Professional Documents
Culture Documents
Type
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Date of election if
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Type
of Statement
Statement
Type
of
Recipient
Committee
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Rerall
puanerly
SUtement
COnnolled t
Sponsorvtl
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General Pu rpvsa COmminee
Also
Ole
Form 410
Termination
Amendment
Explain below
Sponsoretl
Primarity
rum
FOnnetl Cantlitla el
OKCeFnltler COmminee
pbM1P O
D I NUM
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s Treasurer
NAME
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STATE
CODE
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OPFIONAL
EMAIL ADDRESS
OPTIONAL
FAX
EMAIL ADDRESS
Verification
I nave usetl all reasonable
antler
penally
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tliligencein preparingantl reviewingthis statement and to the esto myknowledgo omia ptl perjury untlerthel wsof the State pf Call that Neloregving is tm a co
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SEE INSTRUCTIONS
NAME OF PILER ON
REVERSE
through
l10 3 L0
0
4
Page
LO NUMBER
Of
D
CYr IV CL
Contributions Received
1 2 3 4
52 rrrZ
ColumnA
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Columns
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rox
Calentlar Year
Summary
for Candidates
ponre
Monetary Gontributions
Loans Received SUBTOTAL CASH CONTRIBUTIONS
scneewe q sees
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Dale
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2g Contributions Received 21
Nonmonetary
COntribulions
C Lined
Expentlitures
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qae Lrnesa a
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8 7
8
Expentliture
smedura E used
scnedwe
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Summary
for State
Payments
Matle
Candidates
Loans Made
SUBTOTAL CASH PAYMENTS
w enact
23 Cumulative
Expentlitures Matle
am Lines s
9 10
Accrued
ed me5u scne
scnedme
Dale of Election
TotaltaUate
Nonmonetary Adjustment
MADE
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5
11 TOTAL EXPENDITURES
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sammaryaage
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13 Cash
Lme ve a 3ah
hl
corzesponding
scneeme l area
amounts
14 Miscellaneous
15 Cash
PaYmenis
IUmnA C
Line
ve 9a
repprtedin
Column B
previous
It this is
lletl
period
smeeme e Pon z
amounts
being
Cash
18 19
Debts
see mermcrons
on reverse
arwl
8 4
unea
and s
pr
Cash
Outstanding Debts
Type
to
or
in inx
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may
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Pag
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NUMBER
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FULL
Tl
STREET
Larri2dsa
ADDRESS ANO ZIP COpE OF CONTRIBUTOR
IF qN
cJ 3D6
CONTRI6UTOR
CODES
NAME
INDIVIDUAL ENTER
RECEIVED
OLCUPATIONgND EMPLOYER
oveOEmsauane amv Iltsatr W wES51
DEL 1 JAN 3t
IF REQUIRED
COM OTH
PTY SGc
SCC
mD
COM OTH PTV SCC
SUBTOTALS
Schedule A Summary
1 Amount received this
coRmM1amr coxs
period period
mamiaual IND
Include
all Schedule
ASUbtotals
unitemized
monetary contributions of
less than
100
Recipienteomminee coM oNerman PTV or SCC OTH omen e g M1uameas entity PTY Political Party
small ntaM1m scc c comminaa r
monetary
period
TOTAL
FPPC Toll Free
Add
Januaryl66
Helpline
B66lAS WFPPC
Z 5 3 fifi6
Schedule C
Type arprim
m Ink
NonmonetaryContributionsReceived
SCHEDULE C
from
ementcovfrsperiod Sta 9
l a n
z
SEEINSTRUCTIONSON REVERSE
NAME OF FILER
Lhrough
of Pdge
D I NUMBER
r
DgTE RECEIVED
na
FULL
Ilr
KizDSR
CONTRIBUTOR CODE IFAN INpIVIDUAL ENTER
OCCUPATION ANO EMPLOYER
Ilr saLr erv ememvEO sl
9 93DD
DESCRIPTION OF
NAME STREET ADDRESS AND CODE OF CONTRIBUTOR a cowmmEE use Fvi ro xoNaEn
ZIP
CUMULATIVE TO
pER ELECTION
TO DATE
GOODS OR SERVICES
pF REONREO
IND
COM
00TH p Prv
scc IND COM
I J
COM pores
Prv
scc
IND
COM
OTH PTV
SCC
Attach additional information
on
appropriately
SUBTOTAL S
Schedule C
Summary
period
edod itemized
comdhmor code
nonmonetary contributions
contributions of less than 100
Qnclude
all Schedule
Csubtolals
unitemlzed nonmoneta eriod
Column
II
mdimdnal IND
Recipient CDM
committee
or
PTV P
li tical
aanyrv
scc
g business eniiiy
Add
Lines 1 and 2
on
the
Summary Page
2 6J 66612
SGHEDULEE
Type
amounts
to
ar
in ink
rountletl
Statement
covers
may be
period
wnple mllara
from
7 rj
y
Page
I0
lM1mugM1
af
FILEF nO NAME
CODES
OiP
GNS Cm GVG FIL
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one
NUM6ER
rna rl5 l
If of the
zDSu Carr
following
codes
93a019
describes
accurately
the payment you may enter the code Otherwise describe the payment
MBR member communications RAD radio airtime antl
production
costs
MrG OFG
FEr
FNO
meetings
antl appearances
RFp
SAL TEL
TRC
refurnetl conMbulions
office expenses
campaign
workers salaries
petition circulating
pM1One banks polling aM survey research postage delivery antl messenger services
FND fJD
LEG
Lrf
e canditla
fees
PCi
TRS
TSF VOT VJEB
Indepentlenl expenditure
supportinglopposing
others
explain
canditlatelsponsor
services
legal acmunling
casts
interne
NAME AND
usoeuiEamrvumaeal pscomrninss
s
Payments
that
are
contrlbutlans
or
intlepentlent expenditures
must
also be
summarizetl
on
ScM1etlule
SUBTOTAL
Schedule E
1 Itemized
Summary
period
loans of under 100
paid
this
period
on
Enter
B Part 1 e Column
on
payments
made this
the
Line
TOTAL
11 53 3 866
Type
or
pdnt
in ink Statem
tcov rs
scHeouiel periotl
a F
rrom
SEE
through
3 i2
Page
I D NUMBER
al
NAME
3aa 9is
DATE FULL NgME AND ADORE550F SOURCE
xreR pp ccmwines nlso in rvumaeRl
RECEIVED
DESCRIPTION OFftECEIPi
gMOUNT OF
IEiCASH NCREAS yO
f
on
SUBTOTAL
Schedule I Summary
7 Itemized increases to cash this
period
100
on
this
period Schedule H
Column
period
e
on the
Total miscellaneous increases to cash this period Add Lines 1 2 and 3 Enter here and
Summary Page
Line
14
TOTAL
FPPC Form 460
05 January 53 06613