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Schedule AType o, print in ink. SCHEDULE A <br />Amounts may be rounded I Statement covers period <br />Monetary Contributions Received to whole dollar~, from ~ <br />SEE INSTRUCTION$ ON REVERSE through (0' S(,,~ <br />NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITTEEI I.D. NUMBER <br /> FULL NAME ANI~ ADDRESS OF CONTRIBUTOR OCCUPATION AND EMPLOYER AMOUNT CUMULATIVE TO DATE CUMULATIVE TO DATE <br /> DATE (w coeaMrr~eL m Aooffm, To coMMrrvee3 Kqkee Arm ADO~S$, emir Lo. ~UMmR 0~ S~Lf-EMPLOYeD, emeR RECEIVED THIS CALENDAR YEAR OTHER <br /> RECEIVE D o~, f ~o I.D. mJeamR m~s we# AS~D, Emir ~ASU~R~, ~MZ ANO AOO~SS) ~ME O~ mJSmESS) PERIOD (JAN. 1 - DEC. 31 ) (IF APPLICABLE) <br /> SUBTOTAL $ <br /> <br /> Monetary Contributions Summary <br /> 1. Amount received this period -- contributions of $100 or more. <br /> (include all Schedule A subtotals.) .................................................................................................... <br /> 2. Amount received this period -- contributions of less than $100. <br /> (Do not itemize.) ...................................................................................................................... $ ~'O .C~C~) <br /> 3. Total monetary contributions received this period. <br /> (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ......................................... TOTAL <br /> <br /> <br />