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Schedule A Type o~ print in Mk. SCHEDULE A <br /> Amounts may be rounded [ Statement covers period <br /> Monetary Contributions Received towhole dollars. Ifrm11- <br /> I <br /> SEE INSTRUCTIONSON REVERSE I through Page of <br /> NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER <br /> <br /> FULL NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE CUMULATIVE TO DATE <br /> DATE (IF COMMII'IEE, IN ADDITION TO COMMiq~rEE'S NAME AND ADDRESS, EmER I.D. NUMBER (IF SELF-EMFtOYED. ENTER RECEIVED THIS CALENDAR YEAR OTHER <br /> RECEIVE D OR. IF NO I.e. NUMBER HAS BEEN ASSIGNED, EmER TREASURER'S I~,ME AND ADDRESS) NAME O~ BUSm~SS) PERIOD (JAN. 1 - DEC. 31 ) (IF APPLICABLE) <br /> <br /> I <br /> <br /> SUBTOTAL <br /> <br />Monetary Contributions Summary <br />1. Amount received this period -- contributions of $100 or more. <br /> (Include all Schedule A subtotals.) ............................ <br /> <br />2. Amount received this period -- contributions of less than $100. <br /> (Do not itemize.) .................... <br /> <br />3. Total monetary contributions received this period. <br /> (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ..................................... TOTAL <br /> <br /> <br />