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Schedule C Type or print in ink. SCHEDULE C <br /> Amounts may be rounded Statement covers,period <br /> Nonmonetary Contributions Received to whole dollars. �-7 ,r� / ` • ' � , � � <br /> from 1// �(J(e� • <br /> through�.'�!1-1 c"�' Page� of ` <br /> SEE INSTRUCTIONS ON REVERSE <br /> NAME OF FILER I.D.NUMBER <br /> �� � � 5 � � � <br /> CUMULATIVE TO <br /> IF AN INDIVIDUAL,ENTER AMOUNT/ PER ELECTION <br /> FULL NAME,STREET ADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE <br /> DATE OCCUPAT{ON AND EMPLOYER FAIR MARKET TO DATE <br /> RECEIVED Z�P CODE OF CONTRIBUTOR CODE '�' (IF SELF-EMPLOVED,ENTER GOODS OR SERVICES VALUE CALENDAR YEAR ��F REQUIRED) <br /> (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) (JAN 1-DEC 31} <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PlY <br /> ❑SCC <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> pscc <br /> Attach additiona!information on appropriately labeled continuation sheets. SUBTOTAL$ <br /> Schedule C Summary *Contributor Codes <br /> 1. Amount received this period-itemized nonmonetary contributions. �N�-�ndividua� <br /> (Include all Schedule C subtotals.) ..............................................................$ COM-Reapient Committee <br /> ....................................................... <br /> �--�n (other than PTY or SC ) <br /> 2. Amount received this period-unitemized nonmonetary contributions of less than$100 ....................................$ � OTH-Other(e.g., business entity) <br /> PTY-Political Parly <br /> 3. Total nonmonetary contributions received this period. � SCC-SmallContributorCommittee <br /> (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ......................TOTAL $ <br /> FPPC Form 460(January105) <br /> FPPC ToIMFree Helpline:866/ASK-FPPC(866/275-3772) <br />