William Childers - 1975/02/17 - 1975/03/04
'.
(Interim Fonn)
CANDIDA TE'S
CAMPAIGN STATEMENT
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1st day to file: 5-1-75
Last'day: 5-8-75
GOVERNMENT CODE SEC.TION 84200 - 84214
C:orm 430
Statement covers period frorr2-17-75 through3-4-75*
receipts following election.
POLITICAL PARTY AND DISTRICT NUMBER (It Applicable) TOTAL PAGI;:S T IS REPORT
I LIST ALL COMMITTEES SUBJECT TO YOUR CONTROL WHICH HAVE RECEIVED CONTRIBUTIONS OR MADE
EXPENDITURES ON BEHALF OF YOUR CANDICACY
(A controlled committee is one which is controlled directly or indirectly by you or which acts jointly with you or one of your controlled
committees in connection with the making of expenditures. You control a committee if you, your agent or any other committee you
control has significant influence on the actions or decisions of the committee.)
COMMITTEE NAME
AND 1.0. NUMBER
COMMITTEE
ADDRESS
TREASURER
ADDRESS
PHONE
NUMBER
Attach additional information on appropriately labeled continuation sheets.
II LIST ALL ADDITIONAL COMMITTEES OF WHICH YOU HAVE KNOWLEDGE WHICH HAVE RECEIVED
CONTRIBUTIONS OR MADE EXPENDITURES ON BEHALF OF YOUR CANDIDACY
COMMITTEE NAME COMMITTEE PHONE
AND 1.0. NUMBER ADDRESS TREASURER ADDRESS NUMBER
.1'Lh AM .f}
Attach additional information on appropriately IFlbeled continuation sheets.
C
VERIFICATION
D
E
I declare under penalty of perjury that to the best of my knowledge this statement and its attached
schedules are true, correct, and complete and that I have used all reasonable dj ligence in their preparation.
F
Executed apJ'1--tr.t
(DATE)
by .IL)~~ ~r) o~
(SIGNATURE OF CANDIDATE)
-1-
SUMMARY PAGE
Name/u</ff~ g:~ {~aJrA/ .
1.0. Number 7 ~t-'juq I
(It Committee)
RECEIPTS
1. Monetary contributions (Line 5, Part 3 of Schedule A)
2. Unpaid loans (Line 9, Part 3 of Schedule B)
3. Miscellaneous receipts (attach explanation)
4. Total monetary contributions, Net cash receipts (Lines 1+2+3)
5. Non-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)
COLUMN A
Cumulative
total from
previous period
COLUMN 8
This period
$ /~I~~ $Ib,~
(Total at beginning
. of period)
(Net change
for period)
$ /'~-9(:t:c-' 0 $ ro.E-S)
,.-
r
(Total at beginning
of period)
$ /~trf!.O $
$
(Total at beginning
of period)
$
(Net change
for period)
~ ,,~~J
0.--
.
~
COLUMN C
Cumulative
to date
s/6' 7~----
(Column A +
Column B)
(Total at end
of period)
(Column A +
Colurm B)
$ / ~ h'-f-~
(Column A+
Column B)
(Column A+
Column B)
(Total at end
of period)
$47~f-
(Colurm A +
Column B)
$ /-16f 'f l $ J4ttt3' ~#-' ?
(Column A +
Column B)
C
(Net change
for period)
L)
(Total at end
of peri od)
$,J4-/J-~ '7 $,~tf.~4- '7
( olurm A+
Column B)
STATEMENT OF CHANGES IN FINANCIAL CONDITION
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)
16. Surplus (if Line 14 is greater than Line 15, subtract
Line 15 from Line 14)
17. Deficit (if Line 15 is greater than Line 14, subtract
Li ne 14 from Li ne 15)
-2-
$ /1,ff-17
1.5 t?~
/ ,i,I 4:1". /f 7
0
0
$ 0
$ ( CJ
. N~\ME' .il ) ~~Q~ ~ ~, r1J!:.f~ I.D. NUMBER (If Corrmittee) ,7// ~~ (/1
(Interim F onn)
SCHEDULE A, FORM 420 or 430
MONETARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
PART 1 - RECEIVED FROM COMMITTEES: (See information manual for directions and examples)
f,
DATE FULL NAME AND ADDRESS OF COMMITTEE 1.0. NUMBER OR TREASURER'S AMOUNT CUMULATIVE
(Street, City. State) FULL NAME AND ADDRESS RECEIVED TO DATE
fA) ,~ !X_
l r
/
ATTACH ADDITIONAL INFORMATION ON APPROPRIATELY LABELED CONTINUATION SHEETS
SUBTOTAL (Carry with additional Subtotals to line 1, part 3, page 4) $
-3-
r 7.' ~
NAMELUli!},.N~ ,
{!PdAJ,L~ 1.0. NUMBER (If Corrvnittee) 7~10 8 { ,
SCHEDULE A, FORM 420 or 430
(continued)
"
PART 2 - RECEIVED FROM OTHERS: (See information manual for directions and examples)
DATE
FULL NAME AND ADDRESS (Street
City, State) OF CONTRIBUTOR*
OCCUPATION
EMPLOYER (IF CONTRIBUTOR IS
SELF-EMPLOYED LIST STREET
ADDRESS & CITY OF BUSINESS)
AMOUNT
RECEIVED
CUMULATIVE
AMOUNT
~~
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'ft c)--V
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>I: If the contribution was made by an intermediary provide the information for both the intermediary and the principal
contri butor.
Attach addi tional information on appropriately labeled continuation sheets
SU BTOTAL (Carry with additional Subtotals to line 3. part 3) $
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. 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 CONTRIBUTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line 1, Column B of Summary Page)
$
/ fJ~cr 6 ~ {,);~
'to 0 (
$ J t: 7S. () e
.
-4-
~~E . iAJ ~~ ~: (] .R~LlL
10 NUMBER (If corrmitteel 7jZ'\6;?/R/
(Interim Form)
SCHEDULE Bf FORM 420 or 430
LOANS
(Amounts may be rounded off to whole dollars)
PART 1 - LOANS RECEIVED: (see information manual for directions and examples)
DATE
FULL NAME AND ADDRESS OF LENDER
AND ANY GUARANTORS OR COSIGNERS
EMPLOYER (It self-employ'OO
list street address and City
of business.)
AMOUNT OF
LOAN
Inter-
est
Rate
OCCUPATION
Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL $
CUMULATIVE
AMOUNT
PART 2 - LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY:
(see information manual for directions and examples)
(a)
(b)
(c)
(d)
AMOUNT AMOUNT PAID
DATE FULL NAME AND ADDRESS AMOUNT F-ORGIVEN BY A THIRD UNPAID
REPAID ~Enter on PARTY (Enter BALANCE
ched. A) on Schoo, A)
n\{~
I ~. ::.--
~
Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL $
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 PAID 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)
-5-
s~
$ .
$
$
$
'\ . c/- t;'; {/k~J2I!i
NA~lE {~{J tLfi~ . '.rA L
1.0. NUMBER (If Committee)
7f'125(j ,
(Interim Form)
SCHEDULE C, FORM 420 or 430
NON.MONET ARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
See information manual for directions and examples
DESCRIPTION OF FAIR MARKET CUMULATIVE
FULL NAME AND ADDRESS AND EMPLOYER*
DATE OCCUPATION CONSIDERATION VALUE AMOUNT
J.D. NUMBER (If Comnittee) RECEIVED
Jt/JX
,
..-_.,~.~
,-----------
AI....dl addi tional information on appropriately labeled continuation sheets
SUBTOTAL $
'" If contributor is self-employed list street address and city of business
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) $
/
-6-
~\ME /J.) J ~ t: ~ ,RJ ~ M- 10 NUMBER(lf corrmittee) 7 ~(5-oi/
. (Interim Form)
SCHEDULE D, FORM 420 or 430
PLEDGES
(Amounts may be rounded off to whole dollars)
See information manual for directions and instructions
(a)
(b)
(c)
EMPLOYER* AMOUNT AMOUNT CUMULATIVE
DATE FULL NAME AND ADDRESS OCCUPATION PLEDGED PAID (Enter PLEDGE
AND 1.0. NUMBER (It committee) THIS PERIOD on Sched. A) UNPAID
~\ !J-
Attach additional information on appropriately labeled continuation sheets
SUBTOTAL $
* 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 THIS 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) $
-7-
NAME fJ );~. ~ f.: e/j't;jJA/- 1.0. NUMBER 'If Coom"".(;7'f0'2J 1/
(Interim Form)
SCHEDULE E, FORM 420 or 430
PAYMENTS
(Amounts may be rounded off to whole dollars)
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PART 1 - MADE TO COMMITTEE.S: (See information manual for directions and examples)
OFFICIAL
USE ONLY
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Attach additional info
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FULL NAME OF PAYEE COMMITTEE AND 1.0. NUMBER (It the committee has no 1.0. Number, AMOUNT
state full name and address of the Treasurer) THIS PERIOD
-
nnation on appropriately labeled continuation sheets
SUBTOTAL (Carry with additional subtotals to Line 1, part 3, page 9) $
-8-
~"'E t{ (1ILb.- f: rJdtJ!tfu ~ -. '.0. NUMBER '" ",,","moo' 11$7;1;
SCHEDULE E, FORM 420 or 430
(continued)
PART 2 - MADE TO OTHERS: (See information manual for directions and examples)
FULL NAME AND ADDRESS OF PAYEE*
(Street, City, State)
DESCRIPTION OF PAYMENT
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7~t
'U~
a'iU~J
t2du~
,
fl!tc~ 7J~/1d
Attach additional information on appropriately labeled continuation sheets
SUBTOTAL (Carry with additional subtotals to Line 3, part 3) $
AMOUNT
THIS PERIOD
',~
..#6
;2a&6
./0
3S?J~
C;b,~
0t). 'Z V
/CJJ,o ()
/ L/--t3 '17
*If the person providing the goods or services was different than the payee, list each person's name and address.
BULK RATE NO.
Enter your bulk rate and/or postage meter number used in campaign mass
mailings. In addition a copy of each mass mailing should be sent to the
Fair Political Practices Commission.
L
POSTAGE METER NO.
PART 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, Col umn B of Summary Page)
-9-
$
I t.j.t,3 ~ 7
14(,3,..;1
$ / /ft3- ~7
rlit f 1/;.@
NAME';" J L~-~-, . C, ;.' AA-
I.D. NUMBER (If Committee)
1~6u(; .~.
t
.
(Interim Form)
SCHEDULE F, FORM 420 or 430
ACCRUED EXPENSES (Unpaid Bills)
(Amounts may be rounded off to whole dollars)
See Information manual for directions and examples
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DESCRIPTION OF AMOUNT
FULL NAME AND ADDRESS ACCRUEO
(Street, City, State)* ACCRUED EXPENSES THIS PERIOD
t1( ;!Z - ~.....""
?---
Attach additional information on appropriately labeled continuation sheets.
SUBTOTAL $
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*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, city and state.
SUMMARY
1. ACCRUED EXPENSES OF $50 OR MORE THIS PERIOD. Include all Subtotals
2. ACCRUED EXPENSES OF UNDER $50 THIS PERIOD. (Not Itemized)
3. TOTAL ACCRUED EXPENSES INCURRED THIS PERIOD (Line 1 + 2)
4. ACCRUED EXPENSES PAID THIS PERIOD (Not Itemized, Enter on Line 5, Part 3, Schedule E)
5. NET CHANGE THIS PERIOD (Line 3-4, Enter on Line g, Column B of the Summary Page,
This may be a negative amount)
$
$
$
$
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_C-st date to file: 5-1-75
Last'date: 5-8-75
Form 420
(Interim Fonn)
COMMITTEE
CAMPAIGN STATEMENT
(GOVERNMENT CODE SECTION 84200-84214)
Statement covers period Irom2-17-75 through 3-4-75*
*includes expenses & receipts
following election.
I
d//~~"." ~L~.ERJ'
~AM;:; ;OMMIT;;d .sr-
ADDRESS OF COMMITTEE
~M/",,[yA/
~
I.D. NUMBER
lAREA CODE) (PHONE NO.)
~~,,;p
d'~=z-~?~?
.JP..s~<
IS TAT E )
IZIP CODE)
4~ C,,4 6'',(''/4.-P/.) /
NAME OF TREASURER
2 '7J>.60 ~/k~ c::;/~v ~.
RESIDENTIAL ADDRESS OF TREASURER lNO. a. STREET) (CITY) r (STATE)
3 J>t> .". ~/4""eJ -4v",- ~A- #:I~~
BUSINESS ADDRESS OF TREASURER INO. a. STREET) (CITY) ISTATE)
1-r~cP -
(AREA CODE)
17"G"..P .-
(AREA CODI;:)
6 ~3"'...?~'.p)
lPHONE NO,)
y:..>2:T.2 i>
fp"..<-:) 7"~
(PHONE NO.)
lZIP CODE)
~
IZIP CODE)
~LINEl DLINE2 DLINE3 DOTHER
CHECK APPLICABLE BOX FOR MAILING ADDRESS (If other,list No. and ,Street (or P.O. Box), City, Sta e and Zip Code)
c"",e-e:!'R". ~
A
TYPE OF ELECTION (PRIMARY, GENERAL, SPECIAL' DATE OF ELECTION 'MONTH, DAY. YEAR)
TOTAL PAGES
OFFICIAL USE ONLY
ALLOCATION OF EXPENDITURES BY CANDIDATES AND MEASURES
(Allocate the totals of Schedules E and F by Candidates and Measures; Amounts may be rounded off to whole dollars)
OFFICIAL
USE ONLY
~
C
D
E
F
NAME OF CANDIDATE AND OFFICE; NAME OF BALLOT CH ECK AMOUNT OF CUMULATIVE
MEASURE AND BALLOT NUMBER OR LETTER ONE EXPENDITURES TO DATE
THIS PERIOD
a//~~M L:#)j'OER~ g SuPPORT /#~3.97 /~7O:{P
o OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSI;:
0 SUPPORT
0 OPPOSE
0 SUPPORT
0 OPPOSE
o
Attach additional 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 an~~te and tha.0 have used all reasonable diligence in their rep tion.
Executed Q --1- 1...6 at' , by
(DATE) NATURE OF TREASURER)
A candidate who controls a committee must also verify the campaign statement.
I declare under penalty of perjury that to the best of my knowledge this statement and its schedules are true,
correct and complete and the treasurer of this committee has used all r onable dilige e in the preparation
of this statement and its schedules \ r I ",
~. J
Executed 0 ,. ." at
(DATE)
by
(SIGNATURE OF CANDIDATE)
-1-
SUMMARY PAGE
~
Name
~,,/~~ cL/~;.s
7..y o:...r c?'? /
COLUMN A
COLUMN B
COLUMN C
1.0. Number
(It Committee)
Cumulative
total from
previous period
This period
Cumulative
to date
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RECEIPTS
1. Monetary contributions (Line 5, Part 3 of Schedule A)
$ /~~~ $ 80~ $/675;-
(Column A +
Column B)
'-"'"
(Total at beginning (Net change (Total at end
of period) for period) of period)
..--- --
(Column A +
Column B)
$ /:st/5: ~ $ ~" ~.:... $ /675;-
(Column A+
Column B)
(Column A +
Column B)
(Total at beginning (Net change (Total at end
of period) for period) of period)
$ /~$-;'~~ $ 80,~ $ /6'7~
(Column A+
Column B)
S S/ft,3;if7 $ /f'~3,'17
(Column A +
Column B)
-0-- .-()-
(Total at beginning (Net change (Total at and
of period) for peri ad) of peri ad)
$ $ /IjIG '1'7 $ )-V6;l1,l7
(Column A +
Column B)
2. Unpaid loans (Line 9, Part 3 of Schedule B)
3. Miscellaneous receipts (attach explanation)
4. Total monetary contributions, Net cash receipts (Lines 1+2+3)
5. Non-monetary contributions (Line 3 of Schedule C)
6. Pledges (Line 7 of Schedule D)
7. Tctal 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)
$ J33JP., ~7
75:~o
/~63.f7
--c!) -
-e;~
$ --t') -
$ (-~ -)
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 (Line 2, column C + Line 9, column C)
16. Surplus (if Line 14 is greater than Line 15, subtract
Line 15 from Line 14)
17. Deficit (if Line 15 is greater than Line 14, subtract
Line 14 from Line 15)
-2-
40
, NAME'
~/,!-'1~
C$L6E.R,5
1.0. NUMBER (If Corrmittee) 7~<>-ot? /
(Interim Form)
SCHEDULE A, FORM 420 or 430
MONETARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
PART 1 _ RECEIVED FROM COMMITTEES: (See information manual for directions and examples)
.
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DATE FULL NAME AND ADDRESS OF COMMITTEE I.D. NUMBER OR TREASURER'S AMOUNT CUMULATIVE
(Street, City, State) FULL NAME AND ADDRESS RECEIVED TO DATE
- / "7> ~'
,^/...., / ~J.-)' ,n.: -
"7l'f7jt,c -
"'7 fY. /), ,..~'V ~'7A ",- L4~.c I
)
~ #L
,
/
ATTACH ADDITIONAL INFORMATION ON APPROPRIATELY LABELED CONTINUATION SHEETS /'
SUBTOTAL (Carry with additional Subtotals to line 1, part 3, page 4) $
-3-
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NAME
Iv//kM
C#/L~~S
*
1.0. NUMBER (If Committee)7f"~1_-...:..___:_
SCHEDULE A, FORM 420 or 430 .
(continued)
PART 2 - RECEIVED FROM OTHERS: (See information manual for directions and examples)
~
FULL NAME AND ADDRESS (Street EMPLOYER (IF CONTRIBUTOR IS AMOUNT CUMULATI'V
DATE City, State) OF CONTRIBUTOR* OCCUPATION SELF.EMPLOYED LIST STREET RECEIVEO AMOUNT
ADDRESS & CITY OF BUSINESS)
-
~> ~~~/ iPV/-4-~-' P c9~ "i?y /:sC; S- I~v,~ ~SO ~.o
ftc:>. S;< ./ _~tt)..s-- ~k/ 7;,t7,7 elj G//~y
VClOh /\ '" ~ s 7' ~R.R.J' ( k S.....e...;/kl"' 7~/O /-tt'7 /;"--7 ~.... C(Sb ~'.-
75' '76"'/0 A~ /;;"'+y iT c:/ PC b_:..;;;-- 600
.-
, G'r/~y
~5' J;; CH'AI'e I> a~".v C''''''~. C-II/ ;(..,'
.. S~[R(,I,".St.')e
6d C~/ ~~A""r ~ / S'00 _-CC
7...::>/' t(.. rr; Cr/.RJj D, -
.. "ie~~ , ~ .
.
Attach additional information on appropriately labeled continuation sheets gt)/~
SUBTOTAL (Carry with additional Subtotals to line 3, part 3) $
~~
%
I
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>/: 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 CONTRIBUTIONS (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 CONTRIBUTIONS THIS PERIOD (line 1 + 2 + 3 + 4,
Enter this total on Line 1, Column B of Summary Page)
$
/59/
~..f!T
$
JI7s:q:;
-4-
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NA,\1f.: '
~i/k~M. C#/L~ERJ
ID NUMBER (If corrrnittee)7Y.5t'J? /
(Interim Form)
SCHEDULE B, FORM 420 or 430
LOANS
(Amounts may be rounded off to whole dollars)
PART 1 - LOANS RECEIVED: (see infonnation manual for directions and examples)
r
EMPLOYER (If self-emPloxed Inter.
DATE FULL NAME AND ADDRESS OF LENDER OCCUPATION list street address and c ty est AMOUNT OF CUMULATIVE
AND ANY GUARANTORS OR COSIGNERS of business.) Rate LOAN AMOUNT
---- ~,L -
,
Attach additional infonnation on appropriately labeled continuation sheets.
SU BTOT AL $
~
PART 2 - LOANS REPAID, FORGIVEN, OR PAID BY A THIRD PARTY:
(see information manual for directions and examples)
,.
AMOUNT AMOUNT PAID
DATE FULL NAME AND ADDRESS AMOUNT FORGIVEN BY A THIRD UNPAID
REPAID ~Enter on P ARTY (Enter BALANCE
ched. A) on Scheel. A)
-- ,,4// L -
Attach additional infonnation on appropriately labeled continuation sheets.
SUBTOTAL $
(a)
(b)
(c)
(d)
PART 3 - SUMMARY
1. LOANS OF $50 OR MORE THIS PERIOD (Part 1) Include all Subtotal s $
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 PAID BY A THIRD PARTY OF $50 OR MORE THIS PERIOD (Part 2, Column c) Include all
Subtotal s
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) $
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(Interim Form)
SCHEDULE C, FORM 420 or 430
NON-MONETARY CONTRIBUTIONS
(Amounts may be rounded off to whole dollars)
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DESCRIPTION OF FAIR MARKET CUMULATI\j
FULL NAME AND ADDRESS AND EMPLOYER*
DATE OCCUPATION CONSIDERATION VALUE AMOUNT
1.0. NUMBER (If COIM1IUee) RECEIVED
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SUBTOTAL $
* If contributor is self-employed list street address and city of business
SUMMARY
1, NON-MONETARY CONTRIBUTIONS OF $50 OR MORE THIS PERIOD (Include all Subtotals) $$ =1=
2. NON-MONETARY CONTRIBUTIONS UNDER $50 THIS PERIOD (Not Itemized)
3. TOTAL NON-MONETARY CONTRIBUTIONS THIS PERIOD (Une 1 + 2, Enter on
Une 5, Column B of Summary Page)
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NAME _, .
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10 NUMBER (If coomittee) 7--rsc)J>/
(Interim Form)
SCHEDULE D, FORM 420 or 430
PLEDGES
(Amounts may be rounded off to whole dollars)
See information manual for directions and instructions
(a)
(b)
(c)
EMPLOYER* AMOUNT AMOUNT CUMULATIVE
DATE FULL NAME AND ADDRESS OCCUPATION PLEDGED PAID (Enter PLEDGE
AND I.D. NUMBER (If convnlttee) THIS PERIOD on Sched. A) UNPAID
- A// L-
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SUBTOTAL $
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* 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 THIS 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) $
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SCHEDULE E, FORM 420 or 430
PAYMENTS
(Amounts may be rounded off to whole dollars)
PART 1 - MADE TO COMMITTEES: (See information manual for directions and examples)
OFFICI AL
USE ONLY
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state fu II name and address of the Treasurer) THIS PERIOC
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SUBTOTAL (Carry with additional subtotals to Line 1, part 3, page 9) $
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SCHEDULE E, FORM 420 or 430
(continued)
I.D. NUMBER (If Committee)
7:/c527t:?/
PART 2 - MADE TO OTHERS: (See information manual for directions and examples)
FULL NAME AND ADDRESS OF PAYEE*
(Street, City, State)
DESCRIPTION OF PAYMENT
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SUBTOTAL (Carry with additional subtotals to Line 3, part 3) $
AMOUNT
THIS PER,OD
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*If the person providing the goods or services was different than the payee, list each person's name and address.
DULK RATE NO.
Enter your bulk rate and/or postage meter number used in campaign mass
mailings. In addition a copy of each mass mailing should be sent to the
Fair Political Practices Commission.
If
POSTAGE METER NO.
PART 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 8 of Summary Page)
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1.0. NUMBER (If Committee)
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SCHEDULE F, FORM 420 or 430
ACCRUED EXPENSES (Unpaid Bills)
(Amounts may be rounded off to whole dollars)
See Information manual for directions and examples
DESCRIPTION OF AMOUNT
FULL NAME AND ADDRESS ACCRUED
(Street, City I State) * ACCRUED EXPENSES THIS PERIOD
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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, street
address cit and state.
SUMMARY
1. ACCRUED EXPENSES OF $50 OR MORE THIS PERIOD. Include all Subtotals
2. ACCRUED EXPENSES OF UNDER $50 THIS PERIOD. (Not Itemized)
3. TOTAL ACCRUED EXPENSES INCURRED THIS PERIOD (Line 1 + 2)
4. ACCRUED EXPENSES PAID THIS 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)
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