Daniel Palmerlee - 1989/01/01 - 1989/09/23
"'~ ..
FORM 490
1989
CANDIDATE AND OFFICEHOLDER CAMPAIGN STATEMENT -- LONG FORM
AND
CONSOLIDATED CAMPAIGN STATEMENT
(Government Code Sections 84200-84217)
(Type or Print in Ink)
Statement covers period 1-1- 69 through q -:2. 3 -B q ('
0~;'
CHECK ONE OF THE FOLLOWING BOXES TO INDICATE THE TYPE OF STATEMENT BEING FILED .~"
II PRE-ELECTION STATEMENT 0 SUPPLEMENTAL PRE-ELECTION ('r
o SEMI-ANNUAL STATEMENT STATEMENT (If fillOg a Supplemental
Pre-Election Statement. you must
complete Form 495 and attach It to
this statement,)
o TERMINATION STATEMENT
Attach a Form 415 to this Form 490.
'.
NClUDED IN THIS CONSOLIDATED REPORT
OFFICE SOUGHT OR HELD: (In(\u"olo<o"on on" d'>trlct numoer It opplleoblo)
Couf)O/mem k-
NO AND STRfET
CITY
SIAlE
liP CODE
~hU)
Gilroy CA
II CONTROLLED COMMITTEE* INCLUDED IN THIS CONSOLIDATED REPORT
qJO.)O
2.Jot .f '-11 :< 6 a
I. 0 NUMBER
NAME OF COMMITTEE:
r/ee
ADDRESS OF COMMITTEE:
:I! /)~ ~"1 145$
NAME OF TREA URER:
Gm~]) ffee-
9S-06Cf/
CITY
STATE
liP CODE AREA CODEIBUSINESS PHON, NUMB,~
Gilr-{!f
C~
?5"ZJ t1iftJA~ 841-265/1
CITY
ST A Tf
liP CODE
AREA COOt/BUSINESS PHONE NUMB, R
. A controlled committee is one which is co d directly or ihdirectly ,andid.lte or which .lets jointly with .l candid.lte or controlled committee in
connection with the making of expenditures. A c.lndid.lte controls .l committee" the c.lndidate. the candidate's .lgent, or any other committee he or
she controls, has signifh:ant mfluence on the actions or decisions of the committee.
III OTHER COMMITTEES: UST ANY OTHER COMMITTEES NOT INCLUDED IN THIS CONSOLIDATED STATEMENT WHICH
ARE CONTROLLED BY YOU AND ANY COMMITTEES PRIMARILY FORMED TO RECEIVE CONTRIBUTIONS OR MAKE
EXPENDITURES ON BEHALF OF YOUR CANDIDACY
COMMITTEE NAME AND 1.0. NUM8ER
COMMITTEE ADDRESS
TREASURER
CONTROLLED
COMMITTEE'
YES NO
Attach addition.ll information on appropriately labeled continu.ltion sheets.
CANDIDATE OR OffICEHOLDER:
I HAVE USED ALL REASONABLE DILIGENCE AND TO THE BEST OF MY KNOWLEDGE THE TREASURER HAS USED ALL REASONABLE DILIGENCE IN
PREPARING THIS STATEMENT. I HAVE REVIEWED THE STATEMENT AND TO THE BEST OF MY KNOWLEDG THE INFORMATION CONTAINED
HEREIN AND IN THE ATTACHED SCHEDULES IS TRUE AND COMPLETE. I CERTIFY UNDER PENAL F PE U ER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
"'W"DDN~1i!/~AT piV~, CII
ATlI IClTY HDSTATEI
TREASURER (if appliublel:
I HAVE USED AU REASONABLE DILIGENCE 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 PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
EXECUTED ON~ l4Jf!Kl AT fi/T't1l1 I (;Il BY ?1J//./Yh ))7. 1(};;m;)
lOATlI taNd STlrft 1~I4...ru., Of ~"~~~I
VERI FICA TlON
8Y
(SlUHA ruRf Of CAHOIDA TE OR DHlctHOlOERI
PAGE 2_
.
OF /"
ALLOCATION PAGE
FORM 490
STATEMENT COVERS PERIOD
FROM THROUGH
;.. -
ID, NUMBER
NAME OF CANDIDA TE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
.-
LIST CONTRIBUTIONS AND INDEPENDENT EXPENDITURES TOTALING $100 OR MORE MA E FRO HE CANDIDA TE'S OR OFFICEHOLDER'S PERSONAL
FUNDS TO SUPPORT OR OPPOSE OTHER OFFICEHOLOERS, CANDIOATES AND COMMITTEES. (SEE INSTRUCTIONS ON REVERSE.)
INDw NAME OF CANDIDATE. OFFICEHOLDER OR COMMITTEE CHECK ONE CUMULA TIVE
DATE AMOUNT TO DATE
EXP.
SUPPORT OPPOSt
CALENDAR YEAR
$
Jlm1, FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
- $
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
*See reverse regarding independent expenditures. SUBTOTAL $ .0"
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) . .,.. . ........,..........,......,...........................
$ 41tJ-
CAMPAIGN DISCLOSURE STATEMENT SUMMARY PAGE
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE ~
OF'"
STATEMENT COVERS PERIO[
FROM I :HROUGH
1..1. -
:ONTRIBUTIONS RECEIVED COLUMN A COLUMN B COLUMN C
Cumulative total Total thlscrenod from Cumulative to date
from previous period'" attache schedules (Columns A + B)
1. Monetary contributions. . . . . . . . . . . . . . . . . . . . . $ $ 9'1Z,,~ $ 'l9t. aL
SCHEDULE A, LINE J
2. Loans received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . -0" -CJ- -0-
SCHEDULE 8, LINE 7
3. SUBTOTAL CASH RECEIPTS. .. . .. . .. . .. ..... . $ $ ~92. .IX) $ '192. ~
LINES 1 . 2 LINES 1 . 2 LINES 1 . 2
4. Non-monetary contributtons. . . . . . . . . .'. . . . . . -()- -(j -
SCHEDULE c. LINE J
5. TOTAL CONTRIBUTIONS WITHOUT
ENFORCEABLE PROMISES.. . . . . . .. ....... .. . 9qz.~ '192 ./XL
Enforceable Promises (Except loan LINES J . 4 LINES J . 4 LINES J . 4
6. -('J- -0- -0-
guarantees, see Line 18 below).. ... .........
SCHEDULE D, LINE 7 99~.M
7. TOTAL CONTRIBUTIONS.................... $ $ 99Z.ltJ $
LINES S . 6 LINES S . 6 LINES S . 6
:XPENDITURES MADE (SHOULD EQUAL LINE 7,
-0 - COLUMNS A . 8)
$ $ $ ... ()-
8. Payments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SCHEDULE E, LINE 5
9. Loans Made. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -iJ- -0.. .. ,,-
SCHEDULE EE, LINE 7
10. SUBTOTAL.... ....... ... ...... .... '" . .... -0- -0..
, LINES 8 . 9 LINES 8 + 9 LINES 8 + 9
11. Accrued expenses (unpaid bills) . . . . . . . . . . . . . -0. 2.I._'5(J LI.SO
SCHEDULE F, LINE S
12. TOTAL EXPENDITURES..... .. . ... . ....... .. $ ..fj... $ ~5lJ $ li.5tJ
LINES 10 + 11 LINES 10 + 11 LINES 10 + 11
(SHOULD EQUAL LINE 12,
COLUMNS A . 8)
"'IF THIS IS THE FIRST REPORT FILED FOR THE CALENDAR YEAR, COLUMN A SHOULD BE BLANK
EXCEPT FOR LINES 2, 6, 9 AND 11.
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. Cashon hand at end of reporting period (Lines 13 + 14 + 15-16above)
(Ifthis 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). . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . .
$
-{)-
9(;)Z..~O
-(j.
-tJ-
20.
$ fJ'iL .IJO
ENDING CASH ON HAND SHOULD
NOT 8E A NEGA TIVE AMOUNT
$ -tJ-
$ -0-
$ 21.51)
1/1 TH RU 6130
7/1 TO DATE
SUMMARY FOR CANDIDATES IN BOTH A JUNE AND NOVEMBER ELECTION (See Instructions on Reverse)
21. CONTRIBUTIONS RECEIVED:
22. EXPENDITURES MADE:
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE 4-
OF I~
STATEMENT COVERS PERIOD
FROM THROUGH
DATE
REeD.
EMPLOYER
(IF SELF.EMPLOYEO, ENTER
NAME OF BUSINESS)
RECEIVED
THIS PERIOD
CUMULA T1VE
TO DATE
w-~ r . areC/l)r
CJ- S"fi? 799.5 h'tnceYalle
(ji}ro I C;4 t;5'~ZJj
.
r.
CALENDAR YEAR:
$
FISCAL YEAR:
$
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:
FISCAL YEAR:
$
CALENDAR YEAR:
$
Occupation:
Employer:
FISCAL YEAR:
$
SUBTOTAL
$ 2/)0, {)()
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. . . . , . , . . . . . .
$
~
'n2,0/)
$
992,,1JO
SCHEDULE B -- LOANS RECEIVED (PART 1)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE 5
OF /"
PART I: LOANS RECEIVED
DATE
REC'D
FULL NAME AND ADDRESS OF LENDER
OCCUPATION
EMPLOYER
INT,
RATE
(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)
(IF SELF.EMPLOYED, ENTER
NAME Of BUSINESS)
Occupation:
Employer:
Occupation:
Employer:
DUE
DATE
AMOUNT CUMU-
OF LOAN LA TIVE
TO DATE
CALENDAR YEAR
$
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
SUBTOTAL
FULL NAME AND ADDRESS OF GUARANTOR
OCCUPATION
EMPLOYER
(IF SELF.EMPLOYED. ENTER
NAME Of BUSINESS)
Occupation:
(IF COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS,
ENTER I.D NUMBER OR, IF NO I.D NUMBER HAS BEEN ASSIGNED,
ENTER THE TREASURER'S NAME AND ADDRESS)
: NAME Of lENDER
Employer:
: NAME OF lENDER
Occupation:
Employer:
SUBTOTAL
DO NOT CARRY THIS AMOUNT TO THE
SUMMARY BELOW, ENTER ON LINE 18
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. . . . . . . . . . . . . . .
(a)
$ "0.,
AMOUNT
GUARANTEED
CUMU.
LA TIVE
TO DATE
CALENDAR YEAR
$
THIS
PERIOD
FISCAL YEAR
$
CALENDAR YEAR
$
FISCAL YEAR
$
(b)
$-0-
$
-0-
-0-
(May be neg-
atlv~ flgurei
SCHEDULE B -- LOANS RECEIVED (PART 1)
(CONTINUATION PAGE)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE
(,
OF It?
STATEMENT COVERS PERIOD
FROM THROUGH
DATE
RECD,
FULL NAME AND ADDRESS OF LENDER
OCCUPATION
EMPLOYER
INT DUE AMOUNT
RATE DATE OF LOAN
CUMU-
LA TIVE
TO DATE
(IF COMMITTEE, IN ADOITION TO COMMITTEE'S NAME AND ADDRESS,
ENTER 1.0, NUMBER OR,IF NO 1.0, NUMBER HA' BHN ASSIGNED,
ENTER THE TREASURER'S NAME AND ADDRESS)
(IF SlI F-EMPlOYED, ENTER
NAME OF BUSINE SS)
OccupallUrl ,
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
OCcupation:
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
S
Occupation:
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
S
SUBTOTAL
(a)
$ --0..
FUll NAME AND ADDRESS OF GUARANTOR
NAME OF lENDER
OCCUPA TION
EMPLOYER
(If SElf.EMPLOYED. ENTER
NAME Of BUSINESS)
Occupation:
AMOUNT
GUARANTEED
THIS CUMU-
PERIOD LATIVE
TO DATE
(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)
CALENDAR YEAR:
S
Employer:
fiSCAL YEAR:
S
NAME Of lENDER
Occupation:
CALENDAR YEAR:
Employer:
fiSCAL YEAR:
NAME Of lENDER
Occupation:
CALENDAR YEAR:
Employer:
fiSCAL YEAR:
S
NAME Of lENDER
Occupation:
CALENDAR YEAR:
S
Employer:
FISCAL YEAR:
S
(b)
SUBTOTAL
..0-
SCHEDULE B -- LOANS RECEIVED (PART 3)
ANNUAL REPORT OF OUTSTANDING LOANS RECEIVED
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE 1 OF I~
STATEMENT COVERS PERIOD
FROM THROUGH
/-/-
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
TOTAL
$
-0..
(NOTE: THIS TOTAL
SHOULD BE THE SAME
AMOUNT AS ENTERED
ON LINE 2, COLUMN C
OF THE SUMMARY PAGE)
UNPAID
INTEREST
SCHEDULE B -- LOANS RECEIVED (PART 2)
FORM 490
PAGE ~
OF/~
(Amounts May Be Rounded To Whole Dollars)
DA TE OF
REPAY-
MENTOR
FORGIVE-
NESS
DATE OF
ORIGINAL
LOAN
FULL NAME OF LENDER
INT.
RA TE (IF FORGIVEN*
CHANGED)
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)
-() -
**TOTAL AIL INTEREST PAID THIS PERIOD, ALSO ENTER
ON LINE 3 OF THE SUMMARY SECTION OF SCHEDULE E,
DO NOT CARRY THIS TOTAL TO THE SCHEDULE B SUMMARY
TOTAL INTEREST PAID
THIS PERIOD
(d)
$ -CJ-
SCHEDULE C
NON-MONETARY CONTRIBUTIONS RECEIVED
FORM 490
PAGE ?
OF /'"
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
FROM THROUGH
DATE FULL NAME AND ADDRESS FAIR CUMU-
REC'D. OF CONTRIBUTOR DESCRIPTION OF MARKET LA TlVE
(IF COMMITTEE, IN ADDITION TO COMMITTEE'S EMPLOYER GOODS OR SERVICES VALUE AMOUNT
NAME AND ADDRESS, ENTER I.D NUMBER RECEIVED
OR, If NO 1.0, NUMBER HAS BEEN ASSIGNED, (IF SELF-EMPLOYED, ENTER
ENTER THE TREASURER'S NAME AND ADDRESS) 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: FISCAL YEAR:
$
Occupation: CALENDAR YEAR:
$
Employer: FISCAL YEAR:
$
OccupatIOn: CALENDAR YEAR:
$
Employer: FISCAL YEAR:
$
SUBTOTAL $ -0-
SUMMARY
1. NON-MONETARY CONTRIBUTIONS OF $100 OR MORE RECEIVED THIS PERIOD. _ _.:...
2. NON-MONETARY CONTRIBUTIONS UNDER $100 RECEIVED THIS PERIOD (Not
itemized). _ . . . . . . . . _ _ . . . . . . _ . . . _ _ . . . . . , . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
-6..
-0"
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 Th'an 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 B, NOT Schedule D.
(Amounts May Be Rounded To Whole Dollars)
DATE
RECD,
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)
(IF SElF-EMPLOYED, ENTER
NAME OF BUSINESS)
Occupatlun:
EMPLOYER
AMOUNT
PROMISED
THIS PERIOD
Employer:
Occupation:
Employer:
Occupation:
Employer:
Occupation:
Employer:
Occupation:
Employer:
(a)
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 PERIOD (Line 1 + 2). . . . . . . . . . . . . . , . . . . . . . . . . . . . .
4. PAYMENTS ON PROMISES OF $100 OR MORE RECEIVED THIS
PERIOD (Column (b)). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. PAYMENTS ON PROMISES UNDER $100 RECEIVED THIS
PERIOD (Not itemized) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Also enter on Line 2 of the summary section of Schedule A)
6. TOTAL PAYMENTS ON PROMISES RE~EIVED (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. . . . . . . , . . . . . . . .
PAGE It) OF I~
STATEMENT COVERS PERIOD
FROM THROUGH
1.0. NUMBER
AMOUNT
PAID
THIS PERIOD
CUMU-
LA TIVE
AMOUNT
UNPAID
(ALSO ENTER ON
SCHEDULE A)
CALENDAR YEAR:
$
FISCAL YEAR:
$
CALENDAR YEAR:
$
FISCAL YEAR:
$
CALENDAR YEAR:
$
FISCAL YEAR:
$
CALENDAR YEAR:
$
FISCAL YEAR:
$
CALENDAR YEAR:
$
FISCAL YEAR:
$
$
(b)
(May be neg-
atlv~ figure)
. ,
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS (OTHER THAN LOANS) MADE
FORM 490
PAGE /1 OF /~
STATEMENT COVERS PERIOD
(Amounts May Be Rounded To Whole Dollars)
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.
"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 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 "Descriptlon 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 AMOUNT
(IF COMMITTEE, IN ADDITION TO COMMITTEE'S PAID
NAME AND ADDRESS, ENTER 1.0, NUMBER
DR,IF NO 1.0, NUMBER HAS BEEN ASSIGNED, ENTER THE CODE OR DESCRIPTION OF PAYMENT
TREASURER'S NAME AND ADDRESS)
SUBTOTAL $ .,,-
SUMMARY
1. PAYMENTS OF $100 OR MORE MADE THIS PERIOD $
(Include all Schedule E subtotals) ..... ..... ....... ..... ............ .......... ..... ............ ............,,, ............ ......
-()..
"'0 ..
2. PAYMENTS UNDER $100 THIS PERIOD (Not itemized) ...................
3. TOTAL INTEREST PAID THIS PERIOD ON OUTSTANDING LOANS
(Schedule B, Part 2, Column (d)) .................................................
()'
..{)..
4. TOTAL ACCRUED EXPENSES PAID THIS PERIOD (Not itemized) (Schedule F, Line 4) ,...................
5. TOTAL PAYMENTS THIS PERIOD (Line 1 + 2 + 3 + 4) Enter here and on Line 8, Column B of
Summary Page .......,.........,....................",... .....,..,.........,...............................................,.........,_ $
-(j-
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS (OTHER THAN LOANS) MADE
(CONTINUATION SHEET)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE
/2., OF /h
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 A'ND PERIODICAL ADVERTISING
"S" - SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR
SOLICITATIONS
"0" -- OUTSIDE ADVERTISING
"F" - FUNDRAISING EVENTS
"G" -- GENERAL OPERATIONS AND OVERHEAD
"T" -- TRAVEL, ACCOMMODA TIONS 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.
NAME AND ADDRESS OF PAYEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION
(IF COMMITTEE. IN ADDITION TO COMMITTEE'S AMOUNT
NAME AND ADDRESS, ENTER I,D, NUMBER PAID
OR. IF NO 1.0. NUMBER HAS BEEN ASSIGNED, ENTER THE DESCRIPTION OF PAYMENT
TREASURER'S NAME AND ADDRESS) CODE OR
SUBTOTAL $ -~-
SCHEDULE EE
LOANS MADE TO OTHERS
FORM 490
(Amounts May Be Rounded To Whole Dollars)
6
PARTI: LOANS MADE TO OTHERS
DATE
OF
LOAN
FULL NAME AND ADDRESS OF RECIPIENT
INTEREST
RATE
DUE DATE
SUBTOTAL $
PAGE 10 OF I"
STATEMENT COVERS PERIOD
FROM THROUGH
I.D, NUMBER
AMOUNT
CUMULATIVE
AMOUNT
PART 2: LOAN REPAYMENTS RECEIVED BY THIS CANDIDATE, OFFICEHOLDER OR COMMITTEE AND LOANS FORGIVEN
BY THIS CANDIDATE, OFFICEHOLDER OR COMMITTEE
DATE OF
REPAY. DATE OF
MENTOR ORIGINAL
FORGIVE- LOAN
NESS
FULL NAME OF
RECIPIENT OF LOAN
FORGIVEN/PAID BY THIRD PARTY AMOUNT REPAID OUT-
INT, OR FORGIVEN ON STANDING INTEREST
RA TE (IF FORGIVEN LOANS: Enter "Forgiven" Also PRINCIPAL (00 NOT PRINCIPAL RECEIVED*
CHANGED) itemize for Iven loans on Schedule E. INCLUOE RECEIPT
PAYMENT BY THIRD PARTY: Enter name OF INTEREST)
SUBTOTAL $
*TOTAl AU INTEREST RECEIVED THIS PERIOD. ALSO ENTER
ON LINE) OF THE SUMMARY SEenON OF SCHEllOLE G. DO
NOT CARRY THIS TOTAL TO THE SUMMARY BELOW.
SUMMARY
1. LOANS OF $100 OR MORE MADE THIS PERIOD (Part 1) . . . .. . . . . . . . . .. . . . . . . . . . . . . . . _
2. LOANS UNDER $100 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)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . .
S. 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. . . . . . . . . . . . . . . .
(a)
SCHEDULE EE - LOANS MADE TO OTHERS (PART 3)
ANNUAL REPORT OF OUTSTANDING LOANS MADE
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE /4 OF /6
STATEMENT COVERS PERIOD
FROM THROUGH
PART 3: ANNUAL REPORT OF OUTSTANDING LOANS MADE
BEFORE COMPLETING.
FULL NAME OF RECIPIENT OF LOAN
ORIGINAL
DATE
OF LOAN
AMOUNT
OF
ORIGINAL
LOAN
UNPAID
PRINCIPAL
UNPAID
INTEREST
SUBTOTAL
$ -0-
(NOTE: THIS TOT AL
SHOULD BE THE SAME
AMOUNT AS ENTERED
ON liNE 9, COLUMN C
OF THE SUMMARY
PAGE)
. ,
SCHEDULE F
ACCRUED EXPENSES
(UNPAID BILLS)
FORM 490
(Amounts May Be Rounded To Whole Dollars)
PAGE /5 OF I"
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
~6'P
,
I.D, NUMBER
85C6~
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 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
'T' -- FUNDRAISING EVENTS
"G" -. GENERAL OPERATIONS AND OVERHEAD
"TN .-- 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 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
OR, IF NO 1.0, NUMBER HAS BEEN ASSIGNED, ENTER THE
TREASURER'S NAME AND ADDRESS
Av1Ht t .P4I1ne1"'t'~
~O.~~" -
Gi/~ CJ/ qS~2/)
.P~; (}jft.i:t' ~ ,~
~y "'" SD1/l a>>1/1/at .
AMOUNT
ACCRUED
CODE OR
DESCRIPTION OF OUTSTANDING PAYMENT
,u5lJ
SUBTOTAL
IMPORTANT: Do not itemize the payment of accrued expenses on Schedules E or F. Report the lump sum of these
payments on Schedule F, Line 4 and on Schedule E, Line 4. Do not re-itemize accrued expenses which have been
reported in a previous period.
SUMMARY
1. ACCRUED EXPENSES OF $100 OR MORE THiS ?ERIOD .............................................. $
$ U. 50
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) .............,.....,...,.....,................,..,.,.,.....,..,.......,.,.,......,..
5. NET CHANGE THIS PERIOD (Subtract Line 4 from Line 3) Enter difference here and on
Line 11, Column B of Summary Page ....................................................................
(May be
negative figure)
.,
SCHEDULE G
MISCELLANEOUS INCREASES TO CASH
FORM 490
(Amounts May Be Rounded To Whole Dollars)
NAME OF CANDIDATE OR OFFICEHOLDER AND CONTROLLED COMMITTEE:
..
DATE
REC'D.
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE. IN ADDITION TO COMMITTEE'S
NAME AND ADDRESS, ENTER I.D 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 $100 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. . . . . _ . . . . . . . . . . . . . . . . .
PAGE I~ OF I"
STATEMENT COVERS PERIOD
FROM THROUGH
/-/-
10, NUMBER
$
$
AMOUNT OF
INCREASE
TO CASH
$
-~ -
.. ~ ...
-() -
-0-
-0..