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Schedule C Type o~ print in ink. SCHEDULE C <br /> No M v <br /> Amounts may be rounded Statement covers period <br /> .__n-._.onetar, Contributions Received to who~ do,,,,. ,_ ,~ <br /> from <br /> <br /> SEE INSTRUCTIONS ON REVERSE through ~' ' ~ ~/; <br /> ' i: P&ge ~f <br /> NAME OF OFFICEHOLDER OR CANDIDATE AND CO~NTROLLED COMMITTEE , I.D. NUMBER <br /> FULL NAME AND ADDRESS C)F CONTRIBUTOR ' / i ~ / <br /> OCCUPATION AND EMPLOYER CUMULATIVE TO CUMULATIVE TO <br /> DATE (~ CO~4ktITT~E, m ~DmTK)fl TO CO4dMrrTErS NAM~ AND ADDRESS, DESCRIPTION OF FAIR MARKET DATE <br /> RECEIVED (w S~LF~MP~OYED, ENTER NAME O~ DATE OTHER <br /> ENTE~ I.D. NUM~En O4L W NO i.D. NU~d~ NAS KEN ASgGN~D, ' BUSe~SS) GOODS OR SERVICES VALUE CALENDAR YEAR <br /> ENTER TREASUgER*S NAM~ AND ADi~ESS) (JAN. 1 - DEC. 31) (IF APPLICABLE) <br />I <br />,-~ <br /> <br /> ' Non-Monetary ¢~ntribution~ Summary <br /> 1. Amount receiv~l this I~riod -- non-monetary contributions of $100 or more. <br /> (Include all $¢hodul~ C subtotals.) .................................................................................... $ <br /> 2. Amount received this period-- non-monetary contributions of les~ 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 />