Sara Nelson - 1989/10/22 - 1989/12/31
.:~
CANDIDATE AND OFFICEHOLDER CAMPAIGN STATEMENT - LONG FORM
AND
CONSOUDATEDCAMPAIGN STATEMENT
(Government Code Sections 84200-84217)
(Type or Print in Ink)
Statement covers period /0",2.2. -Bet through l.1.r J t - 89
CHECK ONE OF THE FOLLOWING BOXES TO INDICATE THE TYPE OF STA lEMENT BEING fILED
o PRE-ELECTION STATEMENT 0 SUPPLEMENTAL PRE-ElEcTION
II SEMI-ANNUAl STATEMENT STATEMENT (lffiling a Supplemental
Pre-Election Statement, you must
complete form 495 and attach it to
thIS statement.)
FORM 490
1989
o TERMINATION STATEMENT
Attach a form 415 to this form 490.
I CANDIDATE/OFACEHOLDER INCLUDED IN THIS CONSOUDATED REPORT
PAGEi OF ~
I,'." .
(],IL R (;
OFFICE SOUGHT OR HELD: (Indude IOUllon ond dt>Ulct numw.f oll\>l.uble)
COCVVC/~
NAME Of CANDIDA TEIOFfICEHOlDER:
S EL tJN
RESIDENTiAl OR BUSINESS ADDRESS: NO, AHO STRUT
an
SIAn
7'-1 3/ ~f.vu. R.~ Ju ~ -r: a ILI!../')'j LA
" CONTROUED COMMITTEE* INCLUDED IN THIS CONSOUDATED REPORT
NAME Of COMMITTEE:
9s{)~()
COtO.lt.-Il.. \NO A,u
NO. ANI) STRfU on
~HHI7fEc
STATE lll'COOE
7 <f 3/ C--Au.It.(l AJ 5 7:-
NAME Of TREASURER:
J1 ~ ,r:
fl.l.. r;.f &;;.
PERMANE T ADDRESS Of TREASURER:
G/I..l2.tJ i
fA-
9stJ,JtJ
OTY
STATE
lll'COOE
AlitA COOtI8USINlSS Pl10Nt NUMBER
<ftJI - J'1IJ1-397/
I. 0, NUMBER
9/5 ;;3
AflEA COOtIBUSlNESS PHONE NUMBtR
7' Ci! -,1'It! - .397/
ARfA CQOEI8USlNESS PHONE NUMBER
3300 ~ A/VAtJA- 12,0. Q,/1.12.0~ ~ A- 9socJo '-IaI-J>r7-3956
. A controlled committee Is one which Is controlled dl~ M indi!ecdY bv II Cllndidate M which <<1$ jointly, with II cllndidate or controlled committee in
connection with the IMklng of expent:litures. A anc/idiJte controls II committee if the CilndkMte, the CilnGic:Nte's .nt. (K IIny other committee he or
she controls, has signifiCilnt influence on the iJCtIons M decisions of the committee. .
III OTHER COMMITTEES: UST ANY OTHER COMMITTEES NOT INCLUDED IN THISCONSOUDA TED STATEMENT WHICH
ARE CONTROUED BY YOU AND ANY COMMITTEES PRIMARILY FORMED TO RECEIVE CONTRIBUll0NS OR MAKE
EXPENDITURES ON BEHALF OF YOUR CANDIDACY
CONTROLLED
COMMITTEE NAME AND 1.0. NUMBER COMMITTEE ADDRESS TREASURER COMMITTEE?
yts NO
Attach additioniIl information on IIpproprilltely IlIbeled continuiltion sheets.
VERlACA 110N
CANDIDATE OR OffICEHOLDER:
I HAVE USED AU REASONABLE DILIGENCE AND TO THE lEST Of MY KNOWlEDGE THE TREASURER HAS USED ALL REASONABLE DILIGENCE IN
PREPARING THIS STATEMENT. I HAVE REVIEWED THE STATEMENT AND TO THE lEST OF MY 1CN000EDGE THE INfORMATION CONTAINED
HEREIN AND IN THE ATTACHED SCHEDULES IS TRUE AND COMPlETE. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS Of THE STATE OF
CAUfORNIATHATTHE FOREGOING IS TRUE AND CORRECT. . ~ ~
EXECUTEDON tP~/90 AT (;/l.~ ~A ~.d-~_~
(DAnl . 0 STATEI ( ruu Of UIIOI ATE 011 Of HOI.OERI
TREASURER (if IIppliable):
I HAVE USED ALL REASONABlE DIUGENCE IN PREPARING THIS STATEMENT AND TO THE BEST OF MY KNOWLEDGE THE INFORMATION
CONTAINED HEREIN AND IN THE ATTACHED SCHEDULES IS TRUE AND COMPlETE.
I CERTIFY UNDER PENAL TV Of PERJURY UNDER THE LAWS OF THE STATE Of CALIFORNIA THAT THE fOREGOING IS TRUE AND CORRECT.
"'EC'JlfDOtI 1/:'-;/90 AT GI;:':'J..".(~ ,v'hr, ~...J.~
.
,
PAGE
;l;
OF /7
ALLOCATION PAGE
FORM 490
STATEMENT COVERS PERIOD
FROM THROUGH
9
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
5AfJ.A ~.
I.D. NUMBER
LIST CONTRIBUTIONS AND INDEPENDENT EXPENDITURES TOTALING $100 OR MORE MADE FROM THE CANDIDATE'S OR OFFICEHOLDER'S PERSONAL
FUNDS TO SUPPORT OR OPPOSE OTHER OFFICEHOLDERS, CANDIDATES AND COMMITTEES. (SEE INSTRUCTIONS ON REVERSE.)
IND" NAME OF CANDIDATE. OFFICEHOLDER OR COMMITTEE CHECK ONE AMOUNT CUMULATIVE
DATE EXP. TO DATE
SUPPORT OPPOSE
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
S
- CALENDAR YEAR
. . -0 ~ $
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
S
*See reverse regarding independent expenditures. SUBTOTAL $ -
'"
SUMMARY',
1. CONTRIBUTIONS OF $100 OR MORE MADE THIS PERIOD OUT OF PERSONAL FUNDS $-
(Include all Allocation Page Subtotals) ...... ............ ............ ....... .............. ........................ ......
2. CONTRIBUTIONS UNDER $100 MADE THIS PERIOD OUT OF PERSONAL FUNDS (Not
itemized) .................... ..... ...... ..........................."................. .............................:................-
-
3. TOTAL CONTRIBUTIONS MADE THIS PERIOD OUT OF PERSONAL FUNDS (Do Not carry $_
this total to the Summary Page) ................ ................. ......... ................. ........ ..... ........ ....... .....
CAMPAIGN DISCLOSURE STATEMENT SUMMARY PAGE
FORM 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
"AI
CONTRIBUTIONS RECEIVED
1. Monetary contributions. . . . . . . . . . . . - . . _ . . . . .
2. loans received. ....... .......... ... -. ......
COLUMN A
Cumulative total
from previous period *
COLUMN B
Total this period from
attached schedules
$ I ~/~....
SCHEDULE A. LINE 3
$ J()77-
SCHEDULE B. LINE 7
3. SUBTOTAL CASH RECEIPTS -.. -.... -......... $ fO??-
LINES T + 2
4. Non-monetary contributions. . . . . - . . . .'. . . . . .
5. TOTAL CONTRIBUTIONS WITHOUT
ENFORCEABLE PROMISES. . . . . _ . . . . . .. - . . - . .
6. Enforceable Promises (Except loan
guarantees, see Line 18 below)... ...........
7. TOTAL CONTRIBUTIONS. . . . . . . . . . _ . . . . . . . . .
EXPENDITURES MADE
8. Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Loans Made. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. SUBTOTAL................................
". Accrued expenses (unpaid bills) . . . . . . . . . . . . .
12. TOTAL EXPENDITURES........... _....... ','
$ J!q3.:~-
LINES 1 + 2
PAGE .3
OF /7
SCHEDULE C. LINE 3
ItJ 7'1 -.
LINES 3 + 4
/{,,13 -
LINES 3 + 4
STATEMENT COVERS PERIOD
FROM THROUGH
/O/~/f1
J,2!J/ ;,P
to. NUMBER
COLUMN C
Cumulative to date
(ColumnsA + B)
$ o17t,(j-
$ :J?/,fJ-
LINES T + 2
d 71D()-
LINES 3 + 4
$ j 7/A () -
LINES 5 + 6
(SHOULD EQUAL LINE 7.
COLUMNS A + B)
$ ~ 7 ~~ -
-
~?3 iD -
LINES 8 + 9
~/7-
$ L~ 0;)3 -
LINES 10 + TT
(SHOULD EQUAL LINE 12.
COlUMNS A + B)
$ 1077-
SCHEDULE O.lINE 7
$ II.J.~ -
*IF THIS IS THE FIRST REPORT FILED FOR THE CALENDAR YEAR, COLUMN A SHOULD BE BLANK
EXCEPT FOR LINES 2. 6. 9 AND 11.
LINES 5 + 6
LINESS+6-
.
1.Jo 7 -
$ /9dCJ-
SCHEDULE E. LINE 5
-
f() 7 -
, lINES8 + 9
4J1tJ -
$ /d/7-
LINES 10 + 11
SCHEDULE EE. LINE 7
Jq~9 -
lINES8 + 9
< J 9.3 - >
SCHEDULE F. LINE 5
$ 17.~/f)-
LINES 10 + IT
STATEMENT OF CHANGES IN FINANCIAL CONDITION
13. Cash on hand at the beginning of this period. (Enter "Cash on hand
at end of reporting period" from previous statement filed.) ........
14. Cash receipts this period (Line 3, Column B above) . . . . . . . . . . . . . . . . . . .
15. Miscellaneous increases to cash (Schedule G, Line 4) .................
16. Cash payments this period (Line 10, Column B above) . . - - . . . . . . . . . . . .
17. Cash on hand at end of reporting period (Lines 13 + 14 + 15 - 16 above)
(If this is a Termination Statement, line 17 must be Zero.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18. Amount of loan guarantees received (Schedule B, Part I, Column (b)). . . . . . . . . . . . . . . . . . . . . . .
19. Cash equivalents (other assets held including outstanding loans made to others).
Important: See instructions on reverse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - . . . . . . . . . . . . . . . -
Outstanding debts (Line 2 + Line 11 of Column C above). .. . .. . . . . . . . . . . . . . . . . . . . . . .. . .. . . .
20.
$
~ 7D -
J~f3.-
$ dY-
ENDING CASH ON HANO SHOULD
NOT BE A NEGATIVE AMOUNT
$
$
$
-
d.P7-
-
19~'1 -
1/1 THRU 6130
SUMMARY FOR CANDIDATES IN BOTH AJUNE AND NOVEMBER ELECTION (SeelnstructionsonReverse)
21. CONTRIBUTIONS RECEIVED:
22. EXPENDITURES MADE:
711 TO DATE
, '
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE Lf
OF /7
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
C. Ne
DATE
REC'D.
FULL NAME AND ADDRESS OF CONTRIBUTOR
OCCUPATION
EMPLOYER
AMOUNT
(IF COMMITTEE, IN ADDITION TO COMMmEE'S NAME AND ADDRESS.
ENTER 1.0. NUMBER OR. IF NO 1.0. NUMBER HAS BEEN ASSIGNED.
ENTER THE TREASURER'S NAME AND ADDRESS)
(IF SELF.EMPlOYEO. ENTER
NAME OF BUSINESS)
Occupation:
, i/;'() /19
SA Il It c.. AI. <.,t ow
7 V j I ~j1.f.A. fl..~J.v S -r:
GI/..I~-O CA- 950~()
J1AfJ..!j 8. K'AZ. 4A1J ,'a. 10
lJ I n;;t.t) S'r:.
~/( ~O~, e. '" 9S0"fJ
N/A
Employer:
CE~rrf.( ..
IO/~1, /19
Employer:
Occupation:
Employer:
RECEIVED CUMULATIVE
THIS PERIOD TO DATE
'7,p/-
CALENDAR YEAR:
$ I~/-
FISCAL YEAR:
$ I~ I -
,a;"o~ -
CALENDAR YEAR:
$ tP(){)-
FISCAL YEAR:
S CJ~(J-
CALENDAR YEAR:
Occupation:
LENDAR YEAR:
Employer:
Occupation:
LENDAR YEAR:
Employer:
Occupation:
Employer:
lENDAR YEAR:
Occupation:
Employer:
. ~_:f,
SUBTOTAL
FISCAL YEAR:
$
$ 9~/-
~Tn~nTn...nn"""""""''''''''''''''''''''
.'
. '?,' .... " .::-~~:. '; .~:...,
SUMMARY
1. AMOUNT RECEIVED THIS PERIOD - CONTRIBUTIONS OF $100 OR MORE
(Include all Schedule A subtotals) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. AMOUNT RECEIVED THIS PERIOD - CONTRIBUTIONS OF lESS THAN $100 (Not
itemized). . . . . . . . . . .. _ . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . .
3_ TOTAL MONETARY CONTRIBUTIONS RECEIVED THIS PERIOD
(line 1 + line 2) Enter here and on line 1. Column B of Summary Page. . . . . . . . . . . . . .
$ Cj ~l -
7~~-
$ /'/.3-
SCHEDULE A
: MONETARY CONTRIBUTIONS RECEIVED
(CONTINUATION SHEET)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE S OF /7
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
~
1.0. NUMBER
!?15~3
DATE
REC'D.
FULL NAME AND ADDRESS OF CONTRIBUTOR
OCCUPATION
EMPLOYER
AMOUNT
(IF COMMITTEE, IN ADDITION TO COMMmEE'S NAME AND ADDRESS,
ENTER 1.0. NUMBER OR. IF NO 1.0. NUMBER HAS BEEN ASSIGNED,
ENTER THE TREASURER'S NAME AND ADDRESS)
RECEIVED CUMULATIVE
THIS PERIOD TO DATE
Employer:
CALENDAR YEAR:
$
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
LENDAR YEAR:
Employer:
Occupation:
lENDAR YEAR:
Employer:
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
LEN OAR YEAR:
Employer:
Employer:
Occupation:
lENDAR YEAR:
Employer:
Occupation:
LENDAR YEAR:
Occupation:
LENDAR YEAR:
$
Employer: FISCAL YEAR:
$
. . '" .,. ."
~.. . .. . ","
~ .... ,"",
, , ,
2~.~:... :....~... ,<~...;:~:~
~~~~~~~~i~~~~~;~~~~~\
SUBTOTAL $ .-.
SCHEDULEB -- LOANS RECEIVED (PART 1)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
SA Q..,A C.
PART I: LOANS RECEIVED
DATE
REC'D.
FULL NAME AND ADDRESS OF LENDER
OCCUPATION
EMPLOYER
INT.
. RATE
(IF COMMlllEE, IN ADDITION TO COMMIllEE'S NAME AND ADDRESS,
ENTER 1.0. NUMBER OR. IF NO 1.0. NUMBER HAS BEEN ASSIGNED.
ENTER THE TREASURER'S NAME AND ADDRESS)
(If SELf.EMPLOYED. ENTER
NAME Of BUSINESS)
OccupatIOn:
Employer:
Occupation:
Employer:
SUBTOTAL
~~~~~~
FUll NAME AND ADDRESS OF GUARANTOR
OCCUPATION
EMPLOYER
(If SELf-EMPlOYED. ENTER
NAME Of BUSINESS)
OccupatIon:
(If COMMlllEE, IN ADDITION TO COMMlllEE'S NAME AND ADDRESS.
ENTER 1.0, NUMBER OR,lf NO 1.0, NUMBER HAS BEEN ASSIGNED,
ENTER THE TREASURER'S NAME AND AOORESSI
: NAME Of LENDER
Employer:
: NAME Of LENDER
Occupation:
Employer:
SUBTOTAL
00 NOT CARRY THIS AMOUNT TO THE
SUMMARY BELOW. ENTER ON LINE lB
OF THE SUMMARY PAGE.
SUMMARY
1. LOANS OF $100 OR MORE RECEIVED THIS PERIOD (Part 1 (a))........... -..........
2. LOANS UNDER $100 RECEIVED THIS PERIOD (Not itemized). . . . . . . . . . . . . . . . - . . . . . - .
3. TOTAL LOANS RECEIVED THIS PERIOD (line 1 + 2).... ................ -...,.. -....
4. lOANS OF $100 OR MORE REPAID, FORGIVEN OR PAID BY A THIRD PARTY
THIS PERIOD (Part 2, Column (c)) . . . . . - . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . .
5. LOANS UNDER $100 REPAID, FORGIVEN OR PAID BY A THIRD PARTY
(not previously itemized) (If forgiven or paid by a third party, also enter
amount on line 2 of the summary section of Schedule A). . . - . . . . . . . . . . . . . . . . . . . . . .
6. TOTAL LOANS REPAID, FORGIVEN OR PAID BY A THIRD PARTY THIS PERIOD
(line 4 + 5). . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . - . . . . . . . .
7. NET CHANGE THIS PERIOD (Subtract line 6 from line 3)
Enter the difference here and on line 2, Column B of Summary Page. . . . . . . . . . . . . . .
PAGE 0
OF /7
STATEMENT COVERS PERIOD
FROM THROUGH
I.D. NUMBER
DUE
DATE
AMOUNT CUMU-
OF LOAN LA TIVE
TO DATE
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
(a)
$ -
AMOUNT
UARANTEED
THIS CUMU-
PERIOD LATIVE
TO DATE
CALENDAR YEAR
S
FISCAL YEAR
S
CALENDAR YEAR
S
FISCAL YEAR
S
(b)
$ --.
(Mav be neg-
atlv~ fig u rei
SCHEDULE B -- LOANS RECEIVED (PART 1)
(CONTINUATION PAGE)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
$ ~. EI..J,AJ
PART I: LOANS RECEIVED
DATE
REC'D,
FUll NAME AND ADDRESS OF LENDER
(If COMMITTEE. IN AOOITION TO COMMITTEE'S NAME AND ADDRESS.
ENTER 1.0, NUMBER OR. If NO 1.0. NUMBER HA' BEEN ASSIGNED.
ENTER THE TREASURER'S NAME AND ADDRESS)
FUU NAME AND ADDRESS OF GUARANTOR
(If COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS.
ENTER 1.0. NUMBER OR. If NO 1.0. NUMBER HAS BEEN ASSIGNED,
ENTER THE TREASURER'S NAME AND ADDRESS)
NAME OF LENDER
NAME OF LENDER
NAME OF LENDER
NAME OF LENDER
OCCUPATION
EMPLOYER
(If SELF-EMPLOYED. ENTER
NAME Of BUSINESS)
Occupatlun:
Employer:
Occupation:
Employer:
Occupation:
Employer:
SUBTOTAL
PAGE
7
OF 11
1.0. NUMBER
9/S~
INT, DUE AMOUNT
RATE DATE OF LOAN
~_.__._T_n,_.~_-:-.-~
, ,
, ,
','
<
v;
. ' ,~~
OCCUPATION
EMPLOYER
(If SELf-EMPlOYED, ENTER
NAME Of BUSINESS)
Occupation:
Employer:
Occupation:
Employer:
Occupation:
Employer:
Occupation:
Employer:
SUBTOTAL
(a)
-
AMOUNT
ARANTEED
THIS CUMU-
PERIOD LATlVE
TO DATE
CALENDAR YEAR:
S
fiSCAL YEAR:
S
CALENDAR YEAR:
S
fiSCAL YEAR:
S
CALENDAR YEAR:
S
fiSCAL YEAR:
S
CALENDAR YEAR:
S
fiSCAL YEAR:
S
(b)
-
$
CUMU-
LA TIVE
TO DATE
CALENDAR YEAR:
S
FISCAL YEAR:
S
CALENDAR YEAR:
S
fiSCAL YEAR:
S
CALENDAR YEAR:
S
fiSCAL YEAR:
S
.SCHEDULE B -- LOANS RECEIVED (PART 2)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE
p
OF /7
1.0. NUMBER
? /S~3
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
~
PART 2: LOAN REPAYMENTS MADE, LOANS FORGIVEN OR PAID BY A THIRD PARTY
DATE OF
REPAY-
MENT OR
FORGIVE-
NESS
DATE OF
ORIGINAL
LOAN
FULL NAME OF lENDER
INT,
RATE (If FORGIVEN* REPAID BY
CHANGED) THIRD
PARTY*
AMOUNT REPAID
OR FORGIVEN ON
PRINCIPAL (DO NOT
INCLUDE PAYMENT
OF INTEREST)
OUTSTANDING
PRINCIPAL
INTEREST
PAID**
* IMPORTANT: IF ANY PART OF A lOAN IS FORGIVEN OR REPAID BY A THIRD PARTY, THE PERSON
FORGIVING THE LOAN OR THE THIRD PARTY MAKING THE PAYMENT AND THE AMOUNT
FORGIVEN OR PAID MUST BE ITEMIZED ON SCHEDULE A, WITH A NOTATION
THAT IT IS A FORGIVEN LOAN, OR THIRD PARTY REPAYMENT OF LOAN SUBTOTAL
(C)
l~::i31
$
-
(d)
**TOTAl All INTEREST PAID THIS PERIOD, ALSO ENTER
ON LINE 3 Of THE SUMMARY SECTION Of SCHEDULE E.
00 NOT CARRY THIS TOTAL TO THE SCHEDULE B SUMMARY,
TOTAL INTEREST PAID $
THIS PERIOO
-
SCHEDULE B -- lOANS RECEIVED (PART 3)
ANNUAL REPORT OF OUTSTANDING lOANS RECEIVED
FORM 490
PAGE 9
OF /7
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
1.0. NUMBER
PART 3 - ANNUAL REPORT OF OUTSTANDING LOANS RECEIVED - SEE INSTRUCTIONS ON REVERSE BEFORE COMPLETING.
FULL NAME OF THE lENDER
ORIGINAL DATE
OF LOAN
AMOUNT OF
ORIGINAL LOAN
UNPAID
PRINCIPAL
UNPAID
INTEREST
TOTAL $
(NOTE: THIS TOTAL
SHOULD BE THE SAME
AMOUNT AS ENTERED
ON LINE 2. COLUMN C
OF THE SUMMARY PAGE,)
SCHEDULE C
NON-MONETARY CONTRIBUTIONS RECEIVED
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE 10 OF /7
STATEMENT COVERS PERIOD
FROM THROUGH
9
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
c., WE
1.0. NUMBER
19/s~3
DATE
REC'D.
FULL NAME AND ADDRESS
OF CONTRIBUTOR
(IF COMMITTEE. IN ADDITION TO COMMITTEE'S
NAME AND ADDRESS. ENTER 1.0 NUMBER
DR. IF NO 1.0, NUMBER HAS BEEN ASSIGNED,
ENTER THE TREASURER'S NAME AND ADDRESS)
OCCUPATION
EMPLOYER
DESCRIPTION OF
GOODS OR SERVICES
FAIR
MARKET
VALUE
RECEIVED
CUMU-
LA TIVE
AMOUNT
(IF SELF-EMPlOYED, ENTER
NAME OF BUSINESS)
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
CALENDAR YEAR:
$
Employer:
Occupation:
FISCAL YEAR:
$
CALENDAR YEAR:
$
Employer:
Occupation:
FISCAL YEAR:
$
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
$
. ~~"
SUBTOTAL
$
~, ...
~ .. ...... .' ::.'
~ -" .....~.: ~:.
, ,
. .. . ,'.
t" :,~:"d~~*~;~i>~;,,::~i~
SUMMARY
1. NON-MONETARY CONTRIBUTIONS OF $100 OR MORE RECEIVED THIS PERIOD. . . . . . . . $
2. NON-MONETARY CONTRIBUTIONS UNDER $100 RECEIVED THIS PERIOD (Not
itemized). . . . . . . . . . . . . . . . . . . . . . . . . . _ . - . . . . - . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. TOTAL NON-MONETARY CONTRIBUTIONS RECEIVED THIS PERIOD
(line 1 + line 2) Enter here and on line 4 Column B of Summary Page. . . . . . . . . _ . . . . _ $
SCHEDULE D
ENFORCEABLE PROMISES RECEIVED
(Other Than Loan Guarantees,
Loan Endorsements and Loan Security)
FORM 490
NOTE: Loan guarantees, loan endorsements and loan security are
"enforceable promises." However, such promises must
be reported on Schedule 8, NOT Schedule D.
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
SAfLA C# NEL-$f},J
PAGE II
OF 17
1.0, NUMBER
f?/s~
DATE
REC'D.
FULL NAME AND ADDRESS
OF CONTRIBUTOR
(IF COMMITTEE. IN ADDITION TO COMMITTEE'S
NAME AND ADDRESS, ENTER 1.0 NUMBER
OR, IF NO 1.0. NUMBER HAS BEEN ASSIGNED.
ENTER THE TREASURER'S NAME AND ADDRESS)
OCCUPATION
EMPLOYER
AMOUNT
PROMISED
THIS PERIOO
AMOUNT
PAID
THIS PERIOD
CUMU-
LA TIVE
AMOUNT
UNPAID
(IF SELF-EMPLOYED. ENTER
NAME OF BUSINESS)
Occupation:
(ALSO ENTER ON
SCHEDULE A)
CALENDAR YEAR:
$
FISCAL YEAR:
$
Employer:
Occupation:
CALENDAR YEAR:
$
Employer:
FISCAL YEAR:
$
Occupation:
LENDAR YEAR:
FISCAL YEAR:
$
Employer:
Occupation:
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
S
Occupation:
Employer:
CALENDAR YEAR:
S
FISCAL YEAR:
$
(a)
(b)
!..d r:~~J~
SUBTOTAL $
$
SUMMARY
1. PROMISES RECEIVED OF $100 OR MORE THIS PERIOD (Column (a))..,................
2. PROMISES RECEIVED UNDER $100 THIS PERIOD (Not itemized) . . . . . . . . . . . . . . . . . . . . . .
3. TOTAL PROMISES RECEIVED THIS PERldO (Line 1 + 2). .. .. . .. . .. .. . . .. .. . .. . .. . . ..
4. PAYMENTS ON PROMISES OF $100 OR MORE RECEIVED THIS
PERIOD (Column (b)). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S. PAYMENTS ON PROMISES UNDER $1 00 RECEIVED THIS
PERIOD (Not itemized) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , , , . . , . . . . . . . . . . .
(Also enter on Line 2 of the summary section of Schedule A)
6. TOTAL PAYMENTS ON PROMISES RECEIVED (Line 4 + 5),.,. _ _..""'..............
7. NET CHANGE THIS PERIOD (Subtract Line 6 from Line 3)
Enter the difference here and on Line 6, Column B of Summary Page. , _ , . . _ . . . . . . . . .
(lVIay be neg-
atlv~ figure)
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS {OTHER THAN LOANS} MADE
FORM 490
PAGE /,:
STATEMENT COVERS PERIOD
OF /7
(Amounts May Be Rounded To Whole Dollars)
1.0. NUMBER
'f
NAME OF CANDIDATE O~ OFFICEHOLDER AND CONTROLLED COMMITTEE:
~, C, NI-l.. N
CODES FOR CLASSIFYING EXPENDITURES
If one of the following codes is used to describe the expenditure, no written description is needed. (Note exceptions
on the back of this schedule for code "T".) Refer to the back of this schedule and the back of the Schedule E
Continuation Sheet for detailed explanations of each category.
NL N _ LITERATURE
"BN _ BROADCAST ADVERTISING
"W - NEWSPAPER AND PERIODICAL ADVERTISING
"0" -OUTSIDE ADVERTISING
"S" - SURVEYS, SIGNATURE GATHERING, DOOR- TO-DOOR
SOLICITATIONS
"F" - FUNDRAISING EVENTS
"G" - GENERAL OPERATIONS AND OVERHEAD
"T" - TRAVEL, ACCOMMODATIONS AND MEALS
"P" - PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
If one of the above codes does not accurately or fully describe the expenditure, leave the "Code" column blank and
provide a written description in the "Description of Payment" column.
IMPORTANT: Do not itemize the payment of accrued expenses on Schedule E. Report only the lump sum of these
payments on line 4 of the Summary section, below.
NAME AND ADDRESS OF PA YEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION
(IF COMMITTEE, IN AOOtTION TO COMMITTEE'S
NAME AND ADDRESS, ENTER 1.0. NUMBER
OR, IF NO 1.0. NUMBER HAS BEEN ASSIGNED, ENTER THE
TREASURER'S NAME AND ADDRESS)
CODE OR DESCRIPTION OF PAYMENT
BEN Git..I1()~E.
P. () . Idex 90S
f!O~r;.AN HILL 0A 9SfJ37
e.. D/sp~icJ0
~'1~O HtJNrE/tEy /-Iw!:j
Go ",f.{) C 9SDtPf>
BEN ft.'" t;{It~
p, O. B&)(. 90S"
M l> t-G.A-tJ J..f 1..'- c...r+ tl5'"OJ 7
8AAJAN,* Dff, 'c.~ S'fj r; it ~
1'1 t{ f AAJ 1-1, AI T (JAII.O 12A.,
C '.J~3
P CAhPAIGN All/"s~~
AI Ale. wrp..~e.4 litis
PDS{"--9e... / ~t.. E.'/HJ AJ.
G C DF f;J I~C. Fee..s
AMOUNT
PAID
RSDtJ-
43 are, -
f)-
G ~ttffl,i.s
SUMMARY
1. PAYMENTS OF $100 OR MORE MADE THIS PERIOD
(Include all Schedule E subtotals) ...... ..... .... ........ ................. .......... ............ .......... .......... ,. ....... .....
2. PAYMENTS UNDER $100 THIS PERIOD (Not itemized) ...........................................................:...
3. TOTAL INTEREST PAID THIS PERIOD ON OUTSTANDING LOANS
(Schedule B, Part 2, Column (d)) ..................................................................................................
4. TOTALACCRUED EXPENSES PAID THIS PERIOD (Not itemized) (Schedule F, Line 4) ....................
/t.j()
$ /7D'1-
3~-
-
/ 9~~ -
5. ~~~~La~: ;:;N.~~.~~~~ .~.~~~~~.~~i.~.~..l.. .~. .~.~. .~..~.~~..~.~.~~~.~~.~~.~.~~.~~.~i.~.~.~:.~~I.~.~.~.~.~~......._ $ 19:19 -
SCHEDULE E PAGE 1.3 OF /7
PA YMENTSANDCONTRIBUTIONS'.'(OTHERTHAN LOANS) MADE
(CONTINUATION SHEET)
FORM 490
(Amounts May Be Rounded To Whole Dollars) 10
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE: 1.0. NUMBER
C.
CODES FOR CLASSIFYING EXPENDITURES
If one of the following codes is used to describe the expenditure, no written description is needed. Refer to the back
of this schedule for detailed explanations of each category.
"L"- LITERATURE
"B" - BROADCAST ADVERTISING
"N" ~ NEWSPAPER AND PERIODICAL ADVERTISING
"S" - SURVEYStSIGNA TURE GATHERING, DOOR- TO-DOOR
SOLlCITA IONS
"0" - OUTSIDE ADVERTISING
"F" - FUNDRAISING EVENTS
"G" -GENERAL OPERATIONS AND OVERHEAD
"T" - TRAVEL, ACCOMMODATIONS AND MEALS
"PH - PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
If one of the above codes does not accurately or fully describe the expenditure, leave the "Code" column blank and
provide a written description in the "Descriptlon of Payment" column.
NAME AND ADDRESS OF PAYEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION
<IF COMMITTEE. IN ADDITION TO COMMITTEE'S AMOUNT
NAME AND ADDRESS, ENTER 1.0. NUMBER PAID
OR. IF NO 1.0. NUMBER HAS BEEN ASSIGNED. ENTER THE DESCRIPTION OF PAYMENT
TREASURER'S NAME AND ADDRESS) CODE OR
R-b"; Gu ~/2.le:S
3SYO He.J<.e.L PA.!.$' I-Iw.3 G Of-h ~ e.. S Up;:> lieu '-/1-
G/tLOI.4 C A- 9so~o . .
'!AiL "'S'9AJ De '.t i~ M tt...! CAHfJAlaiJ 9/-
p.o. B o;c /5"1 I L !:'91t/-S
~ I~ ~"'J ~". 9 5"' ();J.. /
W E-S .,. 1& ~'iJ it I c. Il () ~ t);v 'TII. ~ '- J1 A-/~/"ua. L/.r"T r;Je Jtt~1/1!.J ~3 L/-
10' 0 J4 ;v'-l'iEf2-. Oil-. S
'iffJ ~L..I r '7"/!!/l.. e A 9s~t;J.3
G '~IL~'). PIL. iAJrs Lt
30 n,' t> S,-. G ~of~ J1/H- h. I;".(JJ ~ fJ /' II; oS f/-
GIL.:~ ou C A 95~7J
8FtN AAI~ Of f (e e- [~rlP /tt-J G C of ':J d~;; -
VI'1 SAN AN 7'OAl/u 0 HAC.kl ~e..- &/~ AS e.
flt<-o AI.. TO. ~ t? 9'130.3
. . -
,
SUBTOTAL $10 7'.-
SCHEDULE EE
LOANS MADE TO OTHERS
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE 14/ OF /7
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
}/ AJ
PART/: LOANS MADE TO OTHERS
DATE
OF
LOAN
FULL NAME AND ADDRESS OF RECIPIENT
INTEREST
RATE
DUE DATE
AMOU NT
CUMULATIVE
AMOUNT
SUBTOTAL $ -
PART 2: LOAN REPAYMENTS RECEIVED BY THIS CANDIDATE, OFFICEHOLDER OR COMMITTEE A.ND LOANS FORGIVEN
BY THIS CANDIDATE, OFFICEHOLDER OR COMMITTEE
DATE OF
REPAY- DATE OF
MENT OR ORIGINAL
FORGIVE- lOAN
NESS
FULL NAME OF
RECIPIENT OF LOAN
FORGIVENIPAID BY THIRD PARTY
INT. E t "F ' "AI
RATE (IF FORGIVEN LOANS: n er orglven. SO
CHANGED) itemize for iven loans on Schedule E.
PAYMENTBYTHIROP~RTY: Enter name
AMOUNT REFAID OUT-
OR FORGIVEN ON STANDING
PRINCIPAL (DONOT PRINCIPAL
INCLUDE RECEIPT
OF INTEREST>
INTEREST
RECEIVED*
SUBTOTAL
(a)
$--
. ... . ... "','
. . .. .
. ." ',' c
':".. .. '.:',.... -:..~..'.~:\~..j~
" . ",:.
" " .:.,..... ".;.' .:':',
. ..' ..
:": :~,:' ,::':,: ' _-= ::'<!~\~i'1tf~
SUMMARY
1. lOANS OF $100 OR MORE MADE TH IS PERIOD (Part 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. LOANS UNDER $1 00 MADE THIS PERIOD (Not itemized). . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. TOTAL LOANS MADE (Line 1 + 2) ......................... . . . . . . . . . . . . . . . . . . . . . . .
4. PAYMENTS RECEIVED ON LOANS OF $100 OR MORE (Including a forgiveness
or payment by a third party) (Part 2, Column (a)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. PAYMENTS RECEIVED ON LOANS UNDER $100 (Including a forgiveness
or payment by a third party) (Not itemized) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. TOTAL lOAN REPAYMENTS RECEIVED THIS PERIOD (Line 4 + 5). . . . . . . . . . . . . . . . . . . .
7. NET CHANGE THIS PERIOD (Subtract Line 6 from Line 3)
Enter the difference here and on Line 9, Column B of Summary Page. . . . . . . . . . . . . . . .
* TOTAl AU. INTEREST RECEIVED THIS PERIOD. AlSO ENTER
ON lINE 3 OF THE SUMMARY SEcnON OF SCHEDULE G. DO
NOT CARRY THIS TOTAl TO THE SUMMARY BELOW.
TOTAL INTEREST RECEIVED $ (b)
THIS PERIOD
1
SCHEDULE EE - LOANS MADE TO OTHERS (PART 3)
ANNUAL~EPORT OF OUTSTANDING LOANS MADE
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE IS
OF /7
STATEMENT COVERS PERIOD
FROM THROUGH /
/O/;eP/J" /~/31/19
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE: '-D. NUMBER
S"(l.A L R9/5;'.,3
PART 3: ANNUAL REPORT OF OUTSTANDING LOANS MADE TO OTHERS - SEE INSTRUCTIONS ON REVERSE
BEFORE COMPLETING.
FULL NAME OF RECIPIENT OF LOAN
ORIGINAL
DATE
OF LOAN
AMOUNT
OF
ORIGINAL
LOAN
SUBTOTAL
UNPAID
PRINCIPAL
;y;...,i..
$
-
(NOTE: THIS TOTAL
SHOULD BE THE SAME
AMOUNT AS ENTERED
ON LINE 9. COLUMN C
Of THE SUMMARY
PAGE.)
UNPAID
INTEREST
. .
SCHEDULE F
. ACCRUED EXPENSES
(UNPAID BILLS)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE /ftJ OF /7
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
S ~A . tJ CL..,SO,.)
STATEMENT COVERS PERIOD
FROM THROUGH
IO/I'!"
1.0, NUMBER
1'1 S'c1.E
CODES FOR CLASSIFYING ACCRUED EXPENSES
If one of the following codes is used to describe the accrued expense, no written description is ne'eded. (Note
exceptions on the back of this schedule for code "T" _) Refer to the back of this schedule for detailed explanations of
each category.
"L" - LITERATURE
"B" - BROADCAST ADVERTISING
"N" -NEWSPAPER AND PERIODICAL ADVERTISING
"0" - OUTSIDE ADVERTISING
"S" -- SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR
SOLICITATIONS
"F" -- FUNDRAISING EVENTS
"G" - GENERAL OPERATIONS AND OVEF:HEAD
"T" - TRAVEL, ACCOMMODATIONS ANI> MEALS
"P" - PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
If one of the above codes does not accurately or fully describe the expenditure, leave the "Code" column blank and
provide a written description in the "Description of Outstanding Payment" column.
NAME AND ADDRESS OF PAYEE, CREDITOR
OR RECIPIENT OF CONTRIBUTION
(If COMMITTEE, IN ADDITION TO COMMITTEE'S
NAME AND ADDRESS, ENTER 1.0. NUMBER AMOUNT
OR. If NO 1.0. NUMBER HAS BEEN ASSIGNED, ENTER THE CODE OR DESCRIPTION OF OUTSTANDING PA YME NT
TREASURER'S NAME AND AnnA~SS\ ACCRUED
-
SUBTOTAL
IMPORTANT: Do not itemize the payment of accrued expenses on Schedules E or F. Report the lump sum of these
payment~ on Sch~dule F, .line 4 and on Schedule E, Line 4. Do not re-itemize accrued expenses which have been
reported In a prevIous period.
SUMMARY
5. NET CHANGE THIS PERIOD (Subtract Line 4 from Line 3) Enter difference here and on
Line 11, Column B of Summary Page ......................................................................
193 -
1. ACCRUED EXPENSES OF $100 OR MORE THIS PERIOD .............................................. $
2. ACCRUED EXPENSES OF UNDER $100 THIS PERIOD (Not itemized) .........................
3. TOTAL ACCRUED EXPENSES INCURRED THIS PERIOD (Line 1 + 2) ............................
4. ACCRUED EXPENSES PAID THIS PERIOD (Not itemized) (Enter here
and on Schedule E, line 4) ......................................................................................
$</93 -)
(May be
negative figure)
. .
"
SCHEDULE G
MISCELLANEOUS INCREASES TO CASH
FORM 490
PAGE /7 OF 17
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
c.
1.0, NUMBER
DATE
REC'D.
FULL NAME AND ADDRESS OF SOURCE
(If COMMITTEE. IN ADDITION TO COMMITTEE'S
NAME AND ADDRESS. ENTER 1.0 NUMBER
OR. If NO 1.0, NUMBER HAS BEEN ASSIGNED.
ENTER THE TREASURER'S NAME AND ADDRESS)
DESCRIPTION OF ADJUSTMENT
SUBTOTAL $
SUMMARY
1. INCREASES TO CASH OF $100 OR MORE THIS PERIOD. .. . . .. .. .. . .. . .. .. . .. . .. .. .. . $
2. INCREASES TO CASH UNDER $1 00 THIS PERIOD (Not itemized) . . . . . . . . . . . . . . . . . . . . . .
3. TOTAL OF ALL INTEREST RECEIVED THIS PERIOD ON lOANS MADE TO OTHERS
(Schedule EE, Part 2 (b)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. TOTAL MISCELLANEOUS INCREASES TO CASH THIS PERIOD
(Line 1 + 2 + 3) Enter here and on Line 15 of Summary Page - . . . . . . . . . . . . . . . . . . . . . . $
S~3
AMOUNT OF
INCREASE
TO CASH
-