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SCHEDULEH <br /> �criedule H Typa or print in ink. Statement covers period � , <br /> � Amounts may be rounded � � , <br /> :aans Made to Others to whole dollare. from �o- i— o � � • <br /> �iMSTRUCTIONS ON REVERSE I Ihrough �O —�&— °g Page JJ� of��— <br /> . �OF FILER I,O. NUMBER <br /> � L� IT� Z£ e✓S p cCT '\40u�on l./ /'�o��T�VAt /u' `Oil+N/R£ <br /> IF AN INDIVIDUAL,ENTER �e� �e� <br /> �F*31IL NAME,STREET ADDRESS AN�ZIP CODE OUTS7ANDING AMOUNT ��� OUTST��DING INTEREST ORIGINAI CUMl1LATIVE <br /> OCCUPATION AND EMPLOYER REPAYMEN7 OR <br /> OF RECIPIENT BALANCE �OANED 7HI5 &��NCEAT RECEIVED AMOUN70F LOANS <br /> OF Se�r-ernvioreo,eNreA BEGINNMG THIS FORGNENESS CLOSE OF THIS <br /> �IF COMMITTEE,nL50 EIJIER ID.NUMBER� NnMe oF euSwESS1 RI D PERIOD THIS PERIO�' pE I LOAN TO DATE � <br /> G PAIO CALEN�AR YEAR <br /> 5 5 _X S S <br /> � FORGIVEN �� PER ELECTION" <br /> � 3 7 S S 3 <br /> DATE DUE OATE INCURRED <br /> � pq�D CALENOAR YEAR <br /> S S __ri � S <br /> � fORGNEN �� PERELECTION" <br /> 7 5 7 S 5 <br /> � OATE UUE OATEINCURRED <br /> 0aos that are contributions to another candidate or commitlee p�' /�'- <br /> �also be summarized on Schedule D. loans forgiven must SUBTOTALS S /� E � E v $ � <br /> BaUe raported on Schedule E. <br /> (Emar�e)on <br /> Schetlule L Line 3� <br /> :ebedule H Summary � <br /> flaensmade this period .................. . ........................................................................... .................................................S •�If Required <br /> �'bmtal Column(b) plus unitemized loans of less than$100.) <br /> -�jments received on loans ...........................................................................................................................................�� <br /> �tal Column(c)plus unitemized payments of less than$100.) � <br /> ..�t change this period. (Subtrect Line 2 from Line 1.) .......................................................................................... NET S <br /> �inter the net here and on the Summary Page, Column A, Line 7.) `�"'�•�'9'����m"0 <br /> FPPC Form 460(January/05) <br /> FPPC Toll-Free Helpline:866/ASK•FPPC(8661275-37'I2) <br />