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� <br /> .+: , <br /> :i _ r � t � . . . , � <br /> SEE INSTRUGTIONS ON REVERSE <br /> NAME OF FiLER ,�^: � <br /> .^ <br /> ��` t°��1�� a� �'�C�t�d� �. t <br /> Typ� or print i� ink. <br /> Amounts may be raunded <br /> to whole doliars. <br /> �� """' <br /> �.� ` FULL NAME,STREET ADDRESS AND ZIP C4t7E OF CONTRiBUTOR I CONi'RlBUTOR <br /> RECEiVED � (1F COMM{TTEE,ALSO ENTER I.Q.NUMBER} CODE ''k <br /> �l'�v��, �jy'I;°� San <br /> �7�1� t� i o �1m s r��� <br /> � <br /> �ed�0o� C��y� c� ��a�.� <br /> �Q,U�'�.. WVCS'C <br /> %o�3�'�D �,D� I�o X �3� <br /> � ,� <br /> ���c�1�oc����t-' �� ��D� <br /> � �`�����. <br /> � <br /> , <br /> ��(�LC/l�t�. <br /> �`�,�`� b. <br /> ,a Ylttcr�tc�. <br /> � <br /> k,�rs f�ve � <br /> �..l . f'1/?C�`�tr�t_ <br /> ❑�oM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> IF AN INDIVIDUAL, ENTER <br /> OCCUPATlON ANp EMPLOYER <br /> (IF SELF-EMPLaYED,ENTER NAME <br /> pF BUSINES5) <br /> �t�e�`C�f�fQv�t���° <br /> �t�t�cKSC1� ��taa�l <br /> �IND -- ��D���µ°C� <br /> pconn <br /> ❑OTH �,�urc� �t1�es� ��n e. <br /> pscc �r'� �ko��'`�� <br /> ❑OTH <br /> ❑PTY <br /> psCc <br /> []tND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> [J SCC <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> ,�j� , <br /> Q l,1��� <br /> SCHEDULE A <br /> Statement covers period j �. , <br /> w � i � <br /> from �� � <br /> through _��.%� . . Pa3e--�of� - <br /> I.D. NUMSER <br /> ��ipG���'i U <br /> AMOUNT CUMULATIVE TU DATE PER ELECTION <br /> RECEIVED TMiS CALENDAR YEAR TO DATE <br /> PERt00 (JAN.1-DEC.31} (IF RECIUIRED) <br /> �� I ��c� <br /> /�C-� , %c� <br /> ��� I �� <br /> sueTO-ra�$ ��?� <br /> Scheduie A Summary <br /> 1. Amount received this period—itemiZed monetary contributions. � �� <br /> (Include al!Schedule A subtotals.)........................................................................................................ <br /> . .........$ � <br /> 2. Amount received this period—unitemized monetary contributions of less than$100.................. . <br /> '`Cantributor Codes <br /> IND—{ndividual <br /> ' COM—Reapient Committee <br /> '� (other than PTY or SCC) <br /> OTN—Other(e.g., business entity) ! <br /> PTY—Patit'tca{Party <br /> SCC Small Contributor Committee <br /> 3. Totai monetary contributions received this period. <br /> Lines 1 and 2. Enter here and on the Summary Page,Column A, Line 1.)....................... TOTAL $ a <br /> (Add FPPC Form 4fi0(January105j <br /> � FPPC Tol6-Free Helpline:866fASK-FPPC(866/275-3772} <br />