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Schedule C Type or print inlnL SCHEDULE C <br />Amounts may IN rounded Statement covers period <br />Non-Monetary Contributions Received towholldollari. <br />from <br />SEE INSTRUCTIONS ON REVERSE through <br />r <br /> <br /> FULL NAME AND ADDRESS OF coNTI~IBuTo~ // <br /> DATE OF COMMITTEE. Nd ADonK)NTO COMMITTEE'S NAME Am) ADDRES~: OCCUPATION AND EMPLOYER CUMULATIVE TO CUMULATIVE TO <br /> RECEIVED OF S~LF-EMPLOYED, ENTEI~ NAME OF DESCRIPTION OF FAIR MARKET DATE DATE OTHER <br /> ENTER I.D. NUMBEI~ OiL W NO I.D. NUMBER NAS BEEN ASSkT, mD, . BUSlmS$) GOODS OR SERVICES VALUE CALENDAR YEAR <br /> ENTEIITREASUgER'S NAME ANO ADORESS) (JAN. 1 - DEC. 31) (IF APPLICABLE) <br /> <br />Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ <br />Non-Monetary Contributions Summary <br />I. 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 />