Laserfiche WebLink
chedule C Type o~ print in ink. SCHEDULE C <br /> l n--M°n tary Contributions Received Am°unts rely be r°undedto whole do#ars. Statement c°vers periMI <br /> from <br />SEE INSTRUCTIONS ON REVERSE 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 CUMULATIVE TO CUMULATIVE TO <br />i DATE (~F COMMITTEE, IN ADDI~K)N TO COMMrr'rEE'$ NAME AND ADDRESS. (IF SELF*EMPLOYED, ENTER NAME Of DESCRIPTION OF FAIR MARKET DATE DATE OTFiER <br />RECEIVE D ENTER I.D. NUMBER Od. IF NO I.D. NUMIIER HAS IEEN ASSIGNED, BUSINESS) GOODS OR SE RVICE S VALUE CALENDAR YEAR <br /> EN?E K TREASURER'S HA ME A ND A, DDP, ESS) (JAN. 1 - DEC. 31) (IF APPLICABLE) <br /> <br />~Attach additional information on appropriately labeled continuation sheets. SUBTOTAL <br />Non-Monetary Contributions Summary <br />1. Amount received this period-- non-monetary contributions of S100 or more. <br />(Include all Schedule C subtotals.) ............................................................................. S <br />2. Amount received this period -- non-monetary contributions of less than S 100. <br />(Do not itemize.) <br />3. Total non-monetary contributions received this period. <br />(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 4.) ....................... TOTAL $ <br /> <br /> <br />