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5ch ed u le A TV~orpdnt in Ink. $CH EDULF. <br /> Amounts rely be rounded Stltement covers period <br /> Monetary Contributions Receivedto whole dolllr$. <br /> · ' from <br /> SEE INSTRUCTIONS ON REVERSE through ,~'/? j~'/.l,~ ~/'~ Pige / of /' <br /> NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER <br /> <br /> FUL~ NAME AND ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMU~TIVE TO DATE CUMU~TIVE TO DATE <br /> ~ DATE (y C~MI~[[. ~ AO~ TO C~M~EE'S ~Mf AK A~SS, ENIER I D NUMBER (W SELI-[M~OYED, Emir RECEIVED THIS ~LENDAR YEAR OTHER <br /> RiCE IVE D ~ y K ID. NUMI[g ~S liEN ASS~N[D. lml~ T~AS~R'S ~M[ AND A~RESS) NAME m B~SS~ PERIOD (JAN I - DEC. ~ I ) (IF APPLI~BLE) <br /> I <br /> I <br /> SUBTOTAL S <br /> <br />Monetary Contributions Summa~ <br />1. Amount received this ~riod -- contributions of S 100 or more. <br />(Include all Sch~ule A subtotals.) .................................................................................................... <br />2. Amount received this period -- contributions of less than $100. <br />(Do not itemize.) ............................................................................................................ <br />3. Total moneta~ contributions received this peri~. <br />(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line I.) ....................................... TOTAL <br /> <br /> <br />