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Daysog 460Recipient Committee ittee Campaign Statement Cover Page (Government Code Sections 84200-84216-5) Type or print in ink. Statement covers period fr ©tn ... 0 A a SEE INSTRUCTIONS ON REVERSE through 21 3 '10 1 1. Type of Recipient Committee All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee Q State Candidate Election Committee D Primarily Formed 0 Recall 0 Controlled {Also Complete Part 5} 0 Sponsored (Also Complete Part 6) ❑ General Put Committee ❑ Sponsored ❑ Primarily Formed Candidate/ ❑ Small Contributor Committee Officeholder Committee D Political Party /Central Committee {Also Complete Parr 3. Committee Information I .D, N,, BER qlq 9 w 2'. COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) �..... e k STREET ADDRESS (NO P.O. BOX) 0-7 01 14 At �,o 4,,,eC CITY STATE ZIP CODE AREA CODE/PHONE 1-1 &A C^, A' MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX 1 E -MAIL ADDRESS Treasurer(s) DI NAME OF TREASURER MAILING ADDRESS 4 . . ............... a C" A �., CITY S UT E ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of kn ledge 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 i rue a corre Executed on. 111 By D to to `Tr - er orAs tant Treasurer Executed on t J 2,( 1 ? 0 1 B Date Controlling Otf older, Candidate, State asure P ponent or R_e, Ofcervf Spcnsar Executed on Date Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent By ...... ... . . Signature of Controlling Officeholder, Candidate, State Measure Proponent i H 111 Date of election if ap icable: (Month, day, Ye '4 . Date Stamp COVER PAGE 'age _ of For Official Use Only 2. Type of Statement: Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement f_j Supplemental Preelection ❑ Amendment Explain below) Statement - Attach Form 495 FPPC Form 460 (June /01) FPPC Toll - Free Helpline: 8661ASK - FPPC State of California M6:::::::A Ril COVER PAGE 'age _ of For Official Use Only 2. Type of Statement: Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement f_j Supplemental Preelection ❑ Amendment Explain below) Statement - Attach Form 495 FPPC Form 460 (June /01) FPPC Toll - Free Helpline: 8661ASK - FPPC State of California T or print in ink. COVER PAGE - PART 2 Recipient Committee Campai Statement NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Cover Pa — Part 2 ----------- - ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT Pa of 5. Of or Candidate Controlled Committee G. Ballot Measure Committee OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE ❑ OPPOSE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT OPPOSE RES I DENTIAL/BUS I NESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identif the controllin officeholder, candidate, or state measure proponent, if an NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Committees Not Included in this Statement: List an committees not included in this statement that are controlled b y ou or are primaril formed to receive OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of y our candidac COMMITTEE NAME I.D.NUMBER 7. Primaril Formed Committee List names of officehaider or candidate for NAME OF TREASURER CONTROLLED COMMITTEE? which this committee is primaril formed. F YES F NO COMMITTEE ADDRESS STREET ADDRESS ( NO P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS ( NO P.O, BOX NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT [:] OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT F❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODEIPHONE Attach continuation sheets if necessar FPPC Form 460 (Juneffil) FPPC Toll-Free Helpline: 8661ASK-FPPC State of California Campai Disclosure Statement T or print in ink. Amounts ma be rounded Summar Pa to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from t 01 ) / ?,- 'a'l Z� throu NAME OF FILER ............ Contributions Received om � Column A TOTALTHIS PERI©❑ (FROM ATTArHFD SCHEDULES) 1. Monetar Contributions ....... ......................... ......... Schedule A, Line 3 $ 2. Loans Received .... ..................... ...... ................ Schedule B, Line 3 1 SUBTOTAL CASH CONTRIBUTIONS ........ ........ ....... Add Lines I + 2 $ 4. Nonmonetar Contributions .................................... Schedule C, Line C7 10 1/0 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ To calculate Column B, add amounts in Column A to the correspondin amounts from Column B of y our last report. Some amounts in Column A ma be ne fi that should be subtracted from previous period amounts. If this is the first report bein filed for this calendar y ear, onl carr over the amounts from Lines 2, 7, and 9 (if an . . . . . . ...... ............ . ................................................................................ ..... .. . . . .. . . . . . . . . Expenditures Made 47 6. Pa Made ...................... ................................ Schedule E Line 4 $ $ 7. Loans Made .................. ........ ....... ............... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ........ ........ ............. Add Lines 6 + 7 $ tt 9. Accrued Expenses (Unpaid Bills) ....... --- .................. Schedule F Line 3 10. Nonmonetar Adjustment .................................... ..... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 LIP. g $ . ........ ------ 77 ..... ..... $ Current Cash Statement 12. Be Cash Balance ............ — ........ Previous Summar Page, Line 16 $ 13. Cash Receipts ............ .............. ........ Column A, Line 3 above 14. Miscellaneous Increases to Cash — ........................ schedule 1. Line 4 15. Cash Pa ........ ................ ... Column A, Line 8 above 16. ENDING CASH BALANCE ... Add Lines 12 + 13 + 14, then subtract Line 15 $ Lob If this Is a termination statement, Lino 16 must be zero_ 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ ......................................... Cash E and Outstandin Debts 18. Cash E .......................... ...... ...... See instructions on reverse $ 19. Outstandin Debts ......................... Add Line 2 + Line 9 in Column B above $ SUMMARY PAGE 7 Pa of I.D. NUMBER - - ------------ 1,72. 1`027 1 8� Calendar Year Summar for Candidates Runnin in Both the State Primar and General Elections 111 throu 6130 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ . .......... Expenditure Limit Summar for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntar Expenditure Limit Date of Election Total to Date (mm/dd/ ---------- ----------- --- ----- - $ ..... ....... *Since Januar 1, 2001. Amounts in this section ma be different from amounts reported in Column B. FPPC Form 460 (June101) FPPC Toll-Free Helpline: 8661ASK-FPPC Schedule A Type or print in ink. ND com SCHEDULE A Monetary Contributions Receive d Amounts may be rounded to whole dollars. Statement covers period ®» • Ni c. E:] PTY from t' ) thro � C4 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER IND FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE RECEIVED . {1FC ©IL9MITTEE, ALSO ENTER I .D . NUM 1 CODE OCCUPATION AND EMPLOYER (1P SELP_EMPLOYEJ, ENTER NAME RECEIVED THIS PERIOD CALENDAR YEAR (JAN. 1 - DEC. 31) TO DATE (IF REQUIRED) OF BUSINESS) ❑PTY Schedule A Summary 1. Amount received this period — contributions of $100 or more. gA A (Include all Schedule A subtotals.) ............... _ ........................................................................... ............ $ M 2. Amount received this period ---- unitemized contributions of less than $'loo .............. ............................... $ 3. Total monetary contributions received this period. Add Lines 1 and 2. Eater here and on the Summa P Column A, Line 1. Summary g y....y........ TOTAL $ FPPC Form 460 (June/01) FPPC Toll -Free Helpline; 866/ASK-FPPC ND com Ni c. E:] PTY IND ❑ COM ❑ OTH I I I ❑PTY !� El SCC E] IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC E] IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ Schedule A Summary 1. Amount received this period — contributions of $100 or more. gA A (Include all Schedule A subtotals.) ............... _ ........................................................................... ............ $ M 2. Amount received this period ---- unitemized contributions of less than $'loo .............. ............................... $ 3. Total monetary contributions received this period. Add Lines 1 and 2. Eater here and on the Summa P Column A, Line 1. Summary g y....y........ TOTAL $ FPPC Form 460 (June/01) FPPC Toll -Free Helpline; 866/ASK-FPPC Schedule B — Part 1 T or print in ink. SCHEDULE B - FART l Amounts ma be rounded Statement covers period Loans Received to whole dollars. t/4 I J? 'vo from SEE INSTRUCTIONS ON REVERSE throu Pa of NAME OF FILER I.D. NUMBER we-- ..... ...... . 0 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE (b) AMOUNT (C) AMOUNT PAID (d) OUTSTANDING BALANCE AT j e ) INTEREST (f) ORIGINAL W CUMULATIVE OF LENDER ( IF C OM N1 I TTEE, ALSO ENTER I.D, NUM BER} (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS BEGINNING THIS PERIOD RECEIVED THIS PERIOD OR FORGIVEN THIS PERIOD CLOSE OF THIS PERIOD PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE ❑ PAID CALENDAR YEAR $ $ $ $ ❑ FORGIVEN RATE PER ELECTION** , r', L_, r__1 =v r_1 S C C r T[j IND n COM E] OTH ❑ PTY ❑ S C C DATE DUE DATE INCURRED F-1 PAID CALENDAR YEAR $ $ $_ ❑ FORGIVEN RATE PER ELECTION NIN, DATE DUE 'tE:] IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDAR YEAR : FORGIVEN RATE PER ELECTION t IND ❑ COM ❑ OTH F-1 PTY ❑ SCC $ DATE INCURRED $ DATE DUE SUBTOTALS $ Schedule B Summar �Enter (e on Schedule E, Line 3) 1 . Loans received this period ....................................................... .................................................... $ (Total Column (b) plus unitemized loans less than $100.) *AMOLints for or paid b another part also must be reported on Schedule A. 2. Loans paid or for this period ....... ................. ........................ ...................... ............ ....... ...... $ (Total Column (c) plus loans under $100 paid or for If re (Include loans paid b a third part that are also itemized on Schedule A.) J 3. Net chan this period. (Subtract Line 2 from Line 1.) ............. ......... ....... .................. NET $ Enter the net here and on the Summar Pa Column A, Line 2. ( Ma y be a ne number t Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC OTH — Other PTY — Political Part SCC — Small Contributor Committee FPPC Form 460 ( June/0 FPPC Toll-Free Helpline: 8661 At?V� Schedule C Type or print in ink. SCHEDULE C Amounts may he rounded Nonmonetary Contribut Rece to whole dollars. Sta tement cvve period t from ®• h � � � through At Page of SEE INSTRUCTIONS ON R EVERSE NAME OF FILER I.D. NUMBER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR CODE * IF AN INDIVIDUAL ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF GOODS O SERVICES AMOUNT/ FAIR MARKET FAIR CUMULATIVE TO CALENDAR YEAR PER ELECTION TO DATE RECEIVED 1F COMMITTEE. ALSO ENTER I.D. NUMBER) ( €F SELF-EMPLOYED ENTER NAM OF BUSINESS) VALUE (JAN 1 - DEC 31 [ IF REQUIRED} IND COM 4 - ' ­% P I^ job C) o� �-,�� nOTH _ . L ,,,..4 C A 4; PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC IND ❑CC)M ❑ OTH ❑ PTY [ ] SCC SUBTOTAL �4 additional i 0 od she pA p Y $ SOL2 - ��acf� information information rs ap p ro priately lab h a o Iq Schedule C Summary * Contributor Codes 1. Amount received this period — nonmonetary contributions of $100 or more IND — Individual (i nclude all Schedule C subtotals ...................................................................................... ............................... $ COM - R her than PTY C o mm ittee (other or SCC) �� 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..... ............................... $ OTH _ Otl7er PTY-- Political Party 3. Total nonmonetary contributions received this period. Ec — Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 0.) ...................... TOTAL $ t) FPPO Form 460 (June /01) FPPC Tall -Free Helpline: 866 /ASK -FPPC Schedule D SCHEDULED �ummar oy mxpenunures T or print in ink. Statement covers period Su Amounts ma be rounded inmrtin Other to whole dollars. Can' did S s, Measures and om Cmtt 1 iees t ram . .... SEE INSTRUCTIONS 0 EVERSE throu Pa of NAME OF FILER ................. ............... ......... I.D. NUMBER DATE NAME OF CANDIDATE, , E, ICE, AND DISTRICT OR R F MEASURE NUMB L AND JURISDICTION, TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE COMM ITT OR COMMITT ( IF REQUIRED PERIOD ( JAN. I - DEC. 31) ( IF REQUIRED ❑ Monetar Contribution ❑ Nonmonetar Contribution Independent ❑ Support ❑ Oppose enditure Monetar Contribution E] Nonmonetar Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetar Contribution ❑ Nonmonetar Contribution Independent Support ❑ oppose Expenditure SUBTOTAL .......... Schedule D Summar 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 .......................... __ ... ....... ................... 'I Total contributions n n ri inde = v r4 i+ ma i A AA L in e s 1 A 1) M + + 41k 0 0 F U 11� McA 46; per k U 0" U "U en V" C; U111111ol clgu .............. I %J IML. FPPC Form 460 ( June/01 ) FPPC Toll-Free Helpline: 8661ASK-FPPC Schedule E Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from LI I 2 , 0 SCHEDULE E through �� V Page of SEE INSTRUCTIONS ON REVERSE g NAME OF FILER I.D. NUMBER J ( �r �4 o A �� CODES: if one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Cam' campaign paraphernalialmisc. MBR member communications RAID radio airtime and production casts CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND independent expenditure supporting/opposing others explain )* POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads VVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Schedueullrrnary @- 1. Payments made this period of $100 or more. (include all Schedule E subtotals.) ................................................. _ ............... .. .......... ............ ....... $ 2. Unitemized payments made this period of under $100 .................... ............................... ....................................................... ............................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e ).) ................................................ ............................... $ 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............ TOTAL $ FPPC Form 460 (June/01) FPPC Toll -Free Helpline; 866 /ASK -FPPC Schedule F AccrNed Expenses (Unpaid Bills) SEE INSTRUCTIWS.pN REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. Statement carvers period from through CODES: If one of the lowing codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE F Page of I.D. NUMBER Cam' campaign paraphernalialmis MBR member communications RAID radio airtime and production costs CNS campaign consultants IUITG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff /spouse travel, lodging, and meals III independent expenditure supporting /opposing o s (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VDT voter registration LIT campaign literature and mailings PRT print ads VVEB information technology costs (internet, e- -mail) NAME AND ADDRESS OF CREDITOR CODE OR (a) (b) (c) (d) (r COMMITTEE, ALSO ENTER 1.t7. NUMBER) ESCRIPTION OF PAYMENT OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD . .. ............. - -- - -------------- __- - - - - -- - - - - - -- * Payments that are contributions or independent expenditures must also be SUBTOTALS $ $ $ $ summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (include all Schedule F, Column (b) subtotals for NN accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............. ............................... INCUR EDT LS $ 2. Total accrued expenses paid this period. (include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or lore, 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 onthe Summary Page, Column A, Line 9.) ................................................................................................................. ............................... NET $ May be a negative number FPPC Form 460 (June/01) FPPG Toll -Free Helpline: 8661ASK -FPPC Schedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) SEE INSTRUCTION ON REVERSE NAME OF FILER NAME OF AGENT OR INDEPENDENT CONTRACTOR Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from through CODES: If one of the folio ing codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. IF campaign paraphernalia /misc. MBR member communications RAD radio airtime and production c CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmanetary )* OFC office expenses SAL campaign workers' salaries SCHEDULE G Page of I.D. NUMBER NAM EAND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT osts CVC civic donations PEr petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND IND fundraising events independent POL polling and survey research TRS staff/spouse travel, lodging, and meals expenditure supporting /opposing oth �s (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads VIIEB information technology costs (internet, e -mail) Payments that are contributions or independent expenditures m qt also be summarized on Schedule D. NAM EAND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Attach additional information on appropriately labeled continuation sheets. TOTAL* $ * 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. FPPC Form 460 (Junel0l ) FPPC Tall -Free Helplinew 866/ASK Sch ule H Loans de to Others* SEE INSTRUCTION ON R ERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whale dollars. SCHEDULE H Statement covers period from through Page of I.D. NUMBER FULL NAME, STREET ADDRESS AND ZIP CO IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER [a) OUTSTANDING (b) AMOUNT �� REPAYMENT OR (d) OUTSTANDING (e) INTEREST M ORIGINAL (g) CUMULATIVE OF RECIPIENT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) � ��� SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS LOANED THIS FORGIVENESS BALANCE AT CLOSE OF THIS RECEIVED AMOUNT OF LOANS NAME OF BUSIN PERIOD PERIOD THIS PERIOD` PERIOD LOAN To DATE PAID CALENDAR YEAR $ $ $ FORGIVEN PER ELECTION ** RATE DATE DUE DATE INCURRED (� PAID CALENDAR YEAR $ $ $ FORGIVEN PER ELECTION ** RATE DATE DUE DATE INCURRED Loans that are contributions to another candidate or committee m ust also be summa a ed vn ch D L S edule va s far g iven must also be reported rted on Schedule E . SUBTOTALS (Enter (e) on Schedule I, Line 3) Schedule H Summary 1 . Loans made this period ............. ................................................................... ............ ,.................... ............................. $ (Total Column (b) plus unitemized loans less than $100.) if Required 2. Payments received on loans ............................................................................................................ ............................... $ (Total Column (c} plus unitemized payments less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.) ......................................................... ............................... NET $ (Enter the net here and on the Summary Page, Column A, Line 7.) (May be a negative nu , er) FPPC Farm 460 (Junel01) FPPC Toll -Free Helpline: 865IASK -FPPC