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SCHEDULE H -- Part !I <br />Schedule H -- Part II Type or Print i. Ink. Statement covers period <br />Loan Repayments Received on Loans Made Amounts maybe rounded <br />to Others (Including Payments Received to .ho,. do,,.rs, from //--/- <br />from Third Parties) and Loans Forgiven <br />SEE INSTRUCTIONS ON REVERSE through /-- ~ffJ "~/~c~ Page /~ of ~ / <br />NAME OF OFFICEHOLDER OR CANDIDATE AND CONTROLLED COMMITrEE: I.D. NUMBER <br /> <br /> DATE OF DATE OF INTEREST AMOUNT REPAID OR <br /> REPAYMENT OR ORIGINAL FULL NAME OF RECIPIENT OF LOAN RATE FORGIVEN ON PRINCIPAL* OUTSTANDING INTEREST <br /> FORGIVENESS LOAN (IF CHANGED) E~CLUO~ RECE~P] O~ ~.~E~EST) PRINCIPAL RECEIVED <br /> <br /> Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ (a) Total Intanst , (b) <br /> Receive4 thb Period $ '.~%~ ~_)~3_~' <br /> Enter the amount in column (b) in the <br /> summary section of Schedule I, Line 3. Do not <br /> *IMPORTANT: I/any pa~t ora loan is.forgiven, also itemize the forgiveness on Schedule E. Ifa repayment is received from a third part7, enter the carry thL~ total to the summary section of <br /> name and address of third party in the "FULL NAME OF RECIPIENT OF LOAN" column above, along with the natne of the recipient of the loan. Schedule il. <br /> <br /> <br />