ.~c) ;20....00
.-.. f; ".-'" ,"'" -....-..
,;1.5-...0 0 .
,_;:'~p,o
/;2Sco<?__
I,,:.~~,
j-;(J . c:J 0
........_.._.,~.._.........
~'~OD
>i: If the contribution was mace by an intennediary provide the information for both the intermediary and the principal
contri butor.
...:.....~_.
PART 3 - SUMMARY OF M{iNETARY CONT,RleUTIONS (See information manual for directions and example~)
1. RECEIVED FROM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RECEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not ItemiZed)
3. RECEIVED FROM OTI-tERSTI-tIS PERIOD (Part 2) Include all Subtotals
4. RECEIVED FROM OTHERS UNDER $50 THIS PERIOD (Nol Itemized)
5. TOTAL MONETARYCONTRI8UTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line 1, Column B of Summary Page)
$
~~ 9'~='.~)~2_
$ ~1f;f ~~.~ ..
-4-
r~.~~,,~~ ;
~
~4 ~~ 1.0. NU"BER '" ""'"''''"'
SCHEDU A, RM 420 or 430
( continued)
PAnT:2 - RECEIV::D FROM OTHERS: (See informalion manual. for directions and examples)
~
Fl'LL NAME AND ADDRESS (St....t
cay, State) OF CONTAlBUTOR*
OCCUPATION
~e~
~ML
r~
?l' -1.~f,
~<
EMPLOYER (IF CONTRIBUTOR IS
SELF-eMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS)
AMOUNT
RECEIVED
CUMULATIVE
AMOUNT
#~O -cJO /f.~~e.~ DC).
;{;;2 0" C)"O
,$7,-")-;00
J!--5~ ~~_,<?_
1/""-5_____0 c)
It ~ _ ___d'; _"_ _.
1"?_~-C<l_O_
.. ~"'__'_""'.''''.'''_.~~W._'''''''.'
SUBTOTAL. (Carry with additional Subtotals to line 3, part 3) $
~ If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
PART 3 - SUMMARY OF MONETARY CONT.RIBUTIONS (See information manual for directions and examples)
1. RECEIVED FROM COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. RE.CEIVED FROM COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3. RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
4. RECEIVED FROM OTHERS UNDER $50 THIS PERIOD (Nolllemized)
5. TOTAL MONETARY CONTRIBUTIONS THIS PERIOD (line 1 + 2 + 3 + 4.
Enter this total on Line t. Column B of Summary Page)
,j ~-..:-.~...
$
1~!i(l,..~/2_..
$ 'iT< -5C')" ',~",,~
-4-
"~"s~ ~ ~ ~~ J.D. NU"BER (It COOm;tl....
. SCHEDU A, F M 420 or 430
, . (continued)
..~
PAnT'2 - RECE!V'::D F~GM OTHERS: (See information manual. for directions and examples)
.- ---,--
I Fl~LL NAME AHO AODRESS (Streltt
t'ATE I City, State} OF CONTRlBUTOR*
I
l/h)
OCCUPATION
EMPLOYER (IF CONTRIBUTOR IS
SELF-EMPLOYED LIST STREET
ADDRESS & CITY OF USINES
- ,. .....
AMOUNT
RECEIVED
CUMULATIVE
AMOUNT
~~
o
/f~'N)P'~-;~~
~7'J .. o-D
ff.~ ..~ ~.:....,~. -_.~...
.
""'~......._-.----...........
. AttaCh adaitional infonnation on appropnat~y labeled continuation sheets
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
l7?rD 0
>/: If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
PART 3 - SUMMARY OF MONETARY CONT.RIBUTIONS (See information manual for directions and exa,"ple~)
J.-:,-,~...
1. RECEIVED FROM COMMITTEES TIiIS PERIOD (Part 1) Include all Subtotals
2. Rf:CEIVED FROM COMMITTEES UNDER $50 TIiIS PERIOD (Not Itemized)
3, RECEIVED FROM OTHERS THIS PERIOD (Part 2) Include all Subtotals
4. RECEIVED FROM OTIiERS UNDER $50 THIS PERIOD (Not Itemized)
5. TOTAL MONETARY~CONTRI8UTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line " Column 8 of Summary Page)
$
,~~~2.~~.s.) .
- . -~
r-
0C)24~2.-O.
-4-
!. ~
::AW: ,/J, ,
. _fC..,~~
~
-.
~
SCHEDULE B, FORM 420 or 430
LOANS
10 NUMBER (If COIl"IT1itteei
(Amounts may be rounded off to whole dollars)
o:.ART 1 - LOANS RECEIVED: (see information manual for directions and examples)
-----r
-::t
- ,,~. - -- -g .-~~---,~,
EMPLOYER (If self-employ'ed Inter.
FUi..L rJAME AND ADDP.ESS OF LENDER OCCUPATION /1st street address anI! City est AMOUNT OF CUMll L A. TI VE
AND ANY GUARANTORS OR COSIGNERS 01 buslncea.) Rate LOAN A.\\OUNT
- ~-
!
T -
I
I
1 -, _~'""':"7___
I
I
1_. A
.jriitlonal iniormp,ticm on appropriately labeled continuation sheets. 'f
SUBTOTAL $ A
,.......-,
At,ii,,;; 'a
.~ .ow.. ..-
.-.
P~P.i 2 - LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY:
(s;:~ lIlh'rmation manual for directions and examples)
iJATE
c ~
AMOUNT AMOUNT PAID
FULL. NAME AND ADDRESS AMOUNT F-ORGIVEN BY A THIRD UNPAID
REPAID ~Ente' on PARTY (Enter BAl.ANCE
hed. A) on Schell. A)
'-
I
I
I
I ...
.~.t!!!.""
..~'> '._"O<'~__ ...,~, .-
'. "--_.',....~..,...,.....,...,,...-........
;:.ddltionai information on apj)foprlately labeled continuation sheets. .. . ....'~
SUBTOTAL $
(a)
(b)
(c)
(d)
--L
~
Attacl1
~
,.~
PART 3 - SUMMARY
1, LOANS OF $50 OR MORE THIS PERIOD (Part 1) Include all Subtotals
2. LOANS UNDER $50 THIS PERIOD (Not Itemized)
3. TOTAL LOANS RECEIVED (Line 1 + 2)
4. LOANS REPAID OF $50 OR MORE THIS PERIOD (Part 2, Column a) Include all Subtotals
5. LOANS FORGIVEN OF $50 OR MORE THIS PERIOD (Part 2, Column b) Include all Subtotals
6. LOANS PAlO BY A THIRD PARTY OF $50 OR MORE THIS PERIOD (Part 2, Column c) Include all
Subtotals
7. LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY UNDER $50 THIS PERiOD (Not Itemized)
8. TOTAL LOANS REPAID, FORGIVEN OR PAID BY A THIRD PARTY THIS PERIOD (Line 4 + 5 + 6 + 7)
9. NET CHANGE THIS PERIOD (Line 3--8, Enter this total on line 2, Column B of Summary Page)
$ _.:..~~--
$
$
~.,'-i" -','~
-..
$""711. -.
$~_...,
- ~--
~~
(It! rim Form)
SCHEDULE C, FORM 420 or 430
NON.MONET ARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
NAMEAf~ tP~~k
1.0. NUMBER (If Committee)
See information manual for directions and examples
DATE
FULL NAME AND ADDRESS P,ND
i,O. NUMBER (If Corrmlttee)
~H~
.....-~..,."..'....1 _.-.:>Ij, \-',' .,.',',.'.J ....... -.......,..;,
EMPLOYER*
DESCRIPTION OF
CONSIDERATION
FAIR MARKET CUMULATIVE
VALUE AMOUNT
RECEIVED
OCCUPATION
AI",dI additional information on appropriately labeled continuation sheets
SUBTOTAL $
:it If contributor is self.employed I ist street address and city of busine;;l
SUMMARY
1. NON-MONETARY CONTRIBUTIONS OF $50 OR MORE THIS PERIOD (Include all Subtotals)
2. NON-MONETARY CONTRIBUTIONS UNDER $50 THIS PERIOD (Not Itemized)
3. TOTAL NON-MONETARY CONTRIBUTIONS THIS PERIOD (Line 1 + 2, Enter on
Line 5, Column B of Summary Page)
$,I6J~~
$,(IS..-~7? '
-6-
(;:,.A~d~~-l
~"~i~
Interim Form)
SCHEDULE 0, FORM 420 or 430
PLEDGES
(Amounts may be rounded off to whole dollars)
10 NUM SEA (' f corrmi ttee)
51'!E i;,f'HmaticrI manual for directions and instructions
(a)
(b)
(c)
~.~
..... -. .-,-....
EMPLQYER* AMOUNT AMOUNT CUMULATIVE
0'-, r ~ FULL .AI.. ANO AOO.'" OCCUPATION PLEDGED PAID (Enter PLf<DGE
__.' _ _A~~.~O. NUMBER (It committee) THIS PERIOD on Sched. A) UNPAID
. - .-- ---....--
- ~ ....
-.-
. -
----1 r-- -c......--=
.. ...
I
-
.
I
--
--
w
....' ..
,Wacn additional infonnation on appropriately labeled continuation sheets
SUBTOTAL $
"
f
~
* If contributor is self-employed list street address and city of business
SUMMARY
1. PLEDGES OF $50 OR MORE THIS PERIOD (Column a) Include all Subtotals
2. PLEDGES UNDER $50 THIS PERIOD (Not Itemized)
3. TOTAL PLEDGES RECEIVED (Line 1 + 2)
4. PLEDGES OF $50 OR MORE PAID THIS PERIOD (Column b) Include all Subtotals
5. PLEDGES UNDER $50 PAID nitS PERIOD (Not Itemized)
6, TOTAL PLEDGES PAID (Line 4 + 5)
7. NET CHANGE THIS PERIOD (Line 3 - 6, Enter this total on line 6. Column B of Summary
Page)
$
$
-1-
$
. ~. ~ ~ .
;,,::\~,:~, '~<t ' ~, ~'Zi'
(Inte Form)
SCHEDULE E, FORM 420 or 430
PAYMENTS
1.0. NUMBER (If COlTlTlittee)
(Amounts may be rounded off to whole dollars)
.-:)r-~T 1 - MADE TO COMMITTEES: (See information manual for directions and examples)
r:;:. FI CI.4I_
';SE OML Y
FUL.L. NAME Or PAYEe CO~TTEE AND 1.0. NUMBER (If the committee has no I.D. Number,
state full name and address at the Treasurer)
-----
,lI,ttacl1 additional information on aporoprlately 13beled continuation sheets
SUBTOTAL (Carry with additional subtotals to Line 1, part 3, page 9) $
-8--
A....OUNT
THIS PERIOD
,',,-d4- t:(f".47-v ~.,., 1,0, NUMBE: 'If Commlllool
,. SCHEDU E, RM 420 or 430
(continued)
,'.f.;yr 2. - MADE TO OTHERS: (See information manual for directions and examples)
F!JLI_ NAMe AND ADDRESS OF PAYEE*
(:ltrcet, City, State)
DESCRIPTION OF PAYMENT
AMOUNT
THIS PERIOD
/13, ;; Y
"ttach additional infonnation on appropriately labElled continuation sheets
SUBTOTAL (Carry with additional subtotals to Line 3, part 3) $
I *If the person providing the goods or services was different than the payee, list each person's name and ad~~sl
POSTAGE METER NO.
Enter your bulk rate and/or postage meter numbefused in campaign mass
mailings. In addition a copy of each mass mailing should be sent to the
Fair Political Practices Commission.
OULK RATE NO.
?ART 3 - SUMMARY OF PAYMENTS (See information manual for directions and examples)
1. MADE TO COMMITTEES THIS PERIOD (Part 1) Include all Subtotals
2. MADE TO COMMITTEES UNDER $50 THIS PERIOD (Not Itemized)
3. MADE TO OTHERS THIS PERIOD (Part 2) Include all Subtotals
4. MADE TO OTHERS UNDER $50 THIS PERIOD (Not Itemized)
5. TOTAL ACCRUED EXPENSES PAID THIS PERIOD (Schedule F, Line 4)
6. TOTAL PAYMENTS THIS PERIOD (Lines 1 + 2 + 3 + 4 + 5, Enter this
total on line 8, Column B of Summary Page)
$J~,'7Y
.,
$~,
-9-
:\'";'::/1,,, _ __.
1.0. NUMBER (It Committee)
(Interim Form)
SCHEDULE F, FORM 420 or 430
ACCRUED EXPENSES (Urtpaid Bills)
(Amounts may be rounded off to whole dollars)
S<j~ 'nformation manual for directir.ns and examples
,------- AMOUNT
FULL NAME AND ADDRESS DESCRIPTION OF ACCRUED
ISt:~t, City, State)* ACCRUED EXPENSES THIS PEr~I(,[J
-- .---- .__.,~
----, --'_0 ~~
. ..- ---
--- - -~
-- -. . ...~-
-
.,-_.
..
-
Attach additional infonnation on appropriately labeled continuation sheets.
SU BTOT AL $
L....--.%>....,.........~~,
*If the accrued expense is owed to a committee, list the committee's name and 1.0. number (or the full name and address of
the treasurer). If the person providing the goods or services was different from the payee, list each person's full name, street
address ci and state.
SUMMARY
1. ACCRUED EXPENSES OF $50 OR MORE THIS PERIOD. Include all Subtotals
2. ACCRUED EXPENSES OF UNDER SOO THIS PERIOD. (Not Itemized)
3. TOTAL ACCRUED EXPENSES INCURRED THIS PERIOD (Line 1 + 2)
4. ACCRUED EXPENSES PAID n'lIs PERIOD (Not Itemized, Enter on Line 5, Part 3, Schedule E)
5. NET CHANGE THIS PERIOD (Line 3-4, Enter on Line 9, Column B of the Summary Page,
This may be a negative amount)
$
$
~;:e~~
-10 -