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Sch ed u le C ~v.or printin ink. SCHE DU LE C <br /> Amounts may be rounded Statement covers period <br />Non-Monetary Contributions Received to whole dollars. <br /> <br /> from <br /> <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 0F COMMIll'EE, IN ADDITION TO COMMITTEE'S NAME AND ADDRESS, (If SELF-EM~OYED. ENTER NAME Of DESCRIPTION OF FAIR MARKET DATE DATE OTHER <br />RECEIVED Emir I.D. NUMBER O~ IF NO I.D. NUMBER HAS BEEN ASSIGNED, BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (IF APPLICABLE) <br /> (JAN. 1 -DEC. 31) <br /> ENTER TREASURER'S NAME AND ADDRESS) <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 $100 or more. <br />(Include all Schedule C subtotals.) .................................................................................... $ <br />2. Amount received this period-- non-monetary contributions of less than $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 />