Pete Valdez - 1985/10/20 - 1986/01/31
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CAMPAIGN STATEMENT
(Government Code Sections 84200-84217)
or:::-'.
Form 490
1985
For use by candidates/officeholders and their controlled committees.
TOTAL PAGES:
CANDIDATE/OFFICEHOLDER INCLUDED IN THIS CONSOLIDATED REPORT
OFFICE SOUGHT OR HELD (INCLUDE L.OCATION AND DISTRICT
NUMSER IF APPLICABL.EI
ZIP COOE
II CONTROLLED COMMITTEES* INCLUDED IN THIS CONSOLIDATED. REPORT
CITY
Crt
ADDRESS OF COMMITTEE,
NO. AND STREET
CITY
STATE
ZIP COOK
AREA CODE
PHONE NUMBER
NAME OF TREASUR'ER,
PERMANENT ADDRESS OF TREASURER: NO. AND STREET
CITY
STAT!!
ZIP CODE
AREA CODE
PHONE NUMBER
Attach additional information on appropriatelv 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 Controlled Committee?+
AND 1.0, NUMBER COMMITTEE ADDRESS TREASURER Y.ES I NO
I
I
Attach additional information on appropnatelv labeled continuation sheets.
+ (A controlled committee is one which is controlled directlv or indirectly by a candidate or which acts iointly 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.)
Executed on
VERIFICATION
e this statement and iV~dules are true, corr
by ~1?- 'LH-
(SIGNATURE OF T
ct and complete and that
Executed 0
by
-1-
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. .
'~J..:L.U\.JJr\ltUI" vr ,,",'-'I'Ilf1.I&.IV8''-'I.V "'I'lll_ -......-...-..-..-- ....._~
CANDIDATES, OFFICEHOLDERS AND MEASURES (Allocate expenditures from Schedules E & F made
to or on ~ehalf of another candidate, officeholder or measure. Amounts may be rounded off to whole dollars.)
CHECK ONE
Support Oppose
AMOUNT
CUMULATIVE
TO DATE
~
~
/'
/'
Attach additional information on appropriatelv 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
Disci 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 the date of the election.
PART I:
Provide the candidate's or officeholderls 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.
VERI FICATION:
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 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,")
CAMPAIGN DISCLOSURE STATEMENT SUMMARY PAGE
FORM 420,430 OR 490
t!t7t1/lC/
(Amounts May Be Rounded To Whole Dollars)
$ CI~ 1l. 'f'f' :L:3
(SHOULD EQUAL LINE 9.
COLUMNS A .. B I
* 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 'v
10. Cash on hand at the beginning of this period. (Line 14 of previous statement) . $ ;;'3 r5: /0
:26 'J.-- f. {' 5~
~
1tiJ: /If
/aPf( 6i
~
COLUMN A
Cumulative
total from
*
previous period
CONTRIBUTIONS RECEIVED
$~~.g1J
~
$~'A1(~L
I~, tyfJ
~
$ 1/ (, 5~ tJ(Q
1. Monetary contributions . . . . . . . . . .
2. Loans......................
3. Subtotal....................
4. Non-monetary contributions. . . . . . .
5. Pledges.....................
6. TOTAL CONTRIBUTIONS. . . . . . . .
l.INES 3 + 4 + 5
EXPENDITURES MADE
$/~!$)Jf
kY'
$ It; J5t;l1
LINES 7 + 8
7.
Payments. . . ~ . . . . . . . . . . . . . . . .
8.
Accrued expenses (unpaid bills) . . . . .
9.
TOTAL EXPENDITURES. . . . . . . .
11.
Cash receipts this period (Line 3, Column B above) . . . . . . . . . . . . .
12.
Miscellaneous adjustments to cash (Schedule G, Line 7) . . . . . . . . . .
13.
Cash payments this period (Line 7, Column B above) . . . . . . . . . . . .
14.
Cash on hand at closing date (Lines 10+11+12-13 above) *. . . . . . . .
15.
Outstanding debts (Line 2 + Line 8 of Column C above) . . . . . . . . . .
COLUMN B
Total this period
from attached
schedules
COLUMN C
Cumulative
to date
(Columns A + B)
$ ~~b</ f1 50
SCHEDULE A, LINE 3
~
$ Gf0~50
~
$LI~S~+~?;' 50
) riP, ()I()
~
$ it ~i ,5 (()
(SHOULD EQUAL LINE 6,
COLUMNS A + s)
$ SCaZ~/~Np'<2
LINES 1 r'
SCHEDULE C, LINE 3
SCHEDUL~NE 1
$ f)..~:ll JS~
LINES 3 + 4 + 5
$ ~-tA .q9
er
$5:f'f1 :23
.zr
$ /c25lj 6/
,~)
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.
18, CASH EQUIVALENTS (OTHER ASSETS HELD) (See InstructIons on Reverse): $
SUMMARY FOR CANDIDATES IN BOTH A JUNE AND NOVEMBER ELECTION (See Instructions on Reverse)
1/1thru6/30 7/1 to date
19. CONTRIBUTIONS RECEIVED:
20. EXPENDITURES MADE:
-2-
CATE
REC'C
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SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
FORM 420, 430 OR 490
(Amounts May Be Rounded To Whole Dollars)
STATEMENT COVERS PERIOD
AMOUNT
OCCUPATION
(IIPr saL"'-CM"LOVCD. KNTKR
NAME 0... BUSINess)
TO DATE
FtI!CIUVED
CUMULATive
h~ C:OMMITT..,~.NT." 1.0. NUM.." 0"
T".ASU...... II NAMa AND A.ao"..s~
M/~~ i~ lJe Le6/1
r 9.1 l?)y~}It ~
,f rl- CJ '5 e- ~c:J
/l!!0r11 f1rf:/f )eI~
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Gt,. Oft q~lL,;:?
'['(or'€;r'- ic 11; c-Lt/ ~ eLr
n '-116 'A/ew I4--v~ I
G~ rv 76:Z- 0
..!2R
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cP
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CClVl'tntt<f1'ry JIop1t4 (
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~5 >" S4 ~ -r-c<- 1€ .&.s6{ G "''of
C; {/'~ ([0 z..u
J11..tA-rt ~~~O,<1 Jl,
'5'f (}.o It 'ct ~ ~~y 1/" e.-
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/ I~ ~ ~ /J f?~' "-'/ ?{::./,
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to k I C[ VI- cJ a I~
26~ 36'5~
~? 00
liJ(}~ ~ 05 -?:7
Pe lieire,S'
r-Y/ If more space is needed, check box at left
~ and attach additional Schedules A.
SUMMARY
1. AMOUNT RECEIVED - CONTRIBUTIONS OF $100 OR MORE / ~i ~ 7'
(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-
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
(CONTINUATION SHEET)
FORM 420,430 OR 490
STATEMENT COVERS PERIOD
(Amounts May Be Rounded To Whole Dollars)
l'r;U~B:f 6 C7MITTUl
FULL. NAME AND ADDRESS OF EMPLOYER AMOUNT
OATE CONTRIBUTOR OCCUPATION ( I" ...L,......MJlLOV.O. aNT." ,=UMUL.ATTV.
fit _C KIV ao
REC'O (II~ COMMITT..~.NT.R 1.0. NUM.IEFt Ollt NAMa O~ .USIN..S) TO QATa
T"."au"c" S NAME AND AOO".SS)
I~ (J U('i..-~crv.&?:;: ~\()~ 5257
f~F1 (. a V1> f<. rler~ cI(~ ~ 5 L/6-~
20 14-('
/~/ iA I (r(,l.~1. k S~~'l j -e J-~ $ 2 {)O?7 6tSt:
/"Iv ~ Je 11 ~1 t'e If t(59 " e 2:. ~O~~ 0Jf5~
"""y
I+~ f&~r+4 ta/tVi- r de /{)~~ 636~
Lf 5"e.-n c-k:t-- ' ct-J 61$ =c;
If) v 0 10 ~,
T<:<J'I^'( US 'tu~l /;L3t!f b?~
u'vcd (J .~/' 5' Sa '(e Jc./f.-
~kii~ : olUe fctrJs 71~ J67~
I~ Uc.#L J. at; ~rra ahe. ,;;; j15~
Jet'? Vl'\rOvy ( L\..
(;1 Cf ,',) z.,;D
d/6 ~
()8 y
1~J
Rc+r/1 loa ~ 00
/8()6-~
0 If more space is needed, check box at left SUBTOTAL 51Jrf
and attach additional Schedules A.
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
(CONTINUATION SHEET)
FORM 420,430 OR 490
OCCUPATION
(Amounts May Be Rounded To Whole Dollars)
J; :t Ql
DATI!:
REC'D
FULL NAME AND "OORESS 01"
CONTRIBUTOR
(I.- COMM'T,....~.NT.'" 1.0. NU.....lER Oft
,..".....u.... , N......... AND "00,,.s51
:J;vs-~ kc-rt~c h,v
'-f 15' ;3 V- (' ke Dr
G;( I c-'" (] It-- Cf?~ ~ (/
~ - "1.-
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(tJ ( !-I{)(J~ t) /{ Sf,
I (r "f fljl~ 75:; ~r/
.,~,,'V,_ q M- j 0 JI~ e:' ~z-... j- ,/J -' i_.n
r...e J; , /VrWt-..T"C-
1- ,. :; fI C{ 11 II &l Jt_ /fv-'.(? t( It Itt t1
ad!'.), (if\- 75~~D
,17:n e1sr/~~ ~~/A
5'0'<) id t:en.fJ; ]'1 1$0
cy .. tJ 1/1 {)to
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"( I T"<Q oz <!)
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1~)5 (a.....f/rl'l Plo-t!e.
, , tIt ,5r.>l,O
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3 53/t'8 M it ft St-
c;-/ iro Oj4- 5' ~ 0
;Joel 'bflU()lerz _
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t f' 9502 U
Pq€ I oC~ I 'SM-~~
ku 'F/ad-Ci! co CIl r1(oc:'
~Wq t( ,tie ttJ/! ~
If 'f, t/cu'<.~lcl~ Dr-
4'{ / /'0 1 (}r1 '/ 5..,2 0
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,(!)jzer5 / e~ 'ke- S'/t!e
.
/fa
[8 ~
(!J )1
I~
/~
D
If more space is needed, check box at left
and attach additional Schedules A.
{I..- .CL......M..t,.QVEO. .NT."
NAM. 0'" .V.INC..}
".CK'Va:O
CUMULATive
TO QAt. TC
I .
~~~ / [J25~
j$? e5cJ ~
I
I I
Ili/ll1tl~.A, 111 ~e~1
1c t.<"'loL- '1.- -h-, ,^-c -
/'f( c~ /' f"Cj,. 70/7 :
I
~ / j,t::II~
~ ~ ~ ~I
/51" b5~
~CO~>' /365:%
Irft /31S~
Sf-Q r-e
)ie/?;!; II Fools
<91;Jl-\.-e--V
T
I
;;:ruiU5 f;{ ~I Shive ten
- r ~V'f:./;J }'1>t"l!'4t/r-
rJ~
()(fY
SUBTOTAL
SCHEDULE A
MONETARY CONTRIBUTIONS RECEIVED
(CONTINUATION SHEET)
FORM 420,430 OR 490
(Amounts May Be Rounded To Whole Dollars)
~:%e Vac~~f t'hJMlezr: J;-,
OATI!:
REC'D
FULl. NAMIi: AND ADORI!:SS 01'
CONTRIBUTOR
OCCUPATION
( ,,,, .CL,....M.-l,QVI!O. .NT...
NAMC 0" "U.IN..S~
(IIII' COMMITT..~.NT.lIt 1.0. NUM.CR 0"
T_IIAaU"." 5 NAMe AND AOOlfff["S)
1/1
*
1<(
=r
I
~
T
I
/h 'l
'11
c,e,zu'i I
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~{'-h ~ () ~ft-erw f
L'o d+-rctct,"~
41
71ft
1])0 rial J
, W,-e iJW1et- (\
S~ JO,;e~
STATEMENT COVERS PERIOD
1,0. NUMBER (1I1l' COMMITT..)
OI(JY"/
AMOUNT
,,_calveo
CUMULATIve
TO QAT.
15tJ~ )J17'Jfr
J;':;' ;(j 5 6 s;<;.
b'::" J</6,2- ~
()C
J '~'r 2/Tc~ ff;.
6-r ~/TJf:.
f-'L500 51~/~
T~ -<;:":22 1 7< Y
*1i)(J /.5-0
/'2---;::'1' 21 b~
fi]:2.
/ (}O'*~ ,~] r0 }<; ~
$--,
:1.~;::' JU/ >~
50
J()fF't1/ ~
I f more space is needed, check box at left
and attach additional Schedules A.
~ i..l If.:.
SUBTOTAL r./2/-;Ai"
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
FORM 420, 430 OR 490
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 this schedule and the Information Manual
on Campaign Disclosure for detailed explanations and examples of each category.
"5" -
SURVEYS, SIGNATURE GATHERING,
DOOR-TO-DOOR SOLICITATIONS
FUND RAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
PROFESSIONAL MANAGEMENT AND
CONSULTING SERVICES
"C" - CONTRIBUTIONS TO OTHER
CANDIDATES OR COMMITTEES
"I" - INDEPENDENT EXPENDITURES
LITERATURE
"B" - BROADCAST ADVERTISING
"N" - 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.
"L"
NAME AND ADDRESS OF PAVEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION (alW COMMITT.., ~I!NT1I!:1lt
1.0. NUM.." 0.. HAM IE AND ADDR.55 0'" T"""'SU".")
"F" -
UG" _
liT"
"P" -
CODE OR
DESCRIPTION OF PAYMENT
AMOUNT
PAID
5c)~
0-0
Sf}~-."
;25;( #-
I more space is nee e ,check box and
ttach additional Schedules E.
PORT ANT: Contributions and expenditures on behalf of other candidates or committees must also be entered in the
\location section at the front of the campaign statement.
SUMMARY
L
L
L
6
L
SUBTOTAL
1.
Payments of $100 or more made this period (Include all Schedule E Subtotals) . . . . . . . . . . . . ' . . . . . . . . . .$
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. ' . . . . . . . .$
_7_
(~35?, 71.6
3;2i~53
<f!-J O~ oro
B~~~~rl
+ '15
',--7..1.1 /1.,
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
(CONTINUATION SHEET)
FORM 420,430 OR 490)
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
"'" INDEPENDENT EXPENDITURES "F" - FUNDRAISING EVENTS
"L" - liTERATURE "G" - GENERAL OPERATIONS AND OVERHEAD
"S" - SROADCAST 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 PAVEE, CREDITOR OR
RECIPIENT OF CONTRIBUTION (IF COMMITTEE, ~ENTER
1.0. NUMBER OR NAME AND ADDRESS OF TREASURER)
COOE OR
I-
e-.
e:
L
Co~ll:1kP;l~crlettcl'~ I~' ~ (;)Of 13M C-
~I { (10, ~ L f r {J.e IS Clr 0 96 ~117-
}'Urr~(I<R. (yL/-e )
C'h v. I'( h Sf- U
G:lr CA- 9~oz 0
(\\1 oJ ~ lt~~ L
C; (t-\ Of\- {'SD?-CJ
jJ /faC "QI 6 2-- L
~ I1J'OJ e Ov~f ~ ,0j2}q- / 2-f}?
If more space is needed, check box and
attach additional Schedules E.
1j~-MHj ~ I 9"
.6rCJC. ' r /It.
/00 ~y
1:& -:f
'/50 fir
150%
5b5 .;;;
DESCRIPTION OF PAYMENT
~5J1 e lu,1t - / /J'
'(veVI ~'~'5 /-1tJ e.
P<.) sfo- j..e
/1;t~ ( ~.
. dn 1/'110 wr,o'", fo~
r
c~ yu .Q' J1 /3.)1, '/1,
AdVf:.~ -hSI ~s f YJ
~-.....)S .:< e'-
AMOUNT
PAID
,~
r
23
t5~7
I/&O~
SUBTOTAL ~ &501
-";;"';,_.';i_:~"'_"""""~;,, _'._
SCHEDULE E
PAYMENTS AND CONTRIBUTIONS MADE
(CONTINUATION SHEET)
FORM 420, 430 OR 490)
J e::t Tr.
~uncl f
(Amounts May Be Rounded To Whole Dollars)
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", "1" 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
"S" - 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 PAVEE. CREDITOR OR
RECIPIENT OF CONTRIBUTION (IP' COMMITTEE, ~ENTIER
1.0. NUMBER OR NAMa AND AODRIISS 0"- TRe:ASURI!:R)
CODE OR
DESCRIPTION OF PAVMENT
AMOUNT
PAID
El1eQ1r-u Ca:u~S/nf)
0dhaq-f//~~cA-1/J l-q Ca t
./'I .J.....
v(;;/ln/e- VCt,f i.{ee
n Of /let 1fq J't-
f ~z.- D
!BPI/lo n'S (1q IOI'e-
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lite o.ri'Q.J tJer ra~
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wi 7r-7 (J 11-.. 7'?~.:;;1-~
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r
a
-
Cxfel1Jes <Jr
I/q.je lct/~
1/1 [f~l'! '!tbr,,-h~~
Lu fffs
1;000
:;2CJ()~
~
.sa..
36 ~y
r;
(I
It'
e
YCJ c~;-
"
II'
~
//'
,
575
q,.2
?-y
6' I
(/<f'e ffi tlkwC<(A/.1-
6
50:;;
r~
Vt i'f"' ,c 07a. "" be/ C;/ (~'7
Ci'
:;:LS ~
D If more space is needed, check box and
attach additional Schedules E.
SUBTOTAL
v
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