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5 <br /> �ct�edUle� <br /> Nc�nmonefiary Contribu�ons �e�eo�reci <br /> SEE <br /> OF <br /> Type ar print in ink. <br /> Amounts may be rounded <br /> to whole doiiars. <br /> ON REVERSE <br /> �' � �^� ��� <br /> � C,/�� <br /> d t�Ul S �� �`�� <br /> � � <br /> DATE FULL NAME,STREET AQDRESS AND <br /> Z!P CODE OF CONTR{BUTOR <br /> RECEIVED (IF COMMITTEE.ALSO EN7ER►.D.NUMBER) <br /> '�%t�a9 ��`���c,v �,���� <br /> �-� �7.� � ���� <br /> � <br /> �,j , , , <br /> ��f��� �tiC��.UI�,� �t � ��t'�'� <br /> �. �r������� <br /> � � , <br /> .�, � �1��� ���� <br /> �� t <br /> ���� ���a���� <br /> �`°.' <br /> CONTRIBUTOR �F AN IND{VIQUAL,ENTER <br /> OCCUPATiON AND EMPLOYER <br /> CODE * (IF SELF-EUIPLOYED,ENTER <br /> NAME OE 8U51NE553 <br /> ND jj 1� <br /> COM ��GI�C? `� iO�T��b�f` <br /> � , <br /> pPr�r �6C���' � a <br /> ❑scc �� ��Q �'O <br /> D <br /> o M , ��� <br /> 00 � <br /> oPn („���e.� <br /> ❑scc <br /> ❑iND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> ❑iND <br /> ❑COM <br /> ❑OTH <br /> ❑PN <br /> ❑SCC <br /> aff��h ��r��t;�na►informafron on appropriafely labeled corrf�nuation sheets. <br /> S <br /> Statement covers period . �• . <br /> from ��, r _ �� � � <br /> through���;2�'� � P'age_�� of_�� <br /> DESGRIPTlON OF <br /> GOOD5 OR SERVICES <br /> �fl�lC�'l�fC�t� �� <br /> �� t�t <br /> �t� <br /> �������� <br /> SUBTOTAL� <br /> AMOUNTI <br /> FAIR MARKET <br /> VALUE <br /> i.Q.NUMBER <br /> �,,� l����' <br /> CUMUtATiVE 70 pER ELECi1�N <br /> DATE TO DATE <br /> CALENDAR YEAR (�F�EQ��RED) <br /> (JAN 1-DEC 31) <br /> �� f 1, �3� � <br /> � ��� <br /> �� ���- l <br /> �� <br /> f <br /> � <br /> "Contributor Codes <br /> Schedule C Summary iNO—individuaf <br /> 1. Amount received this period—itemized nonmonetary contributions. / / COM—Redpient Committee <br /> ......................................$ " �-- (other than PTY of SCC) <br /> (Include all Schedule G subtotals.). ...........................�.................................. � <br /> ................ <br /> $ OTH—Other(e.g.,business entity <br /> 2. Amount received this period—unitemized nonmonetary contributions of less than$100 .......................... p-n�_political Party <br /> SCC—Small Contributor Commiltee <br /> 3. Total nonmonetary contributions received this period. , .TpTAL $ <br /> (Add Lines 1 and 2. Enter here and on the Summary Page,Column A, Lines 4 and 10.) ................... . <br /> FF'PC Form 460(Januaryl05) <br /> FPPC Totl-F�ee He{pline:866lASPC-FPPC(8661275-3772) <br />