HomeMy WebLinkAboutCOPE SEMIANN01(2)Recipient Committee
Campaign Statement
(Government Code Sections 84200-84216.5)
Type or print In Ink.
SEE iNSTRUCTIONS ON REVERSE
1. Type of Recipient Committee: AlI Commtttees - Complete Parts l, 2,3, and7.
Date of election If applica~llle: ~/
(Month, Day, Year)[~ ~' ~
I -Ol
2. Type of Statement:
Date Slamp
"~CiTYCLEF
[] Officeholder, Candidate
Controlled Committee
(Also Complete Part
[] Ballot Measure Committee
O Primarily Formed
O Controlled
O Sponsored
(Also Complete Part S.)
[] Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 6 )
[] General Purpose Committee ~. Sponsored
O Broad Based
~ Pre-election Statement
[] Semi-annual Statement
[] Termination Statement
[] Amendment (Explain below)
COVER PAGE
For Official Use Only
[] Quarterly Statement
[] Special Odd-Year Report
[] Supplemental Pre-election
Statement - Altach Form 495
3. Committee Information
COMMITTEE NAME
Treasurer(s)
NAME OF TREASURER
CITY
MAILING ADDRESS
CITY STATE ZIPCODE AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODEJPHONE
FPPC Form 460 (8199)
For T®chnlcal Assistance: 916/322-5660
State of California
Recipient Committee
Campaign Statement
Cover Page -- Part 2
Type or print in ink.
COVER PAGE - PART 2
4, Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
5. Ballot Measure Committee
NAME OF BALLOT MEASURE
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENT[AL/BUSINESSADDRESS (NO ANOSTREET} CITY STATE; ZIP
Related Committees Not Included in this Statement: List any cemmitteea
not included in this consolidated statement that are controlled by you or which are primarfly
formed to receive contributions or to make expenditures on behalf of your candidacy.
COMMITTEE NAME I D NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
[] YES [] NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZiP CODE AREA CODE/PHONE
BALLOT NO. OR LE~-rER JURISDICTION
[] SUPPORT
[] OPPOSE
Identify the controlling officeholder, candidate, or orate meaeure proponent, if any.
NAME OF OFFICEHOLDER. CANDIDATE OR. PROPONENT
OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY
6.
Primarily Formed Committee uat names of officeholder(s) or candidate(s)
for which thio committee ia prlmarfly formed.
NAME OF OFFICEHOLDER OR CANDIDAI~ OFFICE SOUGHT OR HELD I~
SUPPORT
[] OPPOSE
NAME OF OFFICEHOLDER OR CANOIDATE OFFICE SOUGHT OR HELD I~
SUPPORT
[] OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD
[] SUPPORT
[] OPPOSE
Attach continuation sheets if necessaq/
7. Verification
I have used all reasonable diligence in preparing and reviewing Ibis 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.
Execuledo~
SIGNATURE OF CONTROLLING (~'FICEHOLOER, CANOIDATE, STATE MSAS~RE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR
By
By
SIGNATURE OF CONTROLLING OFFICEHOCOER, CANDIDATE, STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIOAT E, STATE MEASURE PROPONENT
Executed on
FPPC Form 460 (8199)
For Technical Aseletanca: 9161322-5660
State of California
Campaign Disclosure Statement
Summary Page
Type or print in Ink.
AmountI may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
Contributions Received
1. Monetary Contributions ...................................................... Schedule A, Line 3
2. Loans Received ................................................................... Schedule B. Line 7
3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines I + 2
4. Nonmonetary Contributions ............................................... Schedule C, Line 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4
Column A
,3.3 g. ~3
0,00
g. 9._5
Expenditures Made
6. Payments Made .................................................................... Schedule E, Line
7. Loans Made .......................................................................... Schedule H, Line
8. SUBTOTAL CASH PAYMENTS ............................................... Add Lines 6 *
9. Accrued Expenses (Unpaid Biffs) ........................................... Schedule ~ Line
10. Nonmonetary Adjustment ....................................................... Schedule C, Line
11, TOTAL EXPENDITURES MADE ......................................... Add Lines 8 + 9 ,~ 10
, ,gq .00
-' 0.00
- ~.00
from
SUMMARY PAGE
LO. NUMBER
Column B* Column C
TOTAL PREVIOUS PERIOD TOTAL TO DArE
(SEE NOTE BELOW) (COLUMNS A ~ ~)
0.0::)
OiOO ' o.oo
glo&.7/) s I ,,90~5.q'5
$ "/,..,~0.oo , '7~q. Oo
0,00
Current Cash Statement
12. Beginning Cash Balance ................................ Previous Summary Page, Line 16
13. Cash Receipts .............................................................. Column A. Line 3 above
14. Miscellaneous Increases to Cash ....................................... Schedule I, Line 4
15. Cash Payments ............................................................ Column A. Line 8 above
16. ENDING CASH BALANCE .............. Add Lines 12 + 13 + 14, then sublract Line 15
If lhis is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................... Schedule 6, Part I, Columll lb)
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ..................................................... See instructions on reverse
19. Outstanding Debts ................................... Add Line 2 + Line g in Column C above
, q g3,
s O-O0 =o.
,,0.00 '"
· From p~evious slatement Summary Page, Column C. However, if this
is the first report filed for the calendar year, Column B should be blank
except fo~ Loans Received (Line 2). Loans Made (Line 7). and Accrued
Expenses (Line 9).
Summary for Candidates in Both June and
November Elections
1/1 through 6130 111 to Dale
Contributions
Received ............ $
Expenditures
Made .................. $
FPPC Form 460 (8199)
For Technical Assistance: 9161322-5660
Schedule A Type or print in ink. SCHEDULE
Monetary Contributions Received Am°~ontwSl.~laeYc'ol~lra°rsU~(le~] S;~;~,~,,; covers period
',lAME OF F~/~ MB
IF ~N INDIVIDUal, ENTER AMOUNT CU~U~TIVE TO D&~E CUMU~TIVE TO DATE
DATE FULL NAME. ~AILIN8 ADDRESS AN~ ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION ~D E~OYER RECEIVED THIS CAL/NOAR YEAR OTHER
RECEIVED [iF C~MI~E[, A80 ENTER I O NUMBER) CODE * (IF SELF-EMPLOYED. ENTER ~E PERIOD (JAN. 1 - DEC. 31 ) {IF APPLICABLE)
~ BUSINESS)
~IND
~ COM
~ OTH
~ tED
~COM
DOTH
~ IND
~ COM
~ OTH
~ COM
~ OTH
~ tND
~ COM
~ OTH
SUBTOTALS
Schedule A Summary
1. Amount received this period - contributions o! $100 or more.
(Include all Schedule A subtotals.) .......................................................................................................
2. Amount received this period - unitemized contributions of less than $100 .........................................
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ................... TOTAL
*Contributor Codes
IND - Individual
COM- Recipient Committee
OTH - Olher
FPPC Form 460 {8199)
For Technical Assistance: 9161322-5660
Schedule B - Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
,rD. ?--I--OI
NAME OF FILER
DATE FULL NAME, MAILING ADDRESS AND ZIP CODE
RECEIVED OF LENDER OR GUARANTOR
E] Lender
[] Lender
CONTRIBUTOR
CODE *
[] IND
[] COM
[] OTH
[] IND
[] COM
[] OTH
[] IND
[] COM
[] OTH
IF AN INDIVIOUAL ENTI~R
OCCUPATION AND EMPLOYER
LENDER INFORMATIO~I
DUE DATE
DUE DATE
INTEREST R~TE
%
DUE DATE
SUBTOTAL $
SCHEDULE B - PART 1
I.D. NUMBER
GUARANTOR INFORMATION
$
$
$
$
Schedule B - Part 1 Summary
1. Loans of $100 or more received this period. (Include all Loans Received - Part 1 (a) subtotals.) ...................
2. Amount received this period - unitemized loans of less than $100 ...................................................................
3. Total loans received this period. (Add Lines 1 and 2.) ....................................................................... TOTAL
Schedule B - Part 2 Summary
4. Loans of $100 or more repaid, forgiven, or paid by a third party this period. (Include all Part 2 (c)
subtotals. If forgiven or paid by a third party, also itemize the transaction on Schedule A.) .............................
5. Loans under $100 repaid, forgiven, or paid by a third party. (Do not itemize.) if forgiven or
paid by a third party, include this amount on Schedule A Summary, Line 2 ......................................................
6. Total loans repaid, forgiven, or paid by a third party this pedod. (Add Lines 4 + 5.) ........................... TOTAL
7. Net change this period. (Subtract Line 6 from Line 3.)
Enter the net here and on the Summary Page, Column A, Line 2 .......................................................... NET
'Co~bibutor Codes
COM - Recipient Committee
OTH - Olher
~ay ~e a negaave nume~ FPPC Form 460 (8199)
For Technical Assistance: 9161322-5660
Schedule B - Part 2
Repayments Made on Loans Received, Loans
Forgiven, and Loans Repaid by a Third Party
SEE INSTRUCTIONS ON REVEr~SE
NAME OF FILER
DAlE OF
OR
FORG~VENESS
Type or print In Ink. ·
to whole dollars.
Statement covers period
,.,o... q
DATE OF
ORIGINAL LOAN
FULL NAME OF LENDER
INTEREST
RATE
{IF CHANGED)
AMOUNT REPAID OR
FORGIVEN ON PRINCIPAL *
{EXCI_UOE PAYMENT DF INTEREST)
OUTSTANDING
PRINCIPAL
SCHEDULE B - PART 2
(d)
INTEREST
PAID
TOTAL INTEREST
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ PAID THIS PERIOD $
* IMPORTANT~' If any part of a loan is forgiven or repaid by a third party, also itemize the transaction on Schedule A, Enter the amount in column (d) in the Schedule E 1
including the name and address of the person forgiving the loan or the third party making the payment, and the amount Summa~ Line 3. Do not carry this total to the !
forgiven or paid. Schedule 8 Summarx
FPPC Form 460 (8199)
For Technical Alslstance: 9161322-5660
Type or print in ink. SCHEDULE II - PART 3
AnnualRepo. of Outstanding Loans Received ,owho,*do,,.... ,,.mS~"'""=°v'"~r'od~--~--~/ i ~~
NAMEOFF ER
FULL NAME OF LENDER ORIGINAL DATE OF LO~ AMOUNT ~ ~IGINAL LOAN UNPAID PRINCIPAL T
l,J~:~. ~. .~,~ .~. -~,~
Attach additional information on appropriately/abe/ed continuation sheets. TOTAL $ ~~.~!):~.:..
NOTE; Thl~ to,al should be
the seine emount es entered
o~ the Summary Page.
Column C, Line 2. FPPC Form 460 (6/99)
For Technical A$1iltance: 9161322-5660
Schedule C
Nonmonetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
Type or print in Ink.
Amounts may be rounded
to whole dollars.
DATE FULL NAME, MAILING ADDRESS AND
ZIP CODE OF CONTRIBUTOR
CONTRIBUTOR
CODE *
[] IND
[]COM
[] OTH
[] IND
[] COM
[] OTH
[] IND
FICOM
[] OTH
[] IND
[] COM
[] OTH
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
Attach additional information on appropriately labeled continuation sheets.
DESCRIPTION OF
GOODS OR SERVICES
AMOUNT/
FAIR MARKET
VALUE
SCHEDULE C
ID NUMBER
CUMULATIVE TO
DATE
DATE OTHER
CALENDAR YEAR
(JAN 1 - DEC 31) (IF APPLICABLE)
SUBTOTAL~
Schedule C Summary
1. Amount received this period - nonmonetary contributions of $100 or more.
(Include all Schedule C subtotals.) ...................................................................................................................
2. Amount received this period - unitemized nonmonetary contributions of less than $100 ................................
3. Total nonmonetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ................... TOTAL
[*Contributor Codes
IND - Individual
COM - Recipient Commillee
OTH - Olher
FPPC Form 460 (8199)
For Tschnlcal Assistance: 9161322-5660
Schedule D
Summary of Expenditures
Supporting/Opposing Other
Candidates, Measures and Committees
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts may be rounded
to whole dollars.
SCHEDULE D
Page q offS-
DATE
CANDIDATE AND OFFICE,
MEASURE AND JURISDICTION, OR COMMITTEE
[] Support [] Oppose
[] Supper [] Oppose
[] suppo,t [] o~pose
TYPE OF PAYMENT
[] aonetay
[] Indeponde~l
[] M~eta~y
DESCRIPTION OF NONMONETARY
CONTRIBUTION
(IF R£OUIRED)
ID. NUMBER
AMOUNT THIS PERIOD
CUMULATIVE AMOUNT
Calendar Year
$
Other
Calendar Year
$
Other
Ca~ndarYear
$
Other
SUBTOTAL $
Schedule D Summary
1. Contributions and independent expenditures made this period of $100 or more. (Include all Schedule D subtotals.) ........................................ $
2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................. $
3. Total contributions and independent expenditures made thi~ period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ........ TOTAL $
FPPC Form 460 ($199)
For Technical Assistance: 9161322-5660
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole doller~.
S~,~ covem period
SCHEDULE E
Page --~ oiL
NUMBER
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, descdbe the payment.
CMP campaign par aphemalia/misc.
CNS campaign COnsultants
CTB contHbulion (explain nonmonetary)'
CVC cJv~c donalions
FND fundraisi~g evenIs
IND independent expenditure supporting/opposing olhers (explain)*
LIT campaign lilerature and mailings
MTG meelings and appearances
OFC offica expenses
PET petiito~ ctrcula~ng
PHO phone banks
POL polling and survey researcfl
POS postage, delivery and messenger services
PRO pmlessional secY..es (legal. aocounting)
PRT print ads
RAD radio airt~me and ~oduction cosls
RFD returned conl~ibutions
SAL campaign workers salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging and meals (explain)
TRS slafflspouse Iravet, lodging and meals (explain)
TSF ffansfer belween committees of the same candidate/sponsor
VOT voter registra~on
WEB inton~ation technology costs (internal. e-mail)
* Payments that are contributions or Independent expenditures must also be aummadzed on Schedule D. SUBTOTAL $
Schedule E Summary
1. Payments made this pedod of $100 or more. (include all Schedule E subtotals.) ...............................................................................................
2. U~it,emi. zed ,payments made this period of under ,100 ........................................................................................................................................
3. Total i~nterest paid this period on outstanding loans. (Enter amount from Schedule B, Part 2, Column (d).) .......................................................
4. Total payments made this pedod. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ......................... TOTAL
FPPC Form 460 (BI99)
For Technical Assistance: 916/322-5660
Schedule F
Accrued Expenses (Unpaid Bills)
SEE iNSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounts may be rounded
to whole dollars.
Statement covers period
,ro,n
SCHEDULEF
_
NAM OF FILER
CODES: If one of the following codes accurately describes the payment, you may enter the code, Otherwise, descdbe the payment.
CMP campaign paraphemalia/misc
CNS campoign consultants
CTB conlribution ( ex plain n on moneta r/)'
CVC civic donations
FND fundraising evenls
IND independent expenditure supporting/opposing olhers (explain)'
LIT campaign literature and mailings
MTG meetings and appearances
OFC o~fice expenses
PET petiUon circulaUng
PHO phone banks
POL polling and survey research
POS postage, deliver/and messenger services
PRO professional se~ces (legal, accourtling)
PRT print ads
RAD radio airtime and produclion cosls
I.D. NUMBER
RFD returned conlribu/ions
SAL campaign workers salaries
TEL t.v, or cabie airtime and production costs
TRC candidate bavel, ledging and meals (explaio)
TRS s~alflspousa travel, lodging and meals (explain)
TSF transfer between committees o! ~he same candidale/sponsor
VOT voter rsgislration
WEB intom~ation technctogy cost s (iniernel, e-mail)
(s) (b) (c) (d)
NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING
(iF COMMITTEE ALSO ENTIER ~ D NUMBER) DESCRIPT~ON OF PAYMENT BALANCE SEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE
SUBTOTALS
Schedule F Summary
1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for
accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................ INCURRED TOTALS $
2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on
accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and
on the Summary Page, Column A, Line 9.) .............................................................. : ................................................................................. NET $
FPPC Form 460 (8199)
For Technical Assistance: 9161322-5660
Schedule G
Payments Made by an Agent or Independent
Contractor (on Behalf of This Committee)
SEE INSTRUCTIONS ON REVERSE
Type or print in Ink.
Amounts may be rounded
to whole dollars.
NAM E~'~ AGENT ~)R INDEPENDENT CONTRACTOR
SCHEDULE G
ID+NUMBER
CODES:
If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
DFC office expenses
PET pelilion circulating
PHO phone banks
POL polling and survey resem'ch
POS postage, delivery and messenger sen, ices
PRO pro[essio~al services (legal, account~g)
PRT print ads
PAD radio airtime and prnduclion costs
CMP campaign par a phem alia/misc
CNS campaign consultants
CTB contribution (explain nonmonetary)*
CVC civic donations
FND Iondraising events
IND independent expondilure supporting/opposing others (explain)*
LIT campaign literature and mailings
MTG meetiogs and appearances
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
RFD relurned contributions
SAL campaign workers salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, kxJging and meals (explain)
TRS staff/spouse travel, lodging and meals (explain)
TSF ~ansfer between commiltees of the same candidale/sponsor
VDT vcter registration
WEB inlon~ation technology costs (intemet. e-malt)
NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID
Attach additional information on appropriately labeled continuation sheets. TOTAL*
· Do not transfer to any other schedule or to the Summary Page. This total may not equal the arr~unt paid to the agent or independent contractor FPPC Form 460 (8199)
asrepottedonScheduleE. For Technical Assistance: 9161322-5660
Schedule H - Part 1
Loans Made to Others*
SEEINSTRUCTIONSONREVERSE
NAME F FILER
DATE OF LOAN
Type or print in ink.
Amounts may be rounded
to whole dollars.
NAME AND ADDRESS OF RECIPIENT
SCHEDULE H - PART 1
INTEREST RATE
DUE OATE
AMOUNT
*Loans that are contributions to another candidate or committee must also be summarized on Schedule D. SUBTOTAL
Schedule H - Part I Summary
1. Loans of $100 or more made this period. (include all Loans Made - Part 1 subtotals.) ............................................... $
2. Unitemized loans under $100 made this period ............................................................................................................. $
3. Total loans made this period. (Add Lines 1 and 2.) .......................................................................................... TOTAL $
Schedule H - Part 2 Summary
4. Payments received on loans of $100 or more. (Include all loan payments received and all
loans of $100 or more forgiven by this committee - Part 2 (a) subtotals,
if forgiven, also itemize on Schedule E.) ................................................................................................................... $
5. Unitemized payments received on loans under $100,
(including a forgiveness.) ............................................................................................................................................ $
6. Total loan payments received this period.
(Add Lines 4 and 5.) ........................................................................................................................................ TOTAL $
7. Net change this period. (Subtract Line 6 from Line 3.
Enter the net here and on the Summary Page, Column A, Line 7.) ................................................................ NET $
FPPC Form 460
For Technical Assistance: 9161322-5660
Schedule H - Part 2
Repayments on Loans Made to Others
and Loans Forgiven
Type or print in ink.
Amounts may be rounded
to whole dollars.
SEE INSTRUCTIONS ON REVERSE
from
,,,,o.,,,, /
SCHEOULEH-PART2
NAME OF FILER I.D. NUMBER
(bi
DATE OF DATE OF INTEREST INTEREST
REPAYMENT OR ORIGINAL FULL NAME OF RECIPIENT OF LOAN RATE FORGIVEN ON PRINCIPAL'* OUTSTANDING
FORGIVENESS LOAN PRINCIPAL RECEIVED
TOTAL INTEREST
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ RECEIVED THIS $
PERIOD
* IMPORTANT3 If any part of a loan is forgiven, also itemize the forgiveness on Schedule E. If a repayment is received Enlertheamountincolumn(b)inthe
from a third party, enter the name and address of third par~y in the ~FULL NAME OF RECIPIENT OF LOAN* column above, along with the Schedule I Summaq4 Line 3. Do not carol
name of the recipient of the loan. this total to the Schedule H Summar~z
FPPC Form 460 (6199)
For Technical Assistance: 9161322.5660
SCHEDULE H - PART 3
~chedule H - Part 3 Type or print in ink. S~;.i,,i~,~t covers period -*' -
~,nnual Report of Outstanding Loans Made A m ° ~Jon twSt ~aeY¢ o1~1 ra~ :,nd e d from ~'~-- I -- ~--~ [ ~ ~J~l~/
through (~-c~--~,~ ] Page.-~-- of '/[0
~EE INSTRUCTIONS ON REVERSE
FULL NAME OF RECIPIENT OF LOAN ORIGINAL DATE OF LOAN AMOUNT OF ORIGINAL LOAN UNPAID PRINCIPAL UNPAID INTEREST
Attach additional information on appropriately labeled continuation sheets. TOTAL $ :*~';~'.:'? "-
NOTE: Thistotalshouldbe
the same amount as entered
on the Summary Page,
Column C, Line 7.
FPPC Form 460 (8199)
For Technical Assistance: 916/322-5660
Schedule I
Miscellaneous Increases to Cash
SEE INSTRUCTIONS ON REVERSE
Type or print In Ink.
Amounte may be rounded
to whole dollar~.
,o.
NAME OF FILER
DATE r
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
DESCRIPTION OF RECEIPT
SCHEDULE I
ID, NUMBER
A/VlOUNTOF
INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Increases lo cash of $100 or more this period ...........................................................................................................
2. Unitemized increases to cash under $100 this period ...............................................................................................
3. Total of all interest received this period on loans made to others. (Schedule H, Part 2 (b).) .................................
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) ........................................................................................................................... TOTAL
FPPC Form 460 (8199)
For Technical Asmlstance: 9161322-5660