Daniel Palmerlee - 1985/09/18 - 1985/10/19
Statement covers period from
DATE OF ELECTION (MO.. DAY, YR.) (IF-APPLICABLE):
9 18 85
through
\ TOTI~AGES:
10 19 85
(Government Code Sections 84200-84217)
Form 490
1985
For use by candidates/officeholders and their controlled committees.
(Type or Print in Ink)
November 5, 1985
CANDIDATE/OFFICEHOLDER INCLUDED IN THIS CONSOLIDATED REPORT
NAME OF CANDIDATE:
Daniel D. Palmerlee
RESIDENTIAL ADDRESS:
NO. AND STREET
CITY
AREA COOE
PHONE NUMBER
NO. AND STREET
STATE
ZIP CODE
~8MWrenAvp_-~:-\154 (;il~ CA. OED'll) ,4DS3-~7-2fo5A
II CONTROLLED COMMITTEES* INCLUDED N THIS CONSOLIDATED REPORT
NAME OF COMMITTEE:
1.0. NUMBER
ADDRESS OF COMMITTEE:
NO. ANC STREET
CITY
STATE
ZIP ~ODE
AREA COOE
PHONE NUMSER
NAME OF TREASURER:
PERMANENT ADDRESS OF TREASURER: ~o. AND STREET
CITY
STATE
ZIP CODE
AR EA CODE
PHONE NUMBER
NAME OF COMMITTEE:
1.0. NUMBER
ADDRESS OF COMMITTE:E:
NO. AND STREET
CITY
STATE
ZIP CODE
AREA CODE
PHONE NUMSER
NAME OF TREASURER:
CITY
STATE
ZIP CODE
AREA CODE
PHONE NUMBER
PERMANENT ADDRESS OF TREASURER: NO. AND STREET
Attach additional information a" 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 CONTRlBUTIONS OR MAKE EXPENDITURES ON BEHALF OF YOUR CANDIDACY.
Controlled Committee?*
COMMITTEE ADDRESS
TREASURER
YES
NO
Attach additional information on appropriately labeled continuation sheets.
* fA controlled committee is one which is controlled directly or indirectly bV a candidate or which acts jointly with a candidate or controlled committee in
connection with the making of exoenditures. 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 ail reasonable diligence in their preparation.
Executed onO&1heY1D at G'\rot~ C.b..
(OATe:) I Y AND STATE)
by
c(ul/YJ, In. ~
(SIGNATURE OF ASURE:R(S) )
Executed on
at
by
(OATE) (CITY ANO STATE'
I declare under penalt'; of perjury that to the best of my knowledqe this statement a
treasurer(s) of this committee(s) has used all reasonable diligence in the preparation of
'\ Executed on ()c~~~r ~ LI at ~; f ~e:cXv AI.~E) by
For informatIon required to be provided to you pursuant to the Information Practices A.:t of 1977, see "Information Manual on Campaign Disclosure Provisions
of the Political Reform Act," Part X.
-1-
..
'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 CFFICE CHECK ONE CUMULATIVE
EXP,* OR MEASURE AND B"'.LLOT NUMBER OR LETTER Support Oppose AMOUNT TO DATE
No Y'\p"
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 "I nformation Manual on Campaign
~isci osu re."
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 tre 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 incl~ded 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 co~mittees.
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 i.ndependent 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 expendit re (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 measure's 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,")
LINES7+8 LINES7+8 LINES7TI
(SHOULD EQUAL LINE 9.
COLUMNS A + a)
* 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) $- I 2. 5
11. Cash receipts this period (Line 3, Column B above) . . . . . . . . . . . . '1f3S
12. Miscellaneous adjustments to cash (Schedule G, Line 7) . . . . . . . . . - D-
, .
"
CAMPAIGN DISCLOSURE STATEMENT SUMMARY PAGE
FORM 420, 430 OR 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE
"1b.1 me.r-I ee. (\ fl rY\p(ll~V) 0..Drf\ffi'l +tee./Van ,e, \ ~a \ mer 1e.P-
CONTRIBUTIONS RECEIVED
COLUMN A COLUMN B
Cumulative Total this period
total from from attached
* schedules
previous period
,
$ 126 $ rfes
SCHEDUL.E A, L.INE 3
-()- -0-
SCHEDULE B'. LINE 8
$ I~ s rres
LINES 1 + 2. L.INES 1 -t- Z
-0- 54
SCHEDUL.E C, LINE 3
-()- -0-
SCHEDULE 0, LINE 7
$ \1.5 S ~
LINES 3 + 4 + 5 L.INES 3 + 4 + 5
1.
Monetary contributions
2. Loans......................
3. Subtotal....................
4. Non-monetary contributions. . . . . . .
5. Pledges.....................
6. TOTAL CONTRIBUTIONS. . . . . . . .
EXPENDITURES MADE
7. Payments.................... $
-0- $ 1A7
SCHEDUL.E E, L.INE 4
A(P A~
SCHEDULE F ,L.INE 5
t4{h S IPR
8. Accrued expenses (unpaid bills) . . . . .
9. TOTAL EXPENDITURES. . . . . . . . $
13. Cash payments this period (Line 7, Column B above) . . . . . . . . . . .
14'7
Q4'1
Be
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,
STATEMENT COVERS PERIOD
'985
1.0. NUMBER (IF COMMITTEE)
650(09 \
COLUMN C
Cumulative
to date
(Columns A + B)
$ 910
-o-
S 010
LINES 1 + 2.
~4
-C)-
S 9fD4..
LIN ES 3 + 4 + 5
(SHOULD EQUAL L.INE 6.
COL.UMNS A + a)
$ lA7
Be
$ US5
$
~50
$
18, CASH EaUIVALENTS (OTHER ASSETS HELD) (See Instructions on Reverse): $ -0 -
SUMMARY FOR CANDIDATES IN BOTH A JUNE AND NOVEMBER ELECTION
1/1 thru 6/30 7/1 to date
I ~ I
19
CONTRIBUTIONS RECEIVED:
20.
EXPENDITURES MADE:
-2-
(See Instructions on Reverse)
Sc.hedu1e A
MONETARY CONTRIBUTIONS RECEIVED
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
FROM THROUGH
6'50
EMPL.OYER
AMOUNT
DATE
REC'D
OCCUPATION
(IF SI!LF.EM"t.OVI!O, liNTER
NAMe: OF BUSINESS)
RECEIVED
CUMULATIVE
(1''' COMMITT.IE,~.NTI!:" 1.0. NUMB." OR
TRIEASU".R S NAoMI!: AND ADDRESS)
TO DATE
)/, I~ Hr'". 4t--\rs.\Jlu(ence~"'neIl
9/2.J/85 '1'1~O Killer' Ave.
G" \ 'l"oY.J CA. 9 S02..D
a/'JrJo. 'Dona.\d c.hr'l~topher GtUyl ic..:"D\~-t.
7f#..l..fo 305'B\oo~e..\d Ave,
U'l\Y-OYJ CA 96020
9/~~5 H.H. E:.ncflneer,fY.{ Co. fraireef'S-
1'-" I S(&8b P;ol\-ta-e1'S+. Q.Cnou\t'I ~
Mor- C\.f'\ \-\\ l LCA C)5C537
Ci, \V"oyCoun1:YY_~\ub "'PevelofEX'"
Y. Co~~~e.rs~\?
'1;7>7 f='\~t~.-
\ ~o..1e.
eo"'Y'\e\ l Century ZJ
"'Reel \-t:y
1c;, 70"'PY"i nc.e va.l \e.
u'
A i,. D C,.hV"l '=-1"opher
"'Ro.ncl'"\
1100.00
;tlOO.OO
D
If more space is needed, check box at left
and attach additional Schedules A.
SUBTOTAL 0400.00
SUMMARY
1. AMOUNT RECEIVED - CONTRIBUTIONS OF $100 OR MORE
(Include all Schedule A subtotals). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
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-
s;cnedu\e A
MONETARY CONTRIBUTIONS RECEIVED
(CONTINUATION SHEET)
FORM 420,430 OR 490
STATEMENT COVERS PERIOD
FROM THROUGH
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE: 1.0. NUMBER (IF COMMITTEEI
FULL. NAME AND ADDRESS OF EMPLOYER AMOUNT
DATE CONTRIBUTOR OCCUPATION
(IP' COMM1TTIl".~.NTIlR I.C. NUMBER OR (I'" SI!:L"'-.M~LOYI!:D. .NT." ".CK'\(l!!:D CUMULATIVa
REC'D TRC"'SU"'SR S NAM&: AND ADDNESS) NAM': 0'" BUSINESS} TO QATE
I
'-
-
0 If more space is needed, check box at left SUBTOTAL
and attach additional Schedules A. - 0- .,.,.'
Sc.hedule 13
LOANS
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
THROUGH
I,D. NUMBER (IF COMMITTEE)
DATE
REC'D
FULL NAME AND ADDRESS OF
LENDER AND ANY GUARANTORS OR
COSIGNERS {IF COMMITTEE, ALSO ENTER
I.D. NUMBER OR TREASURER'S
NAME AND ADDRESS}
EMPLOYER
OCCUPATION
(IF SELF-EMPLOYED. I!!:NTER
NAME OF BUSINESS)
INT,
RATE
AMOUNT
OF LOAN
CUMULA.
TIVE
TO DATE
D
I f 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:
(a)
ENTER THIS DATA ON SCHEDULE A ALSO
DATE
FULL NAME AND ADDRESS
OF THE LENDER
AMOUNT
REPAID
(b)
AMOUNT FORGIVEN
OR PAID BY
THIRO PARTY
THIRD PARTY NAME AND ADDRESS
UNPAID
BALANCE
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 (a) ) , . , , . , , , , . , . , . . . , . , , . ,
5. LOANS OF $100 OR MORE THIS PERIOD FORGIVEN OR PAID BY A THIRD PARTY (Part 2, Column (b) )
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.
-4-
SCHEDULE C
NON-MONETARY CONTRIBUTIONS RECEIVED
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
DATE
REC'D
(ur S"LP'~I!M"L.OYI!O. ENTER
NAMII: 0'" BUSIN&:SS)
DESCRIPTION OF
GOODS OR SERVICES
(Ul' COMMITT...~.NTI!U' 1.0. NUMBIE:"
OR TlItEASURER'S NAME AND ACDR.SS)
OCCUPATION
o
If more space is needed, check box at left
and attach additional Schedules C.
SUBTOTALS
SUMMARY
1. NON.MONETARY CONTRIBUTIONS OF $100 OR MORE THIS PERIOD. . . , . . . . . . . . . . , . . . . . . $
2.
NON.MONETARY CONTRIBUTIONS UNDER $100 THIS PERIOD (Not itemized). .
3.
TOTAL NON.MONETARY CONTRIBUTIONS THIS PERIOD
(Line 1 + 2) Enter here and on Line 4, Column B of Summary Page
. . . . . . . . . . . . . . . . . . . . . . . . . . .
-5-
FAIR
MARKET
VALUE
RECEIVED
CUMU.
LATIVE
AMOUNT
~edLLle. 'D
PLEDGES
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT coVERS PERIOD
FROM THROUGH
q-18.ffi 110-\9 -8.5
1.0. NUMBER (If'" COMMITT~E)
85
DATE
REC'D
(tP"' SKL"'-B:MPLOYED, ENTER
NAMIE OF BUSINIiESS)
AMOUNT
PLEDGED
THIS
PERIOD
(.... COMMITTItt. ~ENT~R 1.0. NUMBIER OR
TRK"SUR!!!:R 5 NAME AND ADDRESS)
OCCUPATION
\\In
D
(a)
If more space is needed, check box at left
and attach additional Schedules D.
SUBTOTALS
SUMMARY
1.
2.
3.
4.
5.
6.
7.
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. . . . . . .
-6-
AMOUNT
PAID
(AL.SO
ENTI!i.R ON
SCHI!!:OULE A)
CUMU.
LATIVE
PLEDGE
UNPAID
(b)
(May be
negative figure)
ScheduJe E..
PAYMENTS AND CONTRIBUTIONS MADE
FORM 420, 430 OR 490
1.0. NUMBER (IF COMMITTEK)
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR COMMITTEE,
r'pnlN)edee. C..oJ'Y\~(n@ f\ (' ..()mm \ +teel _ . 11
. CODES FOR CLA",SI FYING EXPENDITURES
6
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 thi~ schedule and the Information Manual
on Campaign Disclosure for detailed explanations and examples of each category.
I'C"
CONTRIBUTIONS TO OTHER
CANDIDATES OR COMMITTEES
INDEPENDENT EXPENDITURES
"L" - LITERATURE
"B" - 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.
IMPORTANT: 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.
liS"
SURVEYS, SIGNATURE GATHERING,
DOOR-TO-DOOR SOLICITATIONS
FUNDRAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
I'I"
"F" ~
"G"
"T"
"N"
lip"
NAME AND ADDRESS OF PAYEE. CREDITOR OR
RECIPIENT OF CONTRIBUTION (IF COMMITTEE. ~I!:NTER AMOUNT
1.0. NUMBER OR HAMI! AND AODR1!SS 0... TREASURER) CODE OR DESCRIPTION OF PAYMENT PAID
I
I
I
I
'- I
-
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.
S ... n ...
Payments of $100 or more made this period (Include all Schedule E Subtotals) .. . . . . . . . . . . .. , . .. .. .. . -
Payments under $100 this period (not itemized) , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . , . . . . . . . . . . . .$ l4'1. 00
-0-
Total Accrued Expenses paid this period (Schedule F, Line 4) , . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
Total Payments this period (Line 1 + 2 + 3) Enter here and on Line 7, Column B of Summary Page . . . . . . . . . . $ --1,q r{, 00
2.
3.
4.
-7-
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
(CONTINUATION SHEET)
FORM 420,430 OR 490)
STATEMENT COVERS PERIOD
(Amounts May Be Rounded To Whole Dollars)
Cd. ;~~M85110T~~;~~S
Cc~'
...-po \ me \"
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 EVENTS
"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. ~ENTER AMOUNT
1.0. NUMBER OR NAME AND ADORESS OF TREASURER) CODE OR DESCRIPTION OF PAYMENT PAID
I
I
I
'-
-
I
D If more space is needed, check box and SUBTOTAL -0-
attach additional Schedules E.
Sc.hedule ~
ACCRUED EXPENSES
(UNPAID BILLS)
FORM 420, 430 OR 490
STATEMENT COVERS PERIOD
FROM THROUGH
(Amounts May Be Rounded To Whole Dollars)
.1 .
1.0. NUMBER (IF COMMITTEEl
85009 I
NAME OF CANDIDATE OR COMMITTEE:
rpa\ N'\en e.e C(lfY\~\g "'('..omm, \tpe~. /:Dnr'\ie.. t:Pa.l Y'1\~~\ ~~
CODES FOR CLASSIFYING 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", "1" 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-DOORSOLlCITATIONS
"I" INDEPENDENT EXPENDITURES "F" FUNDRAISING 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.
I
NAME AND ADDRESS OF PAYEE. CREDITOR OR AMOUNT
RECIPIENT OF CONTRIBUTION (IF COMMITTEE, ALSO ENTER
1.0. NUMBER OR NAME AND ADDRESS OF TREASU""R""ER) CODE OR DESCRIPTION OF PAYMENT ACCRUED
'-
-
o If more space is needed,
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
3. Total Accrued Expenses Incurred This Period (Line 1 + 2) .. . . . . . . . . . . . . . . . . . . . . . . . .
(May be
negative figure)
1. Accrued Expensesof$1000r More This Period. ................................
2. Accrued Expenses of Under $100 This Period (Not Itemized) . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-8-
"
IVII~l,;t:LU.\I\lt:UU~ AUJU~ 11VIt:I\ll ~ I U l,;A~H ....U~IIIUl\I
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
/Pa\f'rIer-\e.e
NAME AND ADDRESS OF SOURCE (IF RECEIPT) OR PAYEE (IF EXPENDITURE), (IF
DATE COMMITTEE, ALSO ENTER 1.0, NUMBER OR NAME "'NO 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 PE~IOD (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. . . . . . . . . . . . . . . . . . . . . . . .
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STATEMENT COVERS PERIOD
FROM THROUGH
AMOUNT OF
INCJ:le;ASE
TO CASH
DECREASe:
TO CASH
(a)
(b)