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Committee to Elect Beverly Johnson, City Council 460Re" : ient Committee ' Campaign Statement (Government Code Sections 84200-84216.5) ----T-yp-e o-r p-rin-t i-n i...,..nk. ___ ___,f=---1{ JUL 3 1 2000 Date Jf election if applicable: SEE INSTRUCTIONS ON REVERSE 1. Type of Recipient Committee: 'f:J Officeholder, Candidate /' Controlled Committee (Also Complete Part 4.) D Ballot Measure Committee O Primarily Formed O Controlled O Sponsored (Also Complete Part 5.) 3. Committee Information COMMITTEE NAME from _..J-J.-1--1-~:..=0.~~~0~- through b { "°'/ Z{Jt)t) All Committees -Complete Parts 1, 2, 3, and 7. D Primarily F0rmed Candidate/ Officeholder Committee (Also Complete Part 6.) D General Purpose Committee 0 Sponsored O Broad Based ~.,.,..,.,.._,-ff-u fl> ~( ~ vf-gt.rt/'('( :2E~~~~so\Q &-ty ~tMC.c L CITY STATE ZIP CODE AREA CODE/PHONE (Month, Day, Year) Ci Clerk's Office For Official Use Onf9 2. Type of Statement: D Pre-election Statement 'rSl("Semi-annual Statement ;tJ 'Termination Statement D Amendment (Explain below) Treasurer(s) D Quarcerly Statement D Special Odd-Year Report D Supplemental Pre-election Statement -Attach Form 495 NAME OF TREASURER @ ii&,.. &a 1 ot>4 L. CITY STATE ZIP CODE = AREA CODE/PHONE ~ ,Jto ACec ""-"'-~ q LLf= 1<{:;-c; ( 5 iJ -s7 'LS NAME OF ASSISTANT TREASURER, IF ANY tdei M·~ (A-Cf'{~D f{;?1D)5:k';-~fc( MAILl'NGADDRESS (IF DIFFERENT) to. AND sTR'IJToR P.O. BOX • ~...;MLA-IL-IN_G_A_,,D..,..D--R'""'Es-s,,_------------------------ CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS CITY OPTIONAL: FAX/E-MAILADDRESS STATE ZIPCODE AREA CODE/PHONE FPPC Form 460 (8/99) For Technical Assistance: 916/322-5660 State of ca'litornia Recipient Committee Campaign Statement Cover Page -Part 2 Type or print in ink. 4. Officeholder or Candidate Controlled Committee not Included In this consof/dated statement that are controlled by you or which are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. COMMITIEE NAME LO.NUMBER D NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 5. Ballot Measure Committee OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 6. Primarily Formed Committee ust names ot officeholderfsJ or candidatefsJ for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR H'::LD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE D SUPPORT D OPPOSE D SUPPORT D OPPOSE Attach continuation sheets if necessary 7. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on J/b l i '"'l Executed on J ~AJE f)Q Executed on DATE Executed on DATE By By By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 460 (8/99) For Technical Assistance: 916/322-5660 State of Clilifornia Type or print in ink. Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dolla·s. SEE INSTRUCTIONS ON REVERSE NAMEOgR ?~f ::r, Contributions Received 1 . Monetary Contributions .......................... ·............................ Schedule A, Line 3 2. Loans Received................................................................... Schedule a, Line 7 3. SUBTOTAL CASH CONTRIBUTIONS ................................... Add Lines 1 + 2 A Non monetary Contributions............................................... Schedule c, Line 3 TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 Expenditures Made 6. Payments Made.................................................................... Schedule E, Line 4 7. Loans Made .......................................................................... Schedule H, Line 7 8. SUBTOTAL CASH PAYMENTS .................. :............................. Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) ............................................ Schedule F. Line 3 10. Nonmonetary Adjustment ....................................................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE ......................................... Add Lines 8 + 9 + 10 Current Cash Statement 12. Beginning Cash Balance ................................ Previous Summary Page, Line 16 .. 3. Cash Receipts .............................................................. Column A, Line 3 above • 4. Miscellaneous Increases to Cash....................................... Schedule 1, Line 4 15. Cash Payments ................................................ ~........... Column A, Line 8 above 16. ENDING CASH BALANCE .............. Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................... Schedule a, Part 1, Column (bJ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ..................................................... See instructions on reverse 19. Outstanding Debts ................................... Add Line 2 + Line 9 in Column c above Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $~---~eJ""-------o,. $ __ -___ 2),.__-___ _ -0 $ __ 0=-------- $~---~()~·------ 1} - -o- $ 2 0 2..c.{. oo $ __ ~_,v· :.__-___ _ $ __ -_,,,,O::.__ __ _ $ __ -£)___,,_,,,___ ___ _ Statement covers period from )/I { Oo I { through bf 5o{ O() I Column B* TOTAL PREVIOUS PERIOD (SEE NOTE BELOW) $ __ -~v~----D $ __ ---=O:o__ __ _ -0 $_~-0.......__ __ _ --0 -o- $---0~~--- Page 3 ofi!f- Column C TOTAL TO DATE (COLUMNS A+ B) $-----=b=------ 1 ctC:-D $---t.?-'1-'---""-c;--_V __ ::0 $ ___ 1.._:Z-L-.:c::.=---v=--- $ __ -0__._...'------ -0 -0 $-----i.:O=->'------- •From previous statement Summary Page, Column C. However, if this is the first report filed for the calendar year, Column B should be blank except for Loans Received (Line 2), Loans Made (Line 7), and Accrued Expenses (Line 9) . Summary for Candidates in Both June and November Elections ;.../ { t'T- 20. 21. 1/1 through 6/30 Contributions ~~ Received ............ $ ~ Expenditures / Made .................. $ _____ _ 7/1 to Date FPPC Form 460 (8/99) For Technical Assistance: 9161322·5660 .Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, MAILING ADDR SAND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITIEE, ALSO ENTER l.D. NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Schedule A Summary IND DCOM DOTH DINO DCOM DOTH DINO DCOM DOTH DINO DCOM DOTH DINO DCOM DOTH SUBTOTAL$ AMOUNT RECEIVED THIS PERIOD 1. Amount received this period -contributions of $100 or more. ~ (Include all Schedule A subtotals.) ....................................................................................................... $ _____ _ 2. Amount received this period -unitemized contributions of less than $100 ......................................... $ -CJ "" 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ................... TOTAL$ -=Q ,..-- l.D. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) CUMULATIVE TO DATE OTHER (IF APPLICABLE) ·contributor Codes IND-Individual COM -Recipient Committee OTH-Other FPPC Form 460 (8/99) For Technical Assistance: 916/322-5660 Schedule B -Part 1 Loans Received Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from r/1 I tfJo I { SEE lf'.<STRUCTIONS ON REVERSE NAME OF FILE.£~ V ~( FULL NAME, MAILING ADDRESS AND ZIP CODE OF LENDER OR GUARANTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED, ENTER NAME OF BUSINESS) LENDER INFORMATION DATE RECEIVED (IF COMMITTEE, ALSO ENTER 1.D. NUMBER) CONTRIBUTOR CODE * DUE DATE/ AM~6NT CUMULATIVE INTEREST RATE OF LOAN TO DATE 0 Lender 0 Guarantor O Lender O Guarantor O Lender O Guarantor Schedule B -Part 1 Summary DINO D~OM DOTH DINO DCOM DOTH DINO DCOM DOTH DUE DATE INTEREST RATE ___ % DUE DATE INTEREST RATE ___ % DUE DATE INTEREST RATE ___ % SUBTOTAL$ 1. Loans of $100 or more received this period. (Include all Loans Received -Part 1 (a) subtotals.) ................... $ --· Amount received this period -unitemized loans of less than $100 ................................................................... $ 3. Total loans received this period. (Add Lines 1 and 2.) ....................................................................... TOTAL $ Schedule B -Part 2 Summary 4. Loans of $100 or more repaid, forgiven, or paid by a third party this period. (Include all Part 2 (c) subtotals. If forgiven or paid by a third party, also itemize the transaction on Schedule A.) ............................. $ 5. Loans under $100 repaid, forgiven, or paid by a third party. (Do not itemize.) If forgiven or paid by a third party, include this amount on Schedule A Summary, Line 2 ...................................................... $ 6. Total loans repaid, forgiven, or paid by a third party this period. (Add Lines 4 + 5.) ........................... TOTAL $ 7. Net change this period. (Subtract Line 6 from Line 3.) CALENDAR YEAR OTHER CALENDAR YEAR OTHER $ ___ _ CALENDAR YEAR OTHER -0 -o- 2 /') ;;_ i· oa -o -- $ SCHEDULE B -PART 1 CALIFORNIA 460 FORM Page S--of 14- LO.NUMBER GUARANTOR INFORMATION (b) AMOUNT GUARANTEED CUMULATIVE TO DATE CALENDAR YEl\R OTHER CALENDAR YEAR OTHER . $ CALENDAR YEAR OTHER Enler (b) on Summary Page, Line 17 on . *Contributor Codes IND -Individual COM -Recipient Committee OTH-Other Enter the net here and on the Summary Page, Column A, Line 2 .......................................................... NET $ ;<. 0 ;l '-( . C?D ;< 0;2. 'f-: OD May be a negarenumber. FPPC Form 460 (8/99) For Technical Assistance: 916/322-5660 Schedule B -Part 2 Type or print in ink. statemenzovers period ~ Repayments Made on Loans Received, Loans Amounts may be rounded to whole dollars. from l l f f%2_ Forgiven, and Loans Repaid by a Third Party • I Page_Q_ofl!/-. SEE INSTRUCTIONS ON REVERSE through t.J ~() f CJ c) I I SCHEDULE B-PART 2 NAME OF FILER l.D. NUMBER DATE OF INTEREST (c) (d) REPAYMENT DATE OF FULL NAME OF LENDER AMOUNT REPAID OR OUTSTANDING INTEREST OR ORIGINAL LOAN RATE FORGIVEN ON PRINCIPAL* PRINCIPAL PAID FORGIVENESS (IF CHANGED) (EXCLUDE PAYMENT OF INTERESD 2-{oo lo{ 'tt:b Ro cse:12.-1 ~[(r~~ -{) /1 0t2-.e;>o I t ~~. _[) ,,... L{oD (o(q<t ~e.vcr[t.( V6) Ct l"\\9....., -() l ( 0 ( 2-. c::>-O 1.. '2-<6 ~. -O· -- Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ 2.-0 2-'-{. oo TOTAL INTEREST PAID THIS PERIOD $ ---o - *IMPORTANT: If any part of a loan is forgiven or repaid by a third party, also itemize the transaction on Schedule A, Enter the amount in column (d) in the Schedule E including the name and address of the person forgiving the loan or the third party making the payment, and the amount forgiven or paid. Summary. Line 3. Do not carry this total to the Schedule B Summary. FPPC Form 460 (8/99) For Technical Assistance: 916J322-5660 Schedule C Nonmonetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER f) J:> t/vcri DATE RECEIVED FULL NAME, MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) Type or print in ink. Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE* DESCRIPTION OF GOODS OR SERVICES [J IND DCOM DOTH DINO DCOM DOTH DINO DCOM DOTH DINO DCOM DOTH (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule C Summary AMOUNT/ FAIR MARKET VALUE 1. Amount received this period -nonmonetary contributions of $100 or more. ~ ~ (Include all Schedule C subtotals.) ................................................................................................................... $ _____ _ -()--. 2. Amount received this period -unitemized nonmonetary contributions of less than $100 ................................ $ ______ _ 3. Total nonmonetary contributions received this period. ~ _ (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ................... TOTAL$-~----- l.D. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 -DEC 31) CUMULATIVE TO DATE OTHER (IF APPLICABLE) 'Contributor Codes IND -Individual COM -Recipient Committee OTH-Other FPPC Form 460 (8/99) For Technical Assistance: 916!322-5660 Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER DATE CA DI DATE AND OFFICE, MEASURE AND JURISDICTION, OR COMMITIEE 0 Support 0 Oppose 0 Support 0 Oppose O Support 0 Oppose Schedule D Summ.ary Type or print in ink. Amounts may be rounded to whole dollars Statement covers period from 6 t/ l /oo rt through _ _...,._,___..c..c'-1--"0_d:;__ DESCRIPTION OF NONMONETARY I SCHEDULED CALIFORNIA 460 FORM PageL of# l.D. NUMBER TYPE OF PAYMENT CONTRIBUTION AMOUNT THIS PERIOD CUMULATIVE AMOUNT (IF REQUIRED) 0 Monetary Contribution Calendar Year 0 Non-Monetary $ Contribution Other 0 Independent Expenditure $ 0 Monetary Contribution Calendar Year 0 Non-Monetary $ Contribution Other 0 Independent Expenditure $ 0 Monetary Calendar Year Contribution 0 Non-Monetary $ Contribution Other 0 Independent Expenditure $ SUBTOTAL $ 1. Contributions and independent expenditures made this period of $100 or more. (Include all Schedule D subtotals.) ........................................ $ __ -~{)~--- 2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................. $ _72~_-__ _ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ........ TOTAL$ _---0 ___ -__ _ FPPC Form 460 (8/99) For Technical Assistance: 9161322-5660 Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILEn Type or print in ink. Amounts may be rounded to whole dollars. l.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* eve civic donations FND fundraising events IND independent expenditure supporting/opposing others (explain)* campaign literature and mailings . G meetings and appearances NAME AND ADDRESS OF PAYEE OR CREDITOR OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) PRT printads RAD radio airtime and production costs RFD returned contributions SAL campaign workers salaries TEL t.v. or cable airtime and production costs TAC candidate travel, lodging and meals (explain) TRS staff/spouse travel, lodging and meals (explain) TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID ~oi &62/1 ,,....... f'-6~ Lo-Gc/7 /2. ~ rfCt:.~ ./1--'1 0r--10(2. ~v~ r l ~ ::;-, Jok /\.S<Y} l-& ct,,, J2e fCA,'f,.-~~ (CJ{ 2-" .. - * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Z0 Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ............................................................................................... $ zo Zc.f. m 2. Unitemized payments made this period of under $100 ........................................................................................................................................ $ _____ _ 3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part 2, Column (d).) ....................................................... $ "-~"'--' 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ......................... TOTAL$ ~ '-f · Of) FPPC Form 460 (8/99) For Technical Assistance: 9161322-5660 Schedule F Accrued Expenses (Unpaid Bills) Type or print in ink. Amounts may be rounded to whole dollars. covers period from _....!f.'-1--=-i:__.i.~"----- through b(> qMO SCHEDULE F CALIFORNIA 460 FORM Page J;O_ of!!{_ LO. NUMBER 9t!Z9s)- es accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. OFC office expenses RFD returned contributions CNS campaign consultants PET petition circulating SAL campaign workers salaries CTB contribution (explain nonmonetary)* PHO phone banks TEL t.v. or cable airtime and production costs eve civic donations POL polling and survey research TRC candidate travel, lodging and meals (explain) FND fund raising events POS postage, delivery and messenger services TRS staff/spouse travel, lodging and meals (explain) IND independent expenditure supporting/opposing others (explain)* PRO professional services (legal, accounting) TSF transfer between committees of the same candidate/sponsor LIT campaign literature and mailings PRT print ads VOT voter registration 'ffG meetings and appearances RAD radio airtime and production costs WEB information technology costs (internet, e-mail) ayments that are contributions or independent expenditures must also be summarized on Schedule D. (a) (b) (c) (d) NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITIEE, ALSO ENTER l.D. NUMBER) DESCRIPTION OF PAYMENT · BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD SUBTOTALS$ $ $ $ Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................ INCURRED TOTALS $ ----':0~--- 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on '-8 accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS$ _____ _ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and ~ -C> on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ -,-,--,----~___,,--May be a negative number FPPC Form 460 (8/99) For Technical Assistance: 916/t322-5660 $che.dule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. from _ ___,,__,_/_,_-""'==--- through -~b..,_fJ~?-rfl~fJ ...... _?J~ CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. OFC office expenses RFD returned contributions CNS campaign consultants PET petition circulating SAL campaign workers salaries CTB contribution (explain nonmonetary)* PHO phone banks TEL t.v. or cable airtime and production costs CVC civic donations POL polling and survey research TAC candidate travel, lodging and meals (explain) FND fund raising events POS postage, delivery and messenger services TRS staff/spouse travel, lodging and meals (explain) 'f\JD independent expenditure supporting/opposing others (explain)* PRO professional services (legal, accounting) TSF transfer between committees of the same candidate/sponsor .IT campaign literature and mailings PAT print ads VOT voter registration MTG meetings and appearances RAD radio airtime and production costs WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR CODE OR DESCRIPTION OF PAYMENT (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) Attach additional information on appropriately labeled continuation sheets. •Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. AMOUNT PAID TOTAL* $=z? FPPC Form 460 (8/99) For Technical Assistance: 9161322-5660 Schedule H -Part 1 Loans Made to Others* SEE INSTRUCTIONS ON REVERSE NAME OF FILE DATE OF LOAN NAME AND ADDRESS OF RECIPIENT (IF COMMITIEE. ALSO ENTER 1.D. NUMBER) Type or print in Ink. Amounts may be rounded to whole dollars. *Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Schedule H -Part 1 Summary Statement covers period from l /1 / CJC) t I INTEREST RATE DUE DATE SUBTOTAL $ g 1. Loans of $100 or more made this period. (Include all Loans Made -Part 1 subtotals.) ............................................... $ _____ _ 2. Unitemized loans under $100 made this period ............................................................................................................. $ -~O __ 1. Total loans made this period. (Add Lines 1 and 2.) .......................................................................................... TOTAL$ ---"-0 ___ _ Schedule H -Part 2 Summary 4. Payments received on loans of $100 or more. (Include all loan payments received and all loans of $100 or more forgiven by this committee -Part 2 (a) subtotals. If forgiven, also itemize on Schedule E.) ................................................................................................................... $ -~0~--- 5. Unitemized payments received on loans under $100. 15) (Including a forgiveness.) ............................................................................................................................................ $ --=----- 6. Total loan payments received this period. O (Add Lines 4 and 5.) ........................................................................................................................................ TOTAL$------ 7. Net change this period. (Subtract Line 6 from Line 3. -0 .,.,.,,. Enter the net here and on the Summary Page, Column A, Line 7.) ................................................................ NET$ --,--:=----May be a negative number l.D. NUMBER AMOUNT FPPC Form 460 (8/99) For Technical Assistance: 9161322-5660 Schedule H -Part 2 Type or print in ink. Repayments on Loans Made to Others and Loans Forgiven Amounts may be rounded to wl ole dollars. Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER DATE OF REPAYMENT OR FORGIVENESS DATE OF ORIGINAL LOAN r[ FULL NAME OF RECIPIENT OF LOAN Attach additional information on appropriately labeled continuation sheets. INTEREST RATE IF CHANGED SUBTOTAL$ from f / f I f)-c; I a AMOUNT EPAID OR FORGIVEN ON PRINCIPAL* EXCLUDE RECEIPT OF INTERES -o *IMPORTANT: If any part of a loan is forgiven, also itemize the forgiveness on Schedule E. If a repayment is received from a third party, enter the name and address of third party in the "FULL NAME OF RECIPIENT OF LOAN" column above, along with the name of the recipient of the loan. LO.NUMBER OUTSTANDING PRINCIPAL TOTAL INTEREST RECEIVED THIS --$- PERIOD (b) INTEREST RECEIVED Enter the amount in column (b) in the Schedule I Summary. Line 3. Do nor carry this total to the Schedule H Summary. FPPC Form 460 (8/99) For Technlcal Assistance: 9161:322-5660 Schedule I Miscellaneous Increases to Cash Type or print in ink. Amounts may be rounded to wti ole dollars. r ----;;_;;,:;;;:-;:;,:~~:;:;-;,:i~--ll!llNl!I""~~ SCHEDULE! Statement covers period SEE INSTRUCTIONS ON REVERSE NAME OF FILER DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary from l // /c; C2 ( l through ____:,b,q__.....,<.Lf-~[.,..o<.- DESCRIPTION OF RECEIPT SUBTOTAL$ --o 1. Increases to cash of $100 or more this period ........................................................................................................... $--=---- 2. Unitemized increases to cash under $100 this period ............................................................................................... $_={)~~-- -Q 3. Total of all interest received this period on loans made to others. (Schedule H, Part 2 (b).) ................................. $ --'-"-"""----- 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL $ _---{)--"""------ AMOUNT OF INCREASE TO CASH FPPC Form 460 (8/99) For Technical Assistance: 9161322-5660