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SCHEDULE C PAGE ~t / OF <br /> NON-MONETARY CONTRIBUTIONS RECEIVED <br /> FORM 490 STATEMENT COVERS PERIOD <br /> (Amounts May 8e Rounded To Whole Dollars) I <br />NAM~r~O ~~ONOID~TE O~ OFFICEHOLD~R~. ~o~A"O CO.TROLLEO COMMI~EE: ID.~ ~'"~ <br /> <br /> DATE FULL NAME AND ADORESS OCCUPATION FAIR CUMU- <br /> REC'D. OF CONTRIBUTOR DESCRIPTION OF MARKET ~TIVE <br /> U~ CO~I~E. ~ ADDITION TO COM~EE'S EMPLOYER GOODS OR SERVICES VALUE I AMOUNT <br /> NAME AND ADDRESS, ENTER ID <br /> OR, IF NO I.O. NUMBER HAS aEEN ASSIGNED, (IF SELF-EMPLOYED, ENTER RECEIVED <br /> ENTER [HE TREASURER'S NAME AND ADDRESS) NAME OF BUSINESS) <br /> I <br /> Occupat~°n: <br />  Employer: F$tS~L YEAR: <br /> Occu~at~°n: <br /> Employer: I F$1S~L YEAR: <br /> ~Occu~ati~: <br /> Employer: . ~$1S~L YEAR: <br /> occ. .on: <br /> Emg~yer: <br /> Emg~yer: F$1S~L YEAR: <br /> O~u~tl°n: <br /> ? Empl~: I <br /> itemize) ....................................................................... <br /> <br /> 3. TOTAL NON-MONETARY CONTRIBUTIONS RECEIVED THIS PERIOD · <br /> (Line 1 + Line2) Enter here and on Line 4 Column B of Summa~ Page ............... $ <br /> <br /> <br />