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Schedule C <br /> Nonmonetary Contributions Received <br /> ON REVERSE <br /> Type or print in ink. <br /> Amounts may be rounded <br /> to whole dollars. <br /> Statement covers period <br /> from 1/1/05 <br /> through 6��05 Page 3 <br /> I.D.NUMBER <br /> 1266668 <br /> CUMUTATIVE TO <br /> DATE <br /> CAIENDAR YEAR <br /> (JAN 1-DEC 31) <br /> j i4iE N n� �t= ��k�iucr��} �, i Z Y ��G <br /> IFAN INDiVIDUAL,ENTER AMOUNT/ <br /> FULL NAME,STREET ADDRESS AND CONT}21BUTOR DESCRIPTION OF <br /> DATE OCCUPATION AND EMPLOYER FAIR MARKET <br /> ZIP CODE OF CONTRIBUTOR CODE * GOODS OR SERVICES <br /> RECEIVED (�F COMMITTEE,ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER VALUE <br /> NAME OF BUSINESS) <br /> 1/9/05 <br /> 1/9/05 <br /> Pat Forbes <br /> 279 Catalpa <br /> Atherton, CA 94027 <br /> Media Gems <br /> 307 W. Oakwood Blvd. <br /> Redwood City, CA 94061 <br /> 1/9/05 Rachel Kwong <br /> 822 Seal Point Dr. <br /> Redwood City, CA 94065 <br /> 1/9/05 Carol Stafford <br /> 1455 Martborough Rd. <br /> Hilisborough, CA 94010 <br /> �IND <br /> pcoM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> ❑IND <br /> pcoM <br /> BoT� <br /> oP-� <br /> ❑scc <br /> 01ND <br /> ❑conn <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> 01ND <br /> ❑coM <br /> ❑OTH <br /> ❑PTY <br /> ❑SCC <br /> retired <br /> retired <br /> Nurse <br /> San Mateo Counry <br /> Attach additional information on appropriately labeled contir+uafion sheets. <br /> Fundraiser 150 <br /> donation-air <br /> tour <br /> Fundraiser <br /> donation-bird <br /> guides, walk <br /> Fundraiser <br /> donation-tiffany <br /> frame <br /> Fundraiser <br /> donation-SF <br /> Giants tickets <br /> SUBTOTAL$ <br /> Schedule C Summary <br /> 1. Amount received this period—itemized nonmonetary contributions. <br /> (Include all Schedule C subtotals.).....................................................................................................................$ <br /> 2. Amount received this period—unitemized nonmonetary contributions of less than$100 ....................................$ <br /> 3. Total nonmonetary contributions received this period. <br /> (Add Lines 1 and 2. Enter here and on the Summary Page,Column A,Lines 4 and 10.) ......................TOTAL $ <br /> 150 <br /> 250 250 <br /> 125 2,125 <br /> 104 104 <br /> 629 <br /> of 4 <br /> PER ELECTION <br /> TO DATE <br /> (IF REQUIRED} <br /> 'C tnno butor Codes <br /> IND-Individual <br /> COM-Recipient Committee <br /> (other than PTY or SCC) <br /> OTH-Other(e.g.,business entity) <br /> PTY-Political Party <br /> SCC-Small Contributor Committee <br /> FPPC Form 460(January/05) <br /> FPPC Tolt-Free Helpline:866lASK-FPPC(8661275-3772) <br />