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Schedule C Type or print In Ink. <br /> Amounts may be rounded Stetement covers period <br />Nonmonetary Contributions Received to whole dollsrs. <br /> from /~- / ~' O ~ <br /> <br />SEE INSTRUCTIONS ON REVERSE lhrough ~ ~''~ ~) ~ ~ 0 <br />NAME OF FILER <br /> <br /> IF AN INDIVIDUAL. ENTER AUOUNTI CUM~TIVE TO <br /> FU~L NAME, MAILING ADDRESS AND CONTRIBUTOR OCCUPATION AND EMPLOYER DESCRIPTION OF FAIR MA~K~ DATE CUMU~TIVE TO <br /> OME O~ER <br /> DATE ZIP COOE OF CONTRIBUTOR CODE * (IF SELF-E~LOYEO. EH;ER GO0~S OR SERVICES V~UE CALENOAR. YEAR (IF APPLICABLE) <br /> RECENED p; CO~EE. A~O EHT ER ;.D NUMBER) H~E O~ ~S~,ESS) (JAN t - DEC 3t ) <br /> <br /> ~ IND <br /> ~ COM <br /> ~OTH ~ <br /> <br /> [] IND <br /> [] COM <br /> [] OTH <br /> <br /> [] IND <br /> [] COM <br /> [] OTH <br /> <br /> [] IND <br /> [] COM <br /> [] OTH <br /> <br /> Attach additional information on appropriately labeled continuation sheels, SUBTOTAL $ '-- - --~- ...... <br /> <br />Schedule C Summary <br />1. Amounl received lhls period - nonmonetary contributions of $100 or more. { 'C°nlfll~d°r C°desi <br /> (Include all Schedule C subtotals.) ................................................................................................................... $ IND-Irtdlvldual <br /> COM- Recipient Committee <br />2. Amount received this period - unitemized nonmonetary contributions of less than $100 ................................ $ OTH-Other <br /> <br />3. Tolal nonmonelary contributions received lhls period. <br /> (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ................... TOTAL $ <br /> <br /> FPPC Form 460 (8/9g) <br /> For Technical Aeelstence: 918/322-5660 <br /> <br /> <br />