HomeMy WebLinkAboutMCDERMOTT PREELEC98(2)Officeholder, Candidate,
and Controlled Committee Statement covers period Oat Stem
(Government Code Sections 84200-84216.5)
Type or print in ink. COVER PAGE - LONG FORM
SEE INSTRUCTIONS ON REVERSE
Check one of the following boxes to indicate the type of statement being filed:
Pre-election Statement
Supplemental Pro-election Statement (Attach a completed Form 495 to this statement.)
' Special Odd-Year Campaign Report
Semi-annual Statement
Termination Statement (Attach a completed Form 415 to this statement.)
~lffic holder Candidate, and Controlled Committee
Included in t~is Statement
NAME OF OFFICEHOLDER OR CANDIDATE
t~,evl ,v l~De~,b~o'Fr'
OFFICE SOt~HT OR HELD (INtrUDE LOCATION AND DISTRICT, NUMBER IF APPLICABLE)
RESIDENTIAL OR IUSINESS ADDRESS (NO. AND STREET)
LD. NUMIER
through ~ ~ ' Zl - ~ ~:
Date of election ff applicable:
(Month, Day, Year)
~8 OCT 22 PM 3:1~5
'~/:, <ER~'`*t''~ n
~ t,' ~,~,~:~_'~ CITY CLE
For Official Use Only
K
COMMITTEE ADDRESS
(NO. AND STREET)
uther Committees ~ot Included inChEs Statement: un,ny other
committees not included in this consolidated statement that ere controlled by you and any
comm/ffees of which you have knowledge that are primarily formed to receive contributions
Or to make expenditures on behalf of your candidacy,
COMMITTEE NAME LD. NUMBER
NAME Of TREASURER CONTROLLED COMMITTEE/
(
ILD, NUMBER
CONTROLLED COMMITTEE?
] ,,s [] ~o
CITY STATE ZIP CODE AREA CODE/DAYTIME PHONE
Attach additional information on appropriately labeled continuation sheets.
in the attached schedules is
An officehoMer Or candidate who controls s committee must also verify the campaign statement. I have used ell reasonable diligence and to the best of my knowledge the treasurer has used a II
reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my k nowledge the information contained herein and in the attached schedules is true and
"*;7..
~AND STATE
DATE
Executed on At By
DATE CITY AND STATE
Executed on At By
DATE CITY AND STATE
SIGNATURE OF CANDIDATE/OFFICEHOtDER
SIGNATURE 0P CANDIDATE/OFFICEHOlDER
SIGNATURE OF CANDIDATE/OFFICEHOLDER
FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES AC1 OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT
State nf California Fair Political Practire~ Cnrnrni~{inn
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Contributions Received
I. Monetary Contributions ............................... Schedu~eA, Une3 $
2. Loam Received ......................................... Schedule e, Une 7
3. SUBTOTAL CASH CONTRIBUTIONS ...................... AddUnes; ,, 2 $
4. Non-monetary Contributions ......................... Schedule CUne 3
S. SUBTOTAL CONTRI BUTIONSi(Exdude Enforceable Proarises) AddLines3 ,, 4 S
6. Enforceable Promises
(Extlude Loan Guarentees, Une 18 below) ................... $chedule D, Une 7
7, TOTAL CONTRIBUTIONS RECEIVED ..................... AddUnesS + 6 S
Expenditures Made
8. Cash Payments (Other than Loans Made) ............ Schedde E, Une
9. Loans Made .............................................Schedule H, Une ·
10. SUBTOTAL CASH PAYMENTS ............................ AddLines8 +
11. Accrued Expenses (Unpaid Bills) ........................Sdx. du/ef, L]ne5
12. TOTAL EXPENDITURES MADE ......................... AddUnes ;0 · II
'Current Cash Statement
13. Beginning Cash Balance .................. Previous Summery Page,
14. Cash Receipts ...................................... ColumnA, Line3above
15. Miscellaneous Increases to Cash ........................ Schedule ~, Une 4
16. Cash Payments .................................... ColumnA, Line
17. ENDING CASH BALANCE ..... AddLines 13 t 14 · ;S, thensubtract Une
If this is e termlnation statement, Line 17 mult be zero.
18. LOAN GUARANTEES RECEIVED .............. Schedule B, Part #, Column (b) S
Cash Equivalents and Outstanding Debts
19. Cash Equivalents ................................see instructfons on reverse $
20. Outstanding Debts ................. AddLtne 2 ,, Line 11 inColumnCabove
Type or prim in ink.
Amounts may be rounded
to whole dollars.
COlUmn A
TOIAL THIS leT[NOD
ATIACHID SCHEDULES)
;~.q~
s
s
s 7
1
s
ENDING CASH IALANCE SHOULD
NOT BE A NEGATIVE AMOUNT
Statement covers period
from
~o-~-qg
through
SUMMARY PAGE
:. ~ . ~. ~
I.D. NUMBER
Column B*
GEE NOTE IELOW)
s tc>~'Tb-~ _ s __
s to,'/(o~' _ s
s to~'?(~' _ s
s ~o~'~(o';
s
s
Column C
TOTAL TO DATE
(ADO COLUMNS. A · e)
s 3'3,"70 ~/
s t2_,3.3 ~
* From previous Statement Summary Page, Column C. However, if
this is the first reOort filed for the calendar year, Column B should be
blank except for Loans Received (Line 2), Enforceable Promises (Line
6), Loans Made (Line g), and Accrued Expenses (Line 11).
Summary for Candidates in Both June and
November Elections
111 through 6/30 711 to Date
21. ontrib tions
22. ~apc?end!!.u.r.e! S
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE (:; CONIMrrtEE, m NXffKNt TO C(31~MrlIEE 'S I~e, ME AN0 ADDI~ESS, Emir %.0. NUMBER
RECEIVED o~, w NO I.O. NUMBER HAS HEN AS~NED, ENTER TREASURER'$ I~&ME AND AOORESS)
Type or print in ink.
Amounts may be rounded
to whole dollars.
OCCUPATION AND EMPLOYER
(IF $ELF-EMFtOYED, ENIER
N,&,ME OF IUStNESS)
Statement covers period
frOm
through
AMOUNT
RECEIVED THIS
PERIOD
i%
,%
Monetary Contributions Summary
\oo
1,,loo
1. Amount received this period -- contributions of $100 or more.
(Include all Schedule A subtotals.) ....................................................................................................
2. Amount received this period -- contributions of less than $100.
(Do not itemize.) .......................................................................................................................
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1 .) .......... ............................... TOTAL
SCHEDULE A
· ' i~ s. ':- ::'''~ c:::: :k :>
I.D. NUMBER
CUMULATIVE TO DATE CUMULATIVE TO DATE
CALENDAR YEAR OTHER
(JAN. 1 - DEC. 3 1 ) (IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE (IF COMMITTEE, IN ADDITION TO COMMITrE/'S NAME AND ADDRESS, ENTER I.O. NUMBER
RECEIVE D oe, IF NO I.O. NUMBER HAS IEEN ASSIGNED, ENIEB TREASURER"$ NAME AND ADDRESS)
|
,-%
Type or print in ink.
Amounts may be rounded
to whole dollars.
OCCUPATION AND EMPLOYER
(IF SELF-EMPI.OYED, ENTER
NAME Or BUSINESS)
Statement covers period
~o-~\-q:~
through
AMOUNT
RECEIVED THIS
PERIOD
~'o0
SUBTOTAL
SCHEDULE A (cont.)
::: 7 ~i: :::: .:~:: ~::::":~!:
,~ ~. :: ~ ::i~
CUMULATIVE TO DATE CUMULATIVE TO DATE
CALENDAR YEAR OTHER
(JAN. 1 - DEC. ~1) (IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Amount~ may be rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
OCCUPATION AND EMPLOYER
DATE ~ C~M~EE, ~ A~ TO C~M~EE'S IMi AND ~S$, E~ER I.D.
RECEIVED ~ · ~ I.D. ~M~R ~5 ~EN ASkeD, E~ER T~A~R'5 ~ME A~ A~55) ~ME
SUBTOTAL $
Statemen1 covers period
f,, ib- I-q ?
through
AMOUNT
RECEIVED THIS
PERIOD
&,::>o 0
S'C,
Or...)
SCHEDULE A (cont.)
Page
I.D~.,UMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
.,lf
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type cx prim in Ink.
Amounts may be rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED OMMITTEE
FULL NAME AND ADDRESS OF CONTR;~UTOR 5
DATE
RECEIVED
OF COMMITTEE, IN ADDITION 'TO COMMII'rEE'5 NAME AND ADDRESS, INTER I.D. NUMIER
O~ IF NO I.D. NUMIER HAS IEEN ASSIGlOO, ENTER TR. EASUR~R'$ NAME AND ADDRESS)
'~-~/ ~'.~ ,/~'~' "
,=
&~
/7'/~ ,B,m C {~ ~j
~_~
OCCUPATION AND EMPLOYER
(IF $ELF-[MIItOYEDo ENTER
NAME Of IU$1NES$)
SUBTOTAL
Statement covers period
,,,
AMOUNT
RECEIVED THIS
PERIOD
SCHEDULE A (cont.)
I.D. NUMBER
,.25"'C
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
2S'O
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type or print in ink.
Amounts may be rounded
to whole dollars.
' FULL NAME AND ADDRESS OF CONTRIBUT~)t; OCCUPATION AND EMPLOYER
DATE (~ COMMITTEE, IN ADDITION TO COMMITrIE'$ NAME AND ADDRI$S, ENTER I.D. NUMtER (IF $ELF-EMPt. OYED, ENTER
RECEIVED ~ If NO I.D. NUMIER HAS lIEN AS~I6NED, ENTER TREASURER'S NAME AND ADORES5) NAME Of IU$1N!$S)
SUBTOTAL
Statement covers period
fr, '
through
AMOUNT
RECEIVED THIS
PERIOD
SCHEDULE A (cont.)
,...,"7 .. 1(
I.D. NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN, 1 - DEC. 31)
c:::,,Dc3c5
\~c~O
f
2,.5c5
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type of print in Ink.
Amounts may be rounded
to whole dollars.
OCCUPATION AND EMPLOYER
DATE (~ COMMITTEE, IN ADDITION TO COMMITTEE'& NAME AND ADDI~SS, ENTER I,D, NUMI~R(IF $ELF-iMPLOYED, ENTER
RECEIVED oe. IF NO I.D. NUMBER HAS IEEN ASSIGNED, ENTER TREASU~ER'$ NAME AND ADDRESS)NAME OF IUSINT$$)
SUBTOTAL
Statement covers period
,,, \ ~ - ~-~, g'
through
AMOUNT
RECEIVED THIS
PERIOD
I.D. NUMBER
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. I - DEC, 31)
(0~
c'~CDL)
s
SCHEDULE A (cont.)
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type m prim in Ink.
Amounts may be rounded
to whole dollars.
FULL NAME AND ADDRESS OF~O'N~RI~TOR
DATE
RECEIVED
(IF COMMrrrEE, IN AD~TION TO COMMITTEE'$ NAME AND ADDRESS, ENTER LD. NUMRER
~ If NO I,D, NUMIER HAS REEN A$~GNED, ENTER TREASUIIER'$ NAME AND ADORE$5)
OCCUPATION AND EMPLOYER
(IF g~LF-EMPLOYED, ENTER
NAME OF
SUBTOTAL
Statement covers period
SCHEDULE A (cont.)
,.,. 92
I.D. NUMBER
970
AMOUNT CUMULATIVE TO DATE
RECEIVED THIS CALENDAR YEAR
PERIOD (JAN. 1 - DEC. 31)
{r-,5C3 /00
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type or print in Ink.
Amounts may be rounded
to whole dollars.
NAME F OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME D ADDRESS OF CO~I~UT~O~ AN
DATE (w COMMrrrEE, IN ADDITION TO COMMrrrEE°$ NAME AND ADDR/$$, ENTER I.D. NUMIER
RECEIVED oe, w NO I.D. NUMIER HAS IEEN ASgGNED, ENTER TREASURER'$ NAME AND ADDRESS)
OCCUPATION AND EMPLOYER
(IF ~,ELF-(MPLOYED, ENTER
NAME Of IU$1t~$S)
SUBTOTAL
through
SCHEDULE A (cont.)
Statement covers period ~ .~ ,.,
to - 2. \ -G "'4 [,,,,./o ~ 15"
I.D. NUMBER
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN, I - DEC, 31)
\
CUMULATIVE TO DATE
OTHER
(IF APPLICABLE)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Type or print in ink.
Amounts may be rounded
to whole dollars.
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
FULL NAME AND ADDRESS OF CONTRIBUTOR
DATE (e COMMITTEE, IN ADD~ION TO COMMffTEE'S NAME ANO ADDRESS, ENTER LD. NUMI~R
RECEIVED oe, i~ NO I.D. NUMIER HAS lIEN ASSIGNED, ENTER TREASURER'S NAME AND
OCCUPATION AND EMPLOYER
(11r SELf-EMPLOYED, ENTER
NAME Of
Statement covers period
through ~L~:Z~w~ ~[/
AMOUNT
RECEIVED THIS
PERIOD
SCHEDULE A (cont.)
·
!
I,D. NUMBER
CUMULATIVE TO DATE CUMULATIVE TO DATE
CALENDAR YEAR OTHER
(JAN, 1 - DEC, ]1) (IF APPLICABLE)
SUBTOTAL
Schedule C
Non-Monetary Contributions Received
Type o~ Ixint in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
Statement covers period
through
FULL NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER DESCRIPTION OF FAIR MARKET
DATE (:; COMMITTEE, IN ADDITIONTO COMMITTEE'S NAME AND ADDRESS, (IF SELF-EMPLOYED, ENTER NAME Of GOODS OR SERVICES VALUE
RECEIVE D E~rrEe I.D. NUMBER OR,. If NO I.D. NUMBER HAS BEEN ASSIGNED,BUSINESS)
ENTER TREASURER'S NAME AND ADDRESS)
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL
Non-Monetary Contributions Summary
1. Amount received this period -- non-monetary contributions of $100 or more,
(Include all Schedule C subtotals.) .................................................................................... $
2. Amount received this period -- non-monetary contributions of less than $100.
(Do not itemize.) ........................................................................................................ $
3. Total non-monetary contributions received this period,
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 4.) ....................... TOTAL $
SCHEDULE C
,.. / A. o,
I.D. NUMBER
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
CUMULATIVE TO
DATE OTHER
(IF APPLICABLE)
Schedule E
Payments and Contributions
(Other Than Loans) Made
Type or print in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE
CODES FOR CLASSIFYING EXPENDITURES
Statement covers period
through
SCHEDULE E
If one of the following codes accurately describes the expenditure, ou may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations of Yecach category.
'C'-
MONETARY AND IN-KIND (NON-MONETARY) 'B* -
CONTRIBUTIONS TO OTHER CANDIDATES °N* -
AND COMMITTEES 'O' -
INDEPENDENT EXPENDITURES 'S' -
LITERATURE "F' -
BROADCAST ADVERTISING
NEWSPAPER AND PERIODICAL ADVERTISING
OUTSIDE ADVERTISING
SURVEYS, SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS
FUNDRAISING EVENTS
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
(If COMMITTEE, IN ADDITION TO COMMITTEE'$ NAME AND ADDRESS, ENTER I.D. NUMIER OR, I; NO I.D.
NUMIER HAS BEEN ASilGNED, ENTER TREASUI~R'S NAME AND ADORE$S)
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIBED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULE E.
REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON LINE 4 OF THE SUMMARY SECTION BELOW.
CODE OR DESCRIPTION OF PAI'MENT
L
AMOUNT PAID
Im rtant: Contributions and expenditures made out of campaign funds to or on behalf of other
o~i~hdders, candidates, committees, or ballot measures must also be entered On the Allocation Page, Part I. SUBTOTAL
Payments and Contributions Made Summary
1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ............................ : .........................
2. Payments made this period of under $100. (Do not itemize.) .......................................................................
3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part II, Column (d).) ..............................
4. Total accrued expenses paid this period. (Do not itemize. Enter amount from Schedule F, Line 4.) .....................................
5. Total payments made this period. (Add Lines 1, 2, 3, and 4. Enter here and on the Summary Page, Column A, Line 8) ........... TOTAL
Schedule F
Accrued Expenses (Unpaid Bills)
Type or print in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
NAME
CODES FOR C~SSIFYING EXPENDITURES
Statement covers period
through lc~ ' 7_ ~ ~, ~
SCHEDULE F
of ·
NUMBER
If one of the following codes accurately describes the expenditure, ou may enter the code and leave the "Description of Payment" column blank. Refer to the
back of Schedule E-Continuation Sheet for detai led explanations otY~ach category.
'c'-
MONETARY AND IN-KIND (NON-MONETARY) °B' -
CONTRIBUTIONS TO OTHER CANDIDATES *N" -
AND COMMITTEES 'O' -
INDEPENDENT EXPENDITURES 'S' -
LITERATURE ' F' -
BROADCAST ADVERTISING 'G' -
NEWSPAPER AND PERIODICAL ADVERTISING 'T" -
OUTSIDE ADVERTISING
SURVEYS. SIGNATURE GATHERING, DOOR-TO-DOOR SOLICITATIONS ' P" '
FUNDRAISING EVENTS
GENERAL OPERATIONS AND OVERHEAD
TRAVEL, ACCOMMODATIONS AND MEALS
(MUST BE DESCRIBED)
PROFESSIONAL MANAGEMENT AND CONSULTING
SERVICES
NAME AND ADDRESS OF PAYEE, CREDITOR, OR RECIPIENT OF CONTRIBUTION
(IF COMMITTEE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS, ENTER I.D. NUMBER OR, IF NO I.D.
NUMIER HAS BEEN ASSIGNED, ENTER TREASURER°S NAME AND ADDRESS)
IMPORTANT: DO NOT ITEMIZE THE PAYMENT OF ACCRUED EXPENSES ON SCHEDULES E OR F. REPORT ONLY THE LUMP SUM OF PAYMENT<,
ON SCHEDULE F, LINE 4 AND ON SCHEDULE E, LINE 4. DO NOT RE-ITEMIZE ACCRUED EXPENSES REPORTED IN A PREVIOUS PERIOD
CODE OR
DESCRIPTION OF OUTSTANDING PAYMENT
AMOUNT ACCRUED
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL
Accrued Expenses Summary
1, Accrued expenses this period of $100 or more. (Include all Schedule F subtotals.) .....................................................
2, Accrued expenses this period of under $100, (Do not itemize.) .....................................................................
3, Total accrued expenses incurred this period. (Add Lines 1 and 2,) ................................................. INCURRED TOTAL
4, Total accrued expenses paid this period. (Do not itemize, Enter here and on Schedule E Summary, Line 4.) ................. PAID TOTAL
5, Netchange this period. (Subtract Line4from Line3, Enter the difference here and on the Summary Page, ColumnA, Line11.) ...... NET
May be a negat:ve number
Schedule G
Payments Made b an Agent or Inde endent
Contractor (on Behalf of an Officeholder or
Candidate)
SEE INSTRUCTIONS ON REVERSE
NAME OF AGENT OR INDEPE NT CONT~CTOR ~
Type or print in ink.
Amounts may be rounded
to whole dollars,
Statement covers period
through { r~ -- 2_ ~ --~ (~
SCHEDULE G
CODES FOR CLASSIFYING EXPENDITURES
If one of the following codes accurately describes the expenditure, ou may enter the code and leave the "Description of Payment' column blank. Refer to the
back of Schedule E-Continuation Sheet for detailed explanations of Y~ach category.
'L'- LITERATURE 'S'- SURVEYS,SIGNATUREGATHERING, DOOR-TO-DOORSOLICITATIONS
'B'- BROADCASTADVERTISING "F"- FUNDRAISINGEVENTS
'N° -- NEWSPAPER AND PERIODICAL ADVERTISING "T' - TRAVEL, ACCOMMODATIONS AND MEALS
'O" - OUTSIDE ADVERTISING (MUST BE DESCRIBED)
NAME AND ADDRESS OF PAYEE OR CREDITOR
COMMITTEE, IN ADDITION TO COMMrr[EE'S NAME &NO ADDRESS, ENTER I .D. NUMBER O1~ IF
NO I.D, NUMIER HAS IIEEN ASSIGNED, ENTER TREASURERS NAME AND ADDRESS)
CODE
Z_
OR DESCRIPTION OF PAYMENT
AMOUNT PAID
Y
Attach additional information on appropriately labeled continua :ion sheets. TOTAL* $
· DO not tranSfer to any other schedule or to the Summan/Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E by the office holder/candidate