HomeMy WebLinkAboutSHEARER SEMIANN98(1) /~ficehoider, Candidate,
and Controlled Committee
Campaign Statement -- Long Form
III
print in Ird~.
SpecialO~ld-¥eat Cam~ig
fficeho~er. ~andidate, and Con.oiled Commi~ee
Included in ~ts S~tement
COVERPAGE-LONGF(
Aiiocation Page -- Part I
Contributions and Independent Expenditures
Made From Campaign Funds
SEE I~STRUCT~O~ ON REVERE
~ Ol: OFIqCEHOLOIER OR CANDIDATE AND COlOrROLLED COMMITTEE
· LiSt each ¢onlr/bu tiOn andindependent expenditure of $! OOor more made from campeign f~nds to other ¢ommi~ee~ or
~o saWlmrt or oppose other candidate~ or ballot mea~ure~
OtECKONE
OATE NAME OF OFFiC~ Ia, OLDER. CANDtDATE, COMMITT~ E, OR MEA~UI~ EXPa AMOUNT
Supper Op~
ALLOCATION - PART I
CUMULATIVE TO DATE
~,~LNE NOAR YEaR
· 1 - DEC ~1)
CUMULATNE TO DATE
'~ ~ re~arcling independent expenditure·.
A£LOCa,T~ON '-- PART I SUMMARY
SUITOTAL S O' O0
1. Contributions and independer~ expenditures of $100 or more made thls period from campaign fu~$,
(In<lade a~t/Ulocation Page -- Par: ~ $ub~.otais`) .......................................................................................
2. Cor~butiom and independem expenditures under $100 made this period from campaign funds.
(Denot itemize.) ..........................................................................................................................
3, To~ co~trlbutlons and independe~ expenditures made ~his period from campaign funds.
(Do rm4: carry th, iE total to the Summary Page.) ................................... TOTAL
A. Uocation Page -- Part 1]
Contributions and independent Expenditures
Made From Personal Funds
Amount~ may be muad~l
to whok~ 4oib,~.
ALLOCAT;ON - PART h'
~ each contrfbution and independent expenditure of $ ~00 or more made from the off*~ehotder or candidate's pe~,onal funds to support or oppose
other off/echo/dee, cand/~t te~ and committee~
NAME OF OFF~EV, OLOER, CANDIDATE, COMMI~E, OR MEASURE
CHEO( CX~E IND.
SulWort Oppme
AMOUNT
DATE
?
*See reve~,e regaMing independent expenditure~
AL~T~ON '-- PART II SUMMARY
SUBTOTAL
t, Co nteibr~iOns and independent. expendilu r~ of Sl ~ or more made this ~r;~
{~ ~ ~mize.) ...........................................................................................................................
3. TaB ~butiom a~ i~e~ent ex~nditur~ made ~is ~ri~ f~
(~ ~ car~ this to~l to t~ 5umma~ Page.) .................................................... TOTAL
Campaign Disclosure Statement
Summary Page
Conlzibufions Received
Amlounis may I~
Statement
fTom
m,~ (""
E~penditures Made
& CMh Payments (Other than Loar~ Made) ............ Sme~ ~, uneS
g. Loans Made ............................................. ScMa~e H, Une ?
t0, SUBTOTAL CASH PAYMENT~ ............................ ~a~Lawe + ~
11, Accrued E~pen~es (Unpaid Biffs) ....................... .,m'm~e F, Uae 5
12. TOT~ ~END}TUR~ MADE ......................... ~ ~e * ~ ~
Cunent ~sh State~nt
13. B~Jnni~ ~sh Bala~e .................. ~~e~,~7
15. Mi~eBa~ Increased ~ ........................ ~L~
18. LOAN GUARANTEES RECEIVED .............. .~,eekUea. l'~t;,Co;m...Ib]
Cash Equivalents and Outstanding Debts
19. ~ Equivalents ...............................S~e I~ an,e~v~e
20. Out~'tand~n9 Debts ............. AdduM2 ~, ~ 1~i~Co~,mnCabeve
Column A Column B*
~ .oo s ~,~, 0 0
O' DO 0,0o
~ c,a ,G o s 0.0 O
~ ~0.0~ s '
~.6~ o
~0.0o s 0.60
SUMMARY
s / ~,~ Sum~ for C~didates in Both June and
,~~ N~ember EJe~lons
s
Schedule A
Monetary Contributions Received
Type M pdwt in ink,
Amounts m~y be rounded
SCHEDULE A
RECEIVED T~
PERIOD
CUI~ULATIYE TO DATE
CALENDAR YEAR
{JAN. 1 - DEC. 31 )
SUBTOTAL S ~ O, 0 0
Monetary Contributions Summary
1. Amourft rece~ve~ this period -- contributions of $ I O0 or more,
(IncluCe aU Schedule A subtotals.) ................................................................................................
2. Am~urA received this ~eHod -- contributions of less t~an $100.
(Do r.a; itemize.) .................................................................................................................
3. Total monetary contributions received this period.
(Add Lines I and 2. Enter here and on the Summary Page, Column A, Line 1.) ............................. TOTAL
$
$
/450.0o
CUM ULATWE TO DATE
OTHER
APPL~Ca.~LE)
ffS, o ,.0o
O.C~
Schedule A (Continuation Sheet)
Monetary Contributions Received
Statement cover~ ~
AMOUNT CLtMUL~T~/E 10 DATE
RECE~/EDTHIS CALENOA. R YEAR
PERIOD (JAN. ? - DEC. 31)
SCHEDL~LE A (cont.)
CUMULAll~ TODATE
OTHER
SUBTOTAL
$chedL
Schedule B -- Part !
Loans Received
I. L~ns of $100 or m~e r~eiv~ t~s ~ti~, (Include all L~m RKeiv~ - Pa~ 14a) ~o~1~) ..........
~ns Retired -- Pa~ II Summa~
4. L~s of $1 ~ ~ m~e re~id, forgiven, ~ ~d ~ a ~rd pa~ ~is ~. (l~ude all Pi~
~bt~. ff f~gi~n or paid by a ~ird pa~, also itemize ~e tra ~on ~ ~e A.) ..............
5. L~ns und~ $ I~ r~id, f~v~, ~ pa~d ~ a third ~. (Do no itemize.) If ~rgiv~ ~
~id ~a ~ird ~, i~iu~ ~is am~nt on ~h~u~A~mma~, Une2 ............................
~ 6. T~ (~ns re~id, forgi~, or ~id by a thi~ ~ ~s
' (~d Lin~ 4 + 5.) ...................................................................... TOTAL
~ 7. N~ cha~e this ~fi~. (Subtr~ Une 6 from ~ne
Enter ~e ~t ~e a~ on t~ Su~a~ Pa~. ~u~ ~ L~ne 2 .................
SCHEDULE ~: -Part
Schedule B --Part i (Continuation Sheet)
Loans Received
Lender n Guarantor'
~ important imtructiom on ~eveM of page 1 of~chedule B, Part I.
Type M I~lnt In
AmOufi~ my be rou'nded
to whole cldbrL
LEND1KR / GUARANTOR'S
SUBTOTAL
Schedule B -- Part II
Repa, yments Made on Loans Received, Loans
Forgwen, and Loans Repaid by a Third Party
SEE' IN~TR~CT]ON$ ON REVERSE
NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMI~'EE
Am ou~ may ~ rounded
t~wh~edol~rs.
INTEREST AMOUNT REPA~DOR .
RATE FORG[VEN ON PRINCIPAL
Attach additiona! information on appro~ately labeled continuation $hee~ SUBTOTAL $ 0 ,.~ C,
I*IMPORTANT: If any part of a loan is for~ive~ or repaid by a thief path/, al~o itemize the t~arrsact/on on $¢heduSe A,
including the name and add~.~s of the pe~on for~ivin~ the I~an or the third pa~ty maki~.r the payment, and the amount
forgi~'n or paid
SCHEDULE B - Parc 11
I.D. NUMBER
OUT~I'A~IDiNG
P~INOPAL
0
TOTAL INTEREST
PAJD THIS PERIOD
Schedule B -- Part Ill
Annual Report of Outstanding Loans Received
~E ~NSTRUCTION$ ON P,~VERSE
NAME O; OFF~HO~ER OR ~D;DA~ ~D COmPLiED
FULL ~E OF L[NDER ORIGIN~ DATE OF
~ m~,y I~ ~
to who~ d~MI~rL
AMOUNT OF ONGINA~ t.OAN
UNPAID PRINCIPAL
SCHEDULE B -
I,O. NUMBER
UNPAID iNTEREST
Attach additional information on appropriately labeled continuation ~hee~
TOTAL $ 0,~)
¢o/un'~, C, Une 2,
m
z
z
o
z
o
Schedule C
Non-Monetary Contributions Rece;ved
SEE II~TRUCllONS ON REVER~
NAME OF OFF1C~ HOi. Dtr R OR CAN DIDAT~ AND CONTROLt IrD COMMITTEE
T)'T~ M Iwtnt I. ~nk.
Amoun~ may be rM~de~
toMMrs.
from
OCCUPATION AND EMPLOYER
OE~CRIPTION OF FAJR M&JUC~ T
GOODS OR SERV~ES VALUE
CUMULATIVE TO
CLIMULATIVE TO
'DATE DATE OTHER
CALENDAR YEAR
~AN. '1. DEC. 3~) (IF A.,~I. ICAB.LE)
Attach additional information on appropriately labeted continuafion ~JYeet~ SUBTOTAt $ ~, 0 0
Non-Monetary Contributions Summary
t. Amount received this period -- non-monetary contributions of $100 or more.
(lnclude,~l Sched u le C subt. ot els.) ....................................................................................
2. Amount received this period-- non-monetary contributlo~s of less than $100.
(Do not i~emize.) ......................................................................................................
3. Total non-monetary contributions received this per{od.
(Add tines 1 and 2. Enter here and on the 5umma~ Page, Column A, Line 4.) ..................... TOTAL
Enforceable Promises Received (Other than Loan
Guarantees, Loan Endorsements, and Loan Security)
NOTE: Loan guarantees. loan endorseme, nts and 1Dan security are 'enforceable promises' that must
be reported on ~hedule ! - NOT Schedule O. SEt ~JeS~UCT~ONS ON ~VE~SE
~J~,IE OF OFFIC~OLDER OR C~J~D~DAT£ AND ~T f~LED COMtMITt'EE .-. .
~ach additional information on appropriately )abetedconOP, uation SUBTOTALS S O .O C~
~orceable Promises Received Summary
romSses received of S100 or more this geriod (Cotutah (a)) ....................... S
romlses received under $100 t,his period,
)O not. it. am ize.) ............................................................ $
~al promises r~eived this period. TOTAL $
~ld Unes 1 and 2.) ..................................................
tyroants rece~ o~ promises of $ ~ 0D or more this
o~umn ~b)) ....................................................................................
~yments received on promises unde~ S100 this period,
~ not itemize. Also incJude on Schedule A Summary, Line 2.) ......................................
~a! p~yments received. TOTAL
dd L~nes 4 and 5.) ................................................... ' ..................
,~changethis period. (Subtract L~ne$ fro~ Line3. Enter tl~e differencet~'e a~d on
Summary P~ge, Column A. Li~e 6.)
PAID
PEI~OD
5CHEDUL~ D
CUMUlaTiVE TO DATE
CALENDAR YEAR
(JAI~. ~ - DEC.
O.-oc~
~,c~o )
O
'Z
'3
o
?
o
Schedule E
Payments and Contributions
(Other Than Loans) Made
Type o~ pdnt in Silk.
Amount1 may be roufided
Co white do~lrL
SEE INSTRUCTIONS ON REY~RSE
NAME OF OFFIC£HOLOER OR CA.NDIDATE AND C~OKTROL/~O COM MITT~E
-- C~ ~R ~S~FYING ~R~
ILC~ec~f_t.he f.o!1o~_ ?g ~odes .accu.?lely~es~:?bes the expenditu,e,y~ may enter the code and leave t~e 'Descriptlon of Payment' column blank. Refer to the
xneou]e t~,om~ nuatJon ~neex loc eetailt, d explanations of each category.
°C'- MONETARYANDIN.KIND(NON-MONETAR~)
CONTRIBUTIONS TO OTH £R CdU~K)IO~KT~S
'1' -- IND~PENDENTEXPENDFTUKES ·
°L' - UTERATUI~
'!'-- BROADCA.ST ADVERTISING
'N'- NEWSPAPER ASdD PERIODICAL ADVERTISING
'0'- OUTSII:~ AOVIrRTKING
'S' -- SURVEYS, SIGNATUREGA'T14EI~NG, DOOK-TO.DOORSOLIa'rATiQNS
'F' - FUNDRA~SJNGEVENT$
'G'- GIN ERAL OPERATK3NS AN D OVERHEAD
'"r' - TRAVEL, AC(~OMMODATIONSANDMF~LS
(RGJST IE DES4~IED)
"P' - PROFESSIONALMANiAGEMENTANDCONSULTIJG
$ERV~ES
NAME AND ~DDRESS OF PAYE E, CREDITOR, OR RECIPIENT OF CONTRIBUTION
IMPORTANT: DO NOT ITIEMIZE THE PAYMENT O$ ACCRUIED IXPENSES ON SCt. IEDULE ~.
REPORT ONLY THE LUMP SUM OF SUCH PAYMENTS ON UNE a OF TM E SLIMMARY SECTION BELOq~.
CODE OR DESCRiPTiON OF PAYME NT AMOUNT PAID
Im,~. n~. Contn' .l~. ,~ions and expenditun~s made out of oampaign funds to or on bel"~lf of other
orecanopies, cantooRiel, ¢ommt~ee~ or ballot measures must al~o be entered on the AJIocalion Page, Part L
Payments and Contr;bufions Made Summary
SUBTOTAL $
1. Payments made this period of $100 or more. (include all Schedule E subtotals.) ............................ : ......................... S
2. Payments made this period of under $100. (Do not itemize.) ....................................................................... $
3, Total interesl paid this period on outstanding Ioan~. (Enter amount from Schedule 8, Part N, Column (cO.) .............................. $
4. Total accrued expenses paid this period. (Do not itemize. Enter amount from Schedule F. Line 4,) ..................................... $
5. Tot~I i~ym~n~ ma~e ~.,his peric, cL {Add Une~ t. 2, ~, and 4 Enter,here~nd on~eSum~arsP~.~e, Coi,;mn A, Lh~e 8.)
9 z
/79. v5-
Schedule E
(Continuation Sheet)
Payments and Contributions
(Other Than Loans) Made
'B'-- JROAOCAST AOVE R711~ING
-N°- NEWSPAPERAN;)I~R~OOI~ALAO~ERTtSING
'0'- OUTSIO~ AO~ERT~NG
'S'- M~RVEY$, SiGNATUR~ GATHERING. 0OOILTO*DOOR SOLiCITATtO NS
'F' - FUNDRAI~NG EVENIS
COOl;
SCHEDULE E (cont.)
DESCRIirtlON OG PAYMEHT
z
f-
Schedule E
(Continuation Sheet)
Payments and Contribu.tions
tother Than Loans) Made
;~E rh~TRUO'/O~I~ ON R~VE~
f-~,~ ~ OF OFF ICE HOLDER O R C~40{OAT~ ~NO CONTRO~t. ED COMMITTEE
CODES FOR CLASSIFYING EXPENDITURES
'l'- ~ROADG~ST ~VERTI'a~G
'N'- NEWSPAPER AND PE I~OD~CAL AD¥~RTIStNG
'O'-- OUT~IOE ADVERTISING
'S~' ~ $UR'VE~,SIGNATUREGATH£R(NG,OOOR-TO-DOO~$OLIOTATJONS
'F°- FUNORAF~tNGEYENT~
CODE OR
SCHEDULE
DE$CPJPT~OH OF PAYMENT
7~
O
Schedule F
Accrued Expenses (Unpaid Bills)
SEE II~'TRUC'~ON~ ON REVERSE
Ty~e or print hi ink.
Kmount~ may be fow~ed
to whale doters.
perkHi
SCHEDULE F
NAME O~C O;;iC;~OLOER ORCA~0A~ AN D C/C)NIROLL;O COMMrrrEE
CODES FOR O.A$$1FYI#G EXPENDITURES
i~neo. f..~e f?!lo~_'9g c..od~s..accu_?tei~.d~. ib?. t.h~ ex. penditure.you may enter the code D nd leav~ t~ ' D~.cription of PaYment° column blank.. Refer to
eB'- seROADCAST ADVE RTI$~NG
°N'- NE WSPAPE R AND PERIODICalL ADVERTISING
'O' - OUtS)DE ADVEKt'I~NG
-S* __ SURVLrYS. SiGNATUREGATHER~NG. DOOR.TO4X)OR$OUCITATiO;N$
'F'- FUNDRAKING EVENTS
i.D. NUMBER
'C'- MONETARYANDJN-KIND(NON-MOP~ETARY)
CONTliUBUTION$ TOOTHER CANDIDATES
AND COMM rTrEES
'1' - IND~PENE~NT EXPENDITURES
°L'- LITERATURE
NAME AND ADDRESS OF PAYEE, CREDITOIL OR RECIPIENT OF CONTRIBUTION
'G'- GENERAL OPERATIONS AND OVERHEAD
'T'- TRAVEL. ACCOMMODATIONS AND M EA~S
(M~ST BE DESCRIMO)
'P'- PROFESSIONAL MANAGEME NT AND CONSULT~'NG
SER~ICES
Attachadditionalinformatioeoneppropriatelylabeiedcontin~ation~eet$. SUBTOTAL S
Accrued Expenses Summary
1. Accrued expenses this period of $100or more. (Include ell Schedule F subtotals.) ..................................................... $
2. Accrued expenses this period of under $100. (Do not itemize.) .....................................................................
3. Totalaccruede~penseslncu,edthisperiod. (Add Lines1 and2.) ................................................. INCURRED TOTAL $ '
4. T0tal accrued expem~s paid this period. (Donoritemize. Enter here and on Schedule E Summary, Line4.) ................. PAID TOTAL $ (
5, ~et chat~gethisper~od. (Subt, ract Li,~e4 from Line 3. Entez~,hedifferenceherear,,dontheSumma.rypege,,C~u.m~A, Li~ !~,,~ ..... NET $_ ~"~'~"
Schedule F
Accrued Expenses (Unpaid Bills)
SEE II~TRUCTION$ O~ REVERSE
flaME OF OFFJCEHOLDER OR CAND{DAI~ AN D CONTROLLED COMMrlTEE
m ~- :,~. In ink,
may be rounded
SCHEDULE F
CODES FOR CL,ASS3FYTNG EXPENOITURES
(:.odes .accu_r. atel¥ describes ~he expend ~ure ~ m
t~ont~ nua~mn ~neet for ,~-~-;~--, ---, -. ,,yo ay enter the code and
v. ~,~ ~., ,~c~a ~Rpla~q&~ Otis O? each category.
'C'- MONETARY AND IN-K;ND (NON4VlONETARY)
~ONTKISUTIONS TO OTHER Ca~IOIDAT~S
AND COMMITTEES
'1" - INDEPENDENTEXPENDiTORE~
'L' - LfTI[KATURE
NUMBER
leave the 'De~riF~ion of Payment' column brank. Refer lo {he
'5' - SURVEYS-SIGNATUREGATHERING, OOOR.TO. DOORSOLFCiTATi~NS
'F' - FUNDRAISING EVENTS
°G'- GENERAL OPERATIONS AND OV£RN EAD
'T'- TRAVEL, ACCOMMODATK)N$ AND MEALS
(MUST IE DE~E~IBED)
'P'- PROFESSIONAL MANAGE M ENrI' AN O CO NSULTii~;
SERVICES
Attach ~dibonal mforma t~on on appropnately labeled continuation
Ac~ued Expenses Summ~ SUB~TAL S
1. Acc~ e~s ~ri~ of S100~m~e' (Include aU ~h~ule F
~, Ac~u~ ex~n~ this ~ri~ of un~ $~ (Do not itemize.~ ................................... S.
~. To~l~c~e~ncu~[s~fi~. ~Lin~land2.) ................................................ INCURREDTOTAL S
L T~al ~c~ ex~ ~id ~is per~. (Do n~ i~Jze. Enter ~ and ~ Sch~ule r Summa~, Line a )
' ' - ..... PAID TO~AL S
'- NetC~ethi~ri~ (5ubtra~L;~f~ Line~. ~nt-.~;,,*~---~ ....... ' ......
............. ~"~e~t~3umma~P~.CoiumnA, Line ~t } ..... NET $
Schedule G
Payments Made by an Agent o.r. independent
Contractoz (on Behalf of an Othceholder or
Candidate)
rounded
SCHEDULE G
CODES FOR CLASSIFYI MG EXPENDITURES
I f one of the following COdes accurately describes tl~ expeea:liture, Jtou ,may enter 1he co~e argl lelve the 'Des4:ription of P&yme~t' cotu mn bl&nk* Refe~ to the
back of ~:hedule E,Cord~nuation Sheet for detailed explana'don$ o? each catego~/.
'L'- LITERATURE 'Sl -- $URVEY$oMGN~TUREGATHERING, DOOR-TO-DOOR~OUCITAT~OI~/
'r - IROADCA.~T ADVERTISING 'F' - FUNDRAISING EVENTS
'N'- NEWSPAJ~ERANDPEKIODICALADYERTJ$1NG 'T'- TRAVEL.~"COMMOOA, T~ONSANDMe-ALS
'O' - OUTSIDE ADVERlISING (MUST BE DESCRIBEO)
NAME AND ADDRESS OF PAYEE OR OIEDITO~R
CODE OR
Attach additional informaUon on appropriately labeled continua :/on sheet~
O,F~OUF TION 01: p~YM~NT
TOTAL*
e l~o r, e4* ~ransf. e~ to ~ny other ~'*~e~ufe a, tc, c~ ~,a,a-n ary P~'e. t~ ~ mev not ~ the amount pa~ ~o t,~, ,,'ge ~ or ~r, de~e~e rn ram~a~o~ as ~e~ed on ~*hedu;e E ~ t~. off~ehoA:ter~¢,ma~de,'e
Schedule H -- Part I
L~ans Made to Others
SEE INSTRUCT~N5 ON REVERSE
NJLME O~ OFfICeHOLDER OR CANDIDATE ~l~lO CONTROLLID C~OMMITTEE
INTEI~ST RATE DUE OATE
SLrlTOTAL
Loans Made to Others -Pa~t I Summary
I. Loans of $ 100 or more made this period.
(Include aH Loans Made - Part ! subtotals,) ............................................................
2. Loans under $ ! 00 made this period.
(Do not itemize.) ....................................................................................
3, TotaJ loans made this period.
(Acid Lines 1 and 2.) .......................................................................... TOTAl.
Loans Repayments Received - Part II Summary
4. Pay, m.e nts received on loans of $1IX) or more. (Inclu~[e all loan payments received and all Ioa ns of $100 or more
wh,ch have been forgiven bythis officeholder, candidate, or committee - Part !1 (e) subtotals.
If forgiven, also itemize ot~ Schedule F.) ................................................................
5. Payments received on loans under $100.
[Ir~uding e forgiveness. Do not itemize.) ..............................................................
6. Tota! loan payments recelved this period.
(Add Line~ 4 and 5.) .......................................................................... TOTAL
7. Net,change this period. (Subtract Line 6 from Une 3,
Enter the net here and on the Summary page, Column A, LL,'~ ~.,~ .....................
SCHEDUUE H - Part
NUMBER
AMO u~rY
Z
0
Z
Z
Z
0
F
Schedule H -- Part I
L4)ans Made to Others
(Continuation Sheet)
Type~ p~fm In i~k.
to whole dolbr~
DUE DATE
SCHEDULE H. P,~"t I,~cont,)
A,~OUNT
SUBTOTAL
to Othe.rs Unclu,d,ng Payments Rec.mved ~ T ~ ~/~ ·
from Third Parties) and Loans Forg,ven
;E; ~NSTRUCno~S ON ~V~eSE
~E OF OFFI~HO~ER OR ~N~DA~ ~O CONTROWED COMM~E E
1~REST ~U~ REPAID OR . Ou~DI~ INTENT
~ OF OA~ ~ ~RG1VEN ~ PRINCIP~ PRI~P~ R~EIVED
~IVENE~S
A~tacltadditionalinformatio~onappropriatetylabetedcontinuatfonsheets' SUBTOTAL $ ~,~
'IMPORTANT: If any part of a loan is forgiven, also itemize the forg/vene~ on Schedule E. !f a repayment is receive. from a
third party. enter the name and addre~ of third party in the 'FULL ~ OF (~C~EIn' OF L O~J~ ' column above, along w~th the
name of the recipient of the loan,
Schedule H -- Part lit
Annual Report of Outstanding Loans Made
Type o~ pdn~ I~ ~fik.
Amo~ n',l¥ be eounded
NAME OF OFFICEHOLDER OR CANDIDATE AN D CON)ROLLED CON MITTE E
FULL NAME OF RECIPIENT OF LOAN OIUGINAL DATE OF LOAN AMOUNT OF ORIGINAL LOAN
At~arh additional information on appropriately labeled continuation sheet~
Statemerit covees
UNPAID PRINOPA~
NOTE: T~N rmald~db~
Column C Line 9.
SCHEDULE H - Part lit
Pi~ ~ ..
t.D, NUMGER
Schedule I
Miscellaneous Increases to Cash
.~EDULEI
I.D. NUM~IER
DESCRIPTION OF RECEIPT
AMOUNT
m
z
7o
o
z
m
o
Attach additionalinfo,marion on approp~etely labeled continuation shee~
tai~cellaneou$ Increases to Cash Summary
· Increese~ to ¢e,,h of $ 100 or more this period .............................................................
I. I~rease~ to (ash under $100 this period. (Do not itemize.) .................................................
:. Total of all interest receiveel this period on loans me~e to other~ (~:hedule H, Part II (b).) ....................
~. Total mi~:elleneo~l im:ree~e~ to (a~h this period. (Add Line~ 1, 2, and 3. Enter here end on the
Summary Page, Line 1 $.) ............................................................. TOTAL
SUBTOTAL $