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Schedule H -- Part I Type or print in ink. SCHEDULE H- Part I Amounts may be rounded Statement covers period Loans Made to Others towholedollars. from / .~,.'/" -- ~;'~ SEEINSTRUCTIONSON REVERSE through ~:) ~0--~'~ Page ~ ~'~ of '~ ~/ NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMtTTEE I.D. NUMBER FULL NAME AND ADDRESS OF RECIPIENT ~ DATE OF LOAN (IF CO~4M~EE. IN ADDmON TO ¢OMMIITEE'S [~AME AnD ADDRESS, EmER LD. NUMBER INTEREST RATE DUE DATE AMOUNT OIL [~ NO LD. nUMBER HAS IEEN ASSIGNED, ENTER TREASURER'S NAME ANO ADDRESS) SUBTOTAL Loans Made to Others - Pa~t I Summary 1. Loans of $100 or more made this period. ' (Include all Loans Made - Part I subtotals.) ............................................................ 2. Loans under $100 made this period. (Do not itemize.) .................................................................................... S 3~ Total loans made this period. ; (Add Lines 1 and 2.) .......................................................................... TOTAL $ Loans Repayments Received - Part II Summary 4. Payments received onloansof$100or more. (Include all Ioan payments received and all loans of $100 or more which have been forgiven by this officeholder, candidate, or committee - Part II (a) subtotals. If forg yen, also temize on Schedule E.) ..................................................... 5. Payments received on loans under $100. (Including a forgiveness. Do not itemize.) .............................................................. $ 6. Total loan payments received this period. (Add Lines 4and S.) .......................................................................... TOTAL $ ( ~ 7. Net change this period. (Subtract Line 6 from Line 3. Enter the net l~ere and on the Summary Page, ColumnA, Line9.) .................................... NET $