Daniel Palmerlee - 1985/07/01 - 1985/09/17
, ,
(Type or Print in Ink)
CAMPAIGN STATEMENT
(Government Code Sections 84200-84217)
Form 490
1985
For use by candidates/officeholders and their controlled committees.
Statement covers period from.
DATE OF ELECTION (MO" DAY, YR.) (.F APP~ICAB~"):
CANDIDATE/OFFICEHOLDER INCLUDED IN THIS CONSOLIDATED REPORT
CITY
AREA CODE
PHONE NUMBER
NAME OF CANDIDATE:
OFFICE SOUGHT OR HELO (INCl.,UDE LOCATION AND DISTRICT
NUMBER ,... AP~L.ICABL.e:)
I \ Z- (l' Str-e.e:t C
BUSINESS ADDRESS: NO. AN STREET
188(', W(ex') Ave.- '6\c\~, E - IS4 Cjt\n:)y CA. Cfe){)zn
II CONTROLLED COMMITTEES* INCLUDED IN THIS CONSOLIDATED REPORT
~Ofj.. 84 '7- 2L~
NAME OF COMMITTEE:
1.0, NUMBER
ADDRESS OF COMMITTEE:
NO. AND STREET
CITY
STATE
ZIP ~ODE
AREA CODE
PHONe; NUMBER
NAME OF TREASURER:
PERMANENT ADDRESS OF TREASURER: NO. ANO STREeT
CITY
STATE
ZIP CODE
AREA CODE
PHONE NUMBER
NAME OF COMMITTEE:
1.0. NUMBER
ADDRESS OF COMMITTEE:
NO. AND STRI!ET
CITY
STATE
ZIP COOl!
AREA CODE
PHONE HUM BER
NAME OF TREASUR'ER:
PERMANENT AODRESS OF TREASURER: NO. AHO STREET
CITY
STATE:
ZIP CODE
AR EA CODE
PHONE NUMBER
Attach additional information on appropriately labeled continuation sheets.
III CANDIDATE/OFFICEHOLDER ONLY: LIST ANY OTHER COMMITTEES NOT INCLUDED IN THIS
CONSOLIDATED STATEMENT WHICH ARE CONTROLLED BY YOU OR ARE PRIMARILY FORMED
TO RECEIVE CONTRIBUTIONS OR MAKE EXPENDITURES ON BEHALF OF YOUR CANDIDACY.
COMMITTEE NAME
AND 1.0. NUMBER
- + 0.. \ fY\ e..c \ e.f'.
COMMITTEE ADDRESS
'\\tteE
TREASURER
Controlled Committee?*
YES NO
Attach additional information on appropriately labeled continuation sheets.
* fA controiled committee is one which is controlled directly or indirectly by a candidate or which acts jointly with a candidate or controlled committee in
connection with the making of expenditures. A candidate controls a committee if the candidate, the candidate's agent, or any other committee he or she
controls, has significant influence on the actions or decisions of the committee.}
VERIFICATION
I declare under penalty of perjury that to the best of my knowledge this statement and its schedules are true, correct and complete and that
I have used all reasonable diligence in their preparation.
Executed on :::=e~. \ Qj10F,:;b at C. i I Ie '~' J CA
(DATE) CIT'y AND STAT!!)
Executed on at
(CITY AND STATE'
(:tt-J/,t ''l2 /r7 (gvu
by ty. . ./1
~ (SIGNATU EO TREASURERls))
by
-1-
~'-L..u\jl-\. I IVI~ vr \JVI'i' .-"'\......V . .""......., r"\1__ _i'" -...- ~ . -. ~-- ....
CANDIDATES, OFFICEHOLDERS AND MEASURES (Allocate expenditures from Schedules E & F made
to' or on behalf of another candidate, officeholder or measure. Amounts may be rounded off to whole dollars.)
DATE IND NAME OF CANDIDATE OR OFFICEHOLDER AND OFFICE CHECK ONE CUMULATIVE
EXP,'*' OR MEASURE AND BALLOT NUMBER OR LETTER Support Oppose AMOUNT TO DATE
None...
I
Attach additional information on appropriately labeled continuation sheets.
Check box if "independent expenditure." (See Instructions below.)
INSTRUCTIONS FOR PREPARING COVER PAGE
CONSOLIDATED CAMPAIGN STATEMENT
FORM 490
PERIOD COVERED BY STATEMENT:
The period covered begins the day after the closing date of the last campaign statement filed. If no previous
statement has been filed, the period begins on January 1 of the current calendar year. The period ends on
the closing date for the current statement. The closing date is specified in the "Information Manual on Campaign
Disclosure."
DATE OF ELECTION:
If this statement is filed in connection with an election held on a date other than June 4, or November 5, 1985,
enter the date of the election.
PART I:
Provide the candidate's or officeholder's full name, residential address, business address and telephone numbers,
and the office sought or held.
PART II:
Identify the controlled committees included in the consolidated report and the treasurers of the committees. Use
the same information that appears on the committees' Statements of Organization filed with the Secretary of
State. Do not use abbreviations. A permanent business or residential address must be provided for the treasurers.
The identification numbers must be included. (If not yet received from the Secretary of State's office, that fact
must be noted.)
PART III:
The candidate or office holder must list all additional committees not included in this consolidated report which
are controlled by the candidate or officeholder or are primarily formed to receive contributions or make expen-
ditures on the candidate's behalf and whether or not they are controlled committees.
VERIFICATION:
The statement must be signed by each committee treasurer included in the consolidated report and by the
candidate or officeholder who controls the committee. The treasurer and candidate or officeholder must review
the information contained in the statement before signing the verification.
ALLOCATION OF CONTRIBUTIONS I~ND EXPENDITURES MADE TO OR ON BEHALF OF OTHER
CANDIDATES, OFFICEHOLDERS AND MEASURES:
List all contributions (including loans) and independent expenditures itemized on Schedules E and F to support or
oppose officeholders, candidates. and ballot measures (other than those controlling this committee or for which
this committee is primarily formed), Also list in-kind contributions and independent expenditures which involve
goods or services provided to or on behalf of a candidate or committee when a payment is not made (e.g.,
employee services, in-house printing, etc.). A description of the goods or services must also be provided. Indicate
the date of the expenditure; if the expenditure is an independent expenditure (an expenditure not made at the
behest of the candidate or committee on whose behalf it is made) check the box to so indicate: the office sought
or held (or the measures number or letter and the jurisdiction); the amount of the expenditure: and the cumulative
amount to date, The "Cumulative to Date" column should include the total of expenditures for or against each
candidate or measure since January 1 of the current calendar year, (See "Information Manual on Campaign
Disclosure" for discussion and examples of "cumulation,")
CAMPAIGN DISCLOSURE STATEMENT SUMMARY PAGE
FORM 420, 430 OR 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE
""--Pn \ nleylEe~ ('i\ffiDC\\OC'l r'.nnl\!l \tte.<'''~ /Dn\IIf'.1 '1>(\\ \11t"-de.e
, ___I r
COLUMN A
Cumulative
total from
COLUMN B
Total this period
from attached
schedules
$ 115
SCHEDULE At LINE 3
--("J-
SCHEDUL.E St LINE 8
$ t1~
LINES I ... Z
-()-
SCHEDULE c, LINE 3
-0-
SCHEDULE 0, L.INE 7
$ l'2h
LINES 3 ... 4 ... 5
$ -0-
SCHEDULE E, LINE 4-
rA-0
SCHEDULE F, LINE 5
$ 04(-"
LINES 7 + 8
*
previous period
CONTRIBUTIONS RECEIVED
1.
Monetary contributions
$
2. Loans......................
3. Subtotal....................
$
LINES 1 + Z
4. Non-monetary contributions. . . . . . .
5. Pledges.....................
6. TOTAL CONTRIBUTIONS. . . . . . . .
$
LINES 3 ... 4. ... 5
EXPENDITURES MADE
7. Payments... ~ . . . . . . . . . . . . . . . .
$
8. Accrued expenses (unpaid bills) . . . . .
9. TOTAL EXPENDITURES. . . . . . . .
$
STATEMENT COVERS PERIOD
1.0. NUMBER (I... COMMITTe:.~
B.5(){o9/
COLUMN C
Cumulative
to date
(Columns A + B)
$
1'2..5
"-0--
$ \ '2E:5
LINES 1 + Z
- ()-
$
-0--
\'2-5
LIN E5 3 ... 4 ... 5
(SHOULD EQUAL L.INt!: 6.
COLUMNS A ... s)
$
-0-
d4GJ
04cn
$
1..1NES7+8 LINe:S7+a
(SHOULD EQUAL L.INE 9.
COLUMNS A ... e)
'" If this is the first report filed for the calendar year, Column A should be blank except for unpaid loans, bills and pledges.
STATEMENT OF CHANGES IN FINANCIAL CONDITION
10. Cash on hand at the beginning of this period. (Line 14 of previous statement) . $ - 0-
11. Cash receipts this period (Line 3, Column B above) . . . . . . . . . . . . I 'lS
12. Miscellaneous adjustments to cash (Schedule G, Line 7) . . . . . . . . . -0-
13. Cash payments this period (Line 7, Column B above) . . . . . . . . . . .
-0-
\ '.25
rA(o
14. Cash on hand at closing date (Lines 10+11+12-13 above)*. . . . . . .
15. Outstanding debts (Line 2 + Line 8 of Column C above) . . . . . . . . . . . . . .
16. Ending surplus (if Line 14 is greater than Line 15, subtract Line 15 from Line 14). . . . . . . . . . .
17. Ending deficit (if Line 15 is greater than Line 14, subtract Line 14 from Line 15). . . . .
* Ending cash on hand should not be a negative amount.
$
'761
.
$
-0-
18, CASH EaUIVALENTS (OTHER ASSETS HELD) (See Instructions on Reverse): $ - c\-
SUMMARY FOR CANDIDATES IN BOTH A JUNE AND NOVEMBER ELECTION (See Instructions on Reverse)
1/1 thru 6/30 7/1 to date
19, CONTRIBUTIONS RECEIVED:
20, EXPENDITURES MADE:
\15
-0-
-2-
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE:
/'0
OCCUPATION
(nO' Slll.......M..LOV.D. liNT."
NAME 0'" IIUSINIISS)
(... COT':.:~T:U.:...A;S~A~~T~~~.~D:::'~T" OR
9;1C/e "PhI \ \'2 H :BudlC1nCln
I rl44C NI\ \er Ave,
G \ \ \'"0' .j CA 05UW
~Pr-)\ \\ t::> H. Bl\Lhc~lY'u"
-r)I),5 .
'DIJS
D
If more space is needed, check box at left
and attach additional Schedules A.
SUBTOTAL
STATEMENT COVERS PERIOD
"'''OM THROUGH
'1
AMOUNT
R.CI!IVED
CUMUL.ATIVe
TO DATil
%100
~IOO
%\00
1.
SUMMARY
AMOUNT RECEIVED - CONTRIBUTIONS OF $100 OR MORE ;:z!\ '\,
(Include all Schedule A subtotals). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ CC,
2.
AMOUNT RECEIVED - CONTRIBUTIONS OF LESS THAN $100 (Not itemized)
3.
TOTAL MONETARY CONTRIBUTIONS THIS PERIOD
(Line 1 + Line 2) Enter here and on Line 1 Column B of Summary Page
-3-
SCHEDULE B
LOANS
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
FROM
THROUGH
1-1-95
NAME OF CANDIDATE OR COMMITTEE:
1.0. NUMBER (Ul' COMMITTE.)
DATE
REC'D
FULL NAME AND ADDRESS OF
LENDER ....ND ....NY GUARANTORS OR
COSIGNERS (I'" COMMITTEE. ALSO ENTER
1.0. NUMBER OR TRII!:A5URII!:R'5
NAME AND ADDRESS)
EMPLOYER
INT.
RATE
AMOUNT
OF LDAN
CUMULA-
TIVE
TO CATE
OCCUPATION
('P" SELF-EMPLOV.O. I!:NTIER
NAME 0'" BUSINESS)
D
If more space is needed, check box at left
and attach additional Schedules B, Part 1.
SUBTOTAL
PART 2 - LOANS REPAID, FORGIVEN OR PAID BY A THIRD PARTY:
(al
ENTER THIS DATA ON SCHEDULE A ....LSO
(b)
AMOUNT FORGIVEN
OR PAID BY
THIRD PARTY
THIRD PARTY NAME AND ADDRESS
UNPAID
BALANCE
DATE
FULL NAME AND ADDRESS
OF THE LENDER
AMOUNT
REPAID
NOrle.
D
If more space is needed, check box at
left and attach additional Schedules B,
Part 2.
(a)
(b)
SUBTOTAL
SUMMARY
1. LOANS OF $100 OR MORE THIS PERIOD (Part 1) ,
,$
(May be
negative figure)
2. LOANS UNDER $100 THIS PERIOD (Not itemized) ,
3, TOTAL LOANS RECEIVED THIS PERIOD (Line 1 + 2),
4. LOANS OF $100 OR MORE REPAID THIS PERIOD {Part 2, Column (al ) , . , . .
5. LOANS OF $100 OR MORE THIS PERIOD FORGIVEN OR PAID BY A THIRD PARTY (Part 2, Column (b) 1
LOANS UNDER $100 REPAID. FORGIVEN OR PAID BY A THIRD PARTY THIS PERIOD (Not itemized)
6, (Also enter this amount on Line 2 of Summary section of Schedule A) , . . . , , , , . . , , . , , , . . . . . , , . , , . , , ,
7, TOTAL LOANS REPAID, FORGIVEN OR PAID BY A THIRD PARTY THIS PERIOD (Line 4 + 5 + 6)
8. NET CHANGE THIS PERIOD
(Subtract Line 7 from Line 3) Enter the difference here and on Line 2, Column B of Summary Page,
SCHEDULE C
NON-MONETARY CONTRIBUTIONS RECEIVED
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
NAME OF CANDIDATE OR COMMITTEE:
l11x.
(U" COMMITT...~.NT." 1.0. NUMBER
OR TPUP;ASURER'S NAME AND ADDRaSS)
OCCUPATION
II... SKLF.I!M"l.OYIlD, ENTER
NAMa: OF BUSINESS}
DESCRIPTION OF
GOODS OR SERVICES
CUMU-
LATIVE
AMOUNT
DATE
REC'D
o
If more space is needed, check box at left
and attach additional Schedules C.
SUBTOTALS
SUMMARY
3.
TOTAL NON-MONETARY CONTRIBUTIONS THIS PERIOD
(Line 1 + 2) Enter here and on Line 4, Column B of Summary Page
. . . . . . . . . . . . . . . . . . . . . . . . . . .
1. NON-MONETARY CONTRIBUTIONS OF $100 OR MORE THIS PERIOD. . . . . . . . . . . . . . . . . . . . . $
2.
NON-MONETARY CONTRIBUTIONS UNDER $100 THIS PERIOD (Not itemized). .
-5-
SCHEDULE D
PLEDGES
FORM 420,430 OR 490
STATEMENT COVERS PERIOD
(Amounts May Be Rounded To Whole Dollars)
~ROM T"ROUG~
'l-I-6S!9-17-<?E
DATE
REC'D
OCCUPATION
EMPLOYER
(.P" S.L."'~.MPLOY.D. CNT."
NAMe 0... BUSINess)
CUMU-
LATIVI!:
PLI!:DGI!:
UNPAID
(I" COMMITT.... ~ENTaR 1.0. NUM.." OR
T".ASU"." S NAM. AND AOORIlSS)
(a)
(b)
D
If more space is needed, check box at left
and attach additional Schedules D.
SUBTOTALS
SUMMARY
1.
2.
3.
PLEDGES OF $100 OR MORE THIS PERIOD (Column (a) ) . . . . . . . . . . . . . . . , , . . . . . . . . . . . . . . . $
PLEDGES UNDER $100 THIS PERIOD (Not itemized). . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . .. . .
TOTAL PLEDGES RECEIVED (Line 1 + 2). , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
PLEDGES OF $100 OR MORE PAID THIS PERIOD (Column (b) ). . . . . . . . . . . . . . . , . , . . . . . . . . . . .
PLEDGES UNDER $100 PAID THIS PERIOD (Not itemized)
(Also enter on Line 2 of the summary section of Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
TOTAL PLEDGES PAID (Line 4 + 5). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , , . . , .
NET CHANGE THIS PERIOD
(Subtract Line 6 from Line 3) Enter the difference here and on Line 5, Column B of Summary Page. . . . . . .
4.
5.
6.
7.
(May be
negative figure)
-6-
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
FORM 420,430 OR 490
TATEMI!:NT COVERS PERIOD
~"OM
TN"OUGM
(Amounts May Be Rounded To Whole Dollars)
- 1'1-85
1.0. NUMBER (.... COMMITTaa)
NAME OF CANDIDATE OR COMMITTEE:
CODES FOR CLASSI FYING 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 codes "C", "\" and "T".) Refer to the back of this schedule and the Information Manual
on Campaign Disclosure for detailed explanations and examples of each category.
"8"
"T"
lip"
SURVEYS, SIGNATURE GATHERING,
DOOR-TO-DOOR SOLICITATIONS
FUNDRAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
I'C"
"S"
CONTRIBUTIONS TO OTHER
CANDIDATES OR COMMITTEES
INDEPENDENT EXPENDITURES
LITERATURE
BROADCAST ADVERTISING
NEWSPAPER AND PERIODICAL
ADVERTISING
"0" OUTSIDE ADVERTISING
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.
IMPORT ANT: Do not itemize the payment of accrued expenses on Schedule E. Report only the lump sum of these
payments on Line 3 of the Summary section, below.
"1"
"F"
I'L"
"G" -
tiN"
NAME AND ADDRESS OF PAYEE, CREDITOR OR
RECIPIENT OF-CONTRIBUTION (,~ COMMITTe.. ~.NTIEJIt AMOUNT
1.0. HUMS.Ut 0" HAMe AND AOOR_55 0'" T"C:ASU".") CODE OR DESCRIPTION OF PAYMENT PAID
I
I
\
o If more space is needed, check box and SUBTOTAL
attach additional Schedules E.
IMPORTANT: Contributions and expenditures on behalf of other candidates or committees must also be entered in the
allocation section at the front of the campaign statement.
SUMMARY
1. Payments of $100 or more made this period (I nclude all Schedule E Subtotals) . . . . . . . . . . . . . . . . . . . . . . .S
2. Payments under $100 this period (not itemized) . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . .$
3. Total Accrued Expenses paid this period (Schedule F, Line 4) , . . . . . . . . . . . . . . . . . . . , . . . . . , . . . . . . . .$
4. Total Payments this period (Line 1 + 2 + 3) Enter here and on Line 7, Column B of Summary Page, . . . . . . . . ,S
--D --
-7-
. <
. .
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
(CONTINUATION SHEET)
FORM 420,430 OR 490)
STATEMENT COVERS PERIOD
FROM THROUGH
(Amounts May Be Rounded To Whole Dollars)
1.0. NUMBER (U" COMMITTEE)
NAME OF CANDIDATE OR COMMITTEE:
CODES FOR CLASSI FYING 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 codes "C", "I" and "T".) Refer to the back of Schedule E and the Information Manual
on Campaign Disclosure for detailed explanations and examples of each category.
"C" - CONTRIBUTIONS TO OTHER CANDIDATES "S" SURVEYS, SIGNATURE GATHERING,
OR COMMITTEES DOOR-TO-DOOR SOLICITATIONS
"I" INDEPENDENT EXPENDITURES "F" - FUNDRAISING i:VENTS
"L" - LITERATURE "G" - GENERAL OPERATIONS AND OVERHEAD
"B" - BROADCAST ADVERTISING 'T' - TRAVEL, ACCOMMODATIONS AND MEALS
"N" - NEWSPAPER AND PERIODICAL ADVERTISING "P" PROFESSIONAL MANAGEMENT AND
"0" - OUTSIDE ADVERTISING 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.
NAME AND ADDRESS OF PAYEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION (IF COMMITTEE. ~e:NTE:R AMOUNT
1.0. NUMBER OR NAME AND ADDRESS OF TREASURER) CODE OR DESCRIPTION OF PAYMENT PAID
I
I
o If more space is needed, check box and SUBTOTAL
attach additional Schedules E. -()-
. '
SCHEDULE F
ACCRUED EXPENSES
(UNPAID BI LLS)
FORM 420, 430 OR 490
STATEMENT COVERS PERIOD
FROM THROUGH
(Amounts May Be Rounded To Whole Dollars)
I.D. NUMBER (I~ COMMJTTIlE)
NAME OF CANDIDATE OR COMMITTEE:
CODES FOR CLASSI FYING ACCRUED EXPENSES
If one of the following codes is used to describe the accrued expense, no written description is needed. (Note exceptions
on the back of this schedule for codes "C", "I" and "T".) Refer to the back of this schedule and the Information
Manual on Campaign Disclosure-for detailed explanations and examples of each category.
"C" CONTRIBUTIONS TO OTHER "S" SURVEYS, SIGNATURE GATHERING,
CANDIDATES OR COMMITTEES DOOR-TO-DOOR SOLICITATIONS
"I" INDEPENDENT EXPENDITURES "F" FUND RAISING EVENTS
"L" LITERATURE "G" GENERAL OPERATIONS AND OVERHEAD
"B" BROADCAST ADVERTISING 'T' TRAVEL, ACCOMMODATIONS AND MEALS
"N" NEWSPAPER AND PERIODICAL "P" PROFESSIONAL MANAGEMENT AND
ADVERTISING CONSULTING SERVICES
"0" OUTSIDE ADVERTISING
If one of the above codes does not accurately or fully describe the accrued expense, leave the "Code" column blank and
provide a written description in the "Description of Payment" column.
NAME AND ADDRESS OF PAYEE, CREDITOR OR AMOUNT
RECIPIENT OF CONTRIBUTION lull' COMMITTE., ALSO IENTI!"
1.0. HUM.IlIIt OR NAME AND ADDRESS OP TREA.SU"R"E'R) CODE OR DESCRIPTION OF PAYMENT ACCRUED
-- ~~
e~, II (D)frpy"'\ \,:t-e:("s ~ Off\ c..e.... S.lpplle:S,II1
30 -'-r n \ n::1 ~-\-Iee.-t ~
(, i \ r-oy"' CA <J 5020 ~-
:>-40
D If more space is needed, ;is oLj (D
check box, and attach additional Schedules F SUBTOTAL
IMPORTANT: Do not itemize the payment of accrued expenses on Schedules E or F. Report the lump sum of these
payments on Schedule E, Line 3, and on Schedule F, Line 4. Do not re-itemize accrued expenses which have been re-
ported in a previous period.
SUMMARY
1. Accrued Expensesof$1000r 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 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Net Change This Period (Subtract Line 4 from Line 3), Enter difference here and
on Line 8, Column B of Summary Page. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(May be
negative figure)
-8-
,,\..nI:UUL.1: U
"
MISCELLANEOUS ADJUSTMENTS TO CASH POSITION
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE:
~"
/ /) \\
DATE
NAME AND ADDRESS OF SOURCE (IF RECEIPT) OR PAYEE (IF EXPENDITURE), (IF
COMMITTEE. ALSO ENTER 10, NUMBER OR NAME AND ADDRESS OF TREASURER.)
DESCRIPTION OF ADJUSTMENT
D
If more space is needed, check box at left
and attach additional Schedules G
SUBTOTAL
SUMMARY
1. INCREASES TO CASH OF $100 OR MORE THIS PERIOD (Column (a) ) . . . . . . . . . . . . . . . . . . $
2. INCREASES TO CASH OF LESS THAN $100 THIS PERIOD (Not itemized) . . . . . . . . . . . . . . . . .
3. TOTAL INCREASES TO CASH THIS PERIOD (Line 1 + Line 2) . . . . . . . . . . . . . . . . . . . . . . . . .
4. DECREASES TO CASH OF $100 OR MORE THIS PERIOD (Column (b) ). . . . . . . . . . . . . . . . . . .
5. DECREASES TO CASH OF LESS THAN $100 THIS PERIOD (Not itemized). . . . . . . . . . . . . . . . .
6. TOTAL DECREASES TO CASH THIS PERIOD (Line 4 + Line 5) . . . . . . . . . . . . . . . . . . . . . . . . .
7. TOTAL MISCELLANEOUS ADJUSTMENTS TO CASH THIS PERIOD
(Line 3 minus Line 6) Enter here and on Line 12 of Summary Page . . . . . . . . . . . . . . . , . . . . . . . .
-9-
STATEMENT COVERS PERIOD
~ROM THROUGH
AMOUNT OF
INCREASE
TO CASH
DEeR.AS.
TO CASH
(.)
(b)
(May be
negative figure)