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' SChedule C Type or pnnt m mk SCHEDULE C <br /> Amounts may be rounded StatemeM covers penod � . <br /> NonmonetaryContributionsReceived towholedollers , o � <br /> , from � ( � <br /> SEE INSTRUCTIONS ON REVERSE thfough � � ' POge� Of I <br /> NAME OF FILER I D NUMBER <br /> �(c Q/In�S bt' �l1.rJaC�' Gr ��C- � Z(� �a �i 6 � <br /> CUMUWT�VE t0 <br /> IF AN INDIVIDUAL ENTER AMOUNT/ PER ELECTION <br /> FULL NAME STREET ADDRESS AND CONTRI9UTOR DESCRIP710N OF DATE <br /> DATE OCCUPATIONANDEMPLOYER FAIRMARKET TODA7E <br /> RECENED ZIP GODE OF CONTRIBl1TOR CODE '� (IF SEIf EMPLOYEO ENTER GOO�S OR SERVICES VALUE CALENOAR YEAR (�F RE�UIRED) <br /> (IF CANAVTfEE ALSO ENTER 1 D NIIMBER� NqNE OF B�SINE55� (JAN 1•DEC 31) <br /> ❑IND <br /> ❑COM <br /> ❑orr+ <br /> ❑arv <br /> ❑scc <br /> ❑IND <br /> ❑COM <br /> ❑orH <br /> ❑arv <br /> ❑scc <br /> ❑IND <br /> ❑COM <br /> ❑on�+ <br /> ❑PTv <br /> ❑scc <br /> ❑IND <br /> ❑COM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> Attach additional mformat�on on appropnately labeled contmuation sheets SUBTOTAL S <br /> Schedule C Summary 'GonlnbutorCodes <br /> 1 Amount received this penod-itemized nonmonetary contnbutions /� IND-Indnidual <br /> (IncludeallScheduleCsubtotals) $ V COM-ReapientCommittee <br /> (o�her than PTY or SCC) <br /> 2 Amount received this penod-unitem�zed nonmonetary contnbutions of less than$100 $ � � 2✓ 7 d OTH-OMe�(e g, business entity) <br /> P7Y-PolRical Party <br /> 3 Total nonmonetary contnburons receroed this penod I ( 3 -�� scc-smaliconmbutorcommmee <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 ToILFree Helplirre 86WASK-FPPC(866/275�3772) <br />