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S c h e d u le A Type ~ p,int ~n Ink. SCH <br />Amounts may be rounded Statement covers period <br />Monetary Contributions Receivedto whola do#ifs. <br />· ' from <br />SEE 'NSTRUOIONS ON REVERSE th,OU.h <br />NAME OF OFFICEHOLDER OR ~NDIDATE AND CONTROLLED COMMITTEE I.D. NUMBER <br /> <br /> FULL'N~ME AND A~DRE$$ OF CONTRIBUTOR ~CUPAT~N AND EMPLOYER AMOUNT CUMU~TIVE TO DATE CUMU~TIVE TO DATE <br /> ~ DATE (~ C~MI~EE, ~ AO~ IO C~M~EE'S ~ME A~ A~SS, ~NTER I.D NUM~IR M SELF-EM~OYED. E~ER RECEIVED THIS ~LENDAR YEAR OTHER <br /> RECEIVE D ~ w K I.D. Naeia aS lllN ASS~NED, IHlln T~AS~'S ~M! A~ A~RESS) ~M! ~ ~SS) PERIOD (JAN I - DE C. 3 I) (IF APPLI~BLE) <br /> I <br /> I <br /> i <br /> SUBTOTAL $ <br /> <br />Monetary Contributions Summa~ <br />1. Amount received this ~riod -- contributions of $100 or more. <br />(Include all Sch~ule A subtotals.) ................................................................................................... <br />2. Amount received this period -- contributions of less than $100. <br />(~o not i~emize.) ............................................................................................................ <br />3. Total mofleta~ contributions received this peri~. <br />(Add Lines l and 2. Enter here and on the Summary Page, ColumnA, Linel.) ...................................... TOTAL $ ~/~ ~//' <br /> <br /> <br />