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SCHEDULE H <br /> Schedule H Type or print in ink. Statement c iers p riod <br /> * Amounts may be rounded � � � � ' <br /> Loans Made to Others to who�e dollars. from 2� 3 • ' <br /> SEE INSTRUCTIONS ON REVERSE <br /> NAME OF FILER <br /> Gi��S <br /> FULL NAME,STREET ADDRESS AND ZIP CODE <br /> OF RECIPIENT <br /> QF COMMITTEE,ALSO ENTER I.D.NUMBER) <br /> through l� <br /> �p� ��i ��i�G� � o� ,�j <br /> IF AN INDIVIDUAL,ENTER OUTSTANDING (b) (�) OUTSTANDING <br /> OCCUPATION AND EMPLOYER AMOUNT REPAYMENT OR <br /> BALANCE LOANED THIS BALANCEAT <br /> (IF SELF-EMPLOYED,ENTER BEGINNING THIS PERIOD FORGIVENESS CLOSE OF THIS <br /> NAME OF BUSINESS) PERIOD THIS PERIOD PERIOD <br /> � PAID <br /> $ $ <br /> � FORGIVEN <br /> $ $ $ 5 <br /> DATE DUE <br /> � PAID <br /> $ $ <br /> � FORGIVEN <br /> $ $ $ $ <br /> DATE DUE <br /> '`Loans that are contributions to another candidate or committee <br /> must also be summarized on Schedule D. Loans forgiven must SUBTOTALS $ $ $ $ <br /> also be reported on Schedule E. <br /> (e) <br /> INTEREST <br /> RECEIVED <br /> _% <br /> ruTE <br /> Page� of� <br /> I.D.NUMBER <br /> 1�3�c�I�Z <br /> (n (9) <br /> ORIGINAL CUMULATIVE <br /> AMOUNTOF LOANS <br /> LOAN TO DATE <br /> CALENDAR YEAR <br /> $ $ <br /> PER ELECTI ON** <br /> $ <br /> DATEINCURRED <br /> CALENDAR YEAR <br /> -% $ $ <br /> �� PER ELECTION"` <br /> $ <br /> DATE INCURRED <br /> (Enter(e)on <br /> Schedule I,Line 3) <br /> Schedule H Summary <br /> 1. Loans made this period ..................................................................................................................................................$ <br /> (Total Column(b)plus unitemized loans of less than$100.) <br /> 2. Payments received on loans ...........................................................................................................................................$____�-- <br /> (Total Column(c)plus unitemized payments of less than$100.) � <br /> 3. Net change this period. (Subtract Line 2 from Line 1.).......................................................................................... NET $ <br /> (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative number) <br /> *"If Required <br /> FPPC Form 460(Januaryl05) <br /> FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772) <br />