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FOR , NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURESUMMARYPAGE J UL2 3 Zf

COMMI TTEE NAME ( Mu s t Ae s ame a s o n St a t emen t o f Or g a n i z wm_ ' ~ -~ P o/ k e ot c n i u s Ke p u.b 1: e o;- , 0 v w t- a , 1 ' 6 -

I MPORTANT : I n d i c a t et y p eo f c o mmi t t e ey o u a r e r e p o r t i n gf o r:

( 1 ) S t a t e w i d e / L e g i s l a t i v eCa n d i d a t e( 2 ) S t a t e w i d ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t y / L o c a lCa n d i d a t e( 5 ) C o u n t yPAC ( 6 ) B a l l o tI s s u e / F r a n c h i s eCommi t t e e( 7 ) C o u n t y / Ci t y Ce n t r a lCommi t t e e( 8 ) S u p p o r tS l a t eo f Ca n d i d a t e s

FORM

DR- 2( Re v . 0 1 / 9 8 )

Fo r O f f i c eUs e On l y

Co mm . #

I n d e x e d

A u d i t e d

Compu t e r

DI SCLOSUREREPORT

R1 13 - i & 7 ? ~ e ,- / 9 - -OS"SI GNATURE OF TREASURER ( o rp e r s o n f i l i n gt h i sr e p o r t ) TELEPHONE DATE SI GNED

Ro u t i n e Pen al t i e s Du e F o r L at e F i l e dRe p or t s Ra n g e f r o m$ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACKAND C OMPLETE THE FOLLOWI NG SENTENCE :

19, R 4 ' 0 -5 _ REPORT FOR AN/ A( 1 )EL ECTI ON/ ( 2 ) NON- ELECTI ONYEAR .I AM F I L I NGA( r e p o r td a t e ) I n d i c a t eo n e

&' CHECK I FAMENDMENT TO REPORT DATED

0 Chec k i ft h i si sf i n a l( t e r m i n a t i o n )r e p o r ta n d a t t a c hN o t i c eo fD i s s o l u t i o nF or m DR- 3.( Yo umust c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo fD i s s o l u t i o ni s f i l e d. )

STATEMENT OF CASH ON HAND

CASH ON HAND a t t h een d o f t h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a nc emus t

b e z e r o )( A t t a c hDR- 3) . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . . .. . . .. . . .. . . . . .. . . .$

1 7 1

L o c a lCo mmi t t e e s ,e n t e rD a t eo fE l e c t i o n

C o u n t y&L o c a lCo mmi t t e e s ,e n t e rC o u n t yi nwh i c hE l e c t i o ni sh e l d

SUB- TOTAL.. . .. $ / 0 1~7SUBTRACT TOTAL MONEY SPENT THI SPERI OD

Sc h e d u l e B: Ex p e n d i t u r e st o t a l( A t t a c hSc h e d u l eB ). . .. . . . ... .. . .. . ... . . . . . . . . . . . . . . . .. .. .. . . .. . . . . .. .. . . . . . . . 6 1 -1 3Sc h e d u l e F: L o a n Rep ay men t s t o t a l( A t t a c hSc h e d u l e F ).. .. . . . . . . . .. .. . . . . . . . . . . . . . .. .. . . . . .. . . .. . . . . .. . . . O

/ ! o o ? 7 , t ' o O

UNPAI DBI L L S( F r o mSc h e d u l e D - A t t a c hSc h e d u l eD).. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . .$

I NKI NDCONTRI BUTI ONS( F r o mSc h e d ul e E - A t t a c hSc h e d u l e E ) . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . .. . . . . .$

OUTSTANDI NG LOANS ( F r o mSc h e d u l e F - A t t a c hSc h e d u l e F ) . . . . . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . .$

CANDI DATE COMMI TTEES ONLY : ~

CONSULTANT BREAKDOWN ( Sc h e du l eG A t t a c h e d ? ) YES t / NO

VALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l eH - A t t a c hSc h e d ul eH)

CASH ON HAND a t t h eb e g i n n i n go f t h er e p o r t i n gp e r i o d. ( T h i si st h e t o t a lo f a l lmon i e s h e l db y t h ec o mmi t t ee. T h i samount MUST b e t h es ame a s t h ec a s ho n h a n d a t t h een d o ft h e l a s tr e p o r t i n gp e r i o d ,o r must b e z e r oi ft h i si s f i r s tr e p o r tf i l e d. ) . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . .$ / , ~ ,&,

3 . ' 7 - 5

ADD TOTAL MONEY TAKEN I NTHI SPERI ODSc h e d u l eA : Cash C o n t r i b u t i o n st o t a l( A t t a c hSc h ed u l e A). . . . . . . . . . . . .. .. .. . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . 1?5 - 40

Sc h e d u l e F : L o a n s Re c e i v e d t o t a l( A t t a c hSc h e d u l eF ) . .. . . . . . . . .. .. . . . .. .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .

Sc h e d u l e H : T o t a lSa l e so f Campa i g nP r o p e r t y( A t t a c hSc h e d u l e H) . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . ..

( Sc h e d ul eH a p p l i e st o Ca n d i d a t e s ' Commi t t e e sOn l y )

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Fo r t n s b v c t i o n s ,Se e Back o f - Fo ur

CONTRI BUTI ONS- MONEY TAKEN I N- ( i n d ud n gc a n d i d aWsp e r s o n a !f u n d s ).

COMMI TTEE NAME ~be s a r r > ea s o n S i ' a t + e m e r l t o f f l r g a r r i z a t F o n )

i ~ o f k 00 . ~ p t L bi i i i WPy n e n 9 t o a S s '

TATECANDMTES NOTE : I FA CONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( POLmCALACTI ONC 0M1 1 I I I T T E E). L I STTHEPAC I DENTI F I CATMNUMBERAND THEPACCHECKNUMBER I NTHEDESI GNATEDCOLUMN . A L I S TOF I DNUMBERSI SAVAI LABLEFROM THEK 7 J YAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON Se c t i o n6 8B . 3 2 A ( 6 ) ,I o waCode , p r o h i b i t st h e u s e o f i n f n m l a t i o nc op i e d f r o mr e p o r t sk i n ds Wt e n e n t sf o rs o f c i t i n 9c o n t r i b u t i o n sa r

o ram Co n I n e r c i opu l s e b y a n y p e r s o n o t h e rt h an s t a t u t o r yp o l i t i c a lc ommi t t e e s -

* D h d o s u ml a wnames c a nd i d a t ec o n md t t o e st od i s d o s ot h er e l a t i o r w J *o fan y r e l a t i v ew k a t d r ga c o n b b u d k u rt o t h ecommi t Me. o n s hi pmi n t be s h am. to t h et h i r dd e g r e eo fc o n sa n g t d n i l y( b l o od v o l o bv e s )an d a l l n i t y( r amUveeb ym a r r i a g e )( S e ePage 2 o ff a n r sp a c k e t _ ) _i f s u r n ameo f c o n t r b k d o rI s t h es ame a s c a n d i d a t e ,b u tt h e t ai sn of a m i l i a lm1abo rwh i p. e nt e r" t r o tawe i r rt h et e b t i o n & t i pc ok mn .

SUB- TOTAL

TOTAL ( i fl as t page o f t h i ss c h ed u l e )S~O

$ x' . 0 4

( f o rSd l e d ul eA)

- SCHEDUL E

A MONETARY( Re v. 0 6 / 9 7 ) RECEI PTS

CHECKTHI S BOX 1 FAMENDI NGFORM

DATE PAC I DNUMBER NAM AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - 4 I FFORRECEMED ( i fa p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND( L 4 M I M DDf Y R)AND PAC CHECK

'( i fa p p l i c a b l e ) RAI SE

NUMBER I NCOME

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T HI SBOXAPPL I E STOCANDI DATES 'COM s o l my:P u r c h a s e so fc e r t a i namp a l Wp r o p e r t yc omM $ 5 0 0o rmommu s ea l s ot h ei n v e n W r l e do nSd e dA*H. t RW t oSc h e d u l eHm9 Vu c t i o n s. )

Emmx k ur a st op a p a amsuhM9. 0. l k md - r ~. p d e " 4 .mgms a v wes m u s ta l s ob ed e Wl t r n l z e da nSd wd u t eG b yt h ea mo u n t ,pumoee. a n dd e 0e o fe a c ht y p e o fe x p e n d i h a en h a d e 4 qt h ep e r s oNe n to nbmW o f t h eg n d i d a e e ' sa a r n n i b e e _( R o t o rt oSc h e d u l eG f i s t r u d l o n sa n dI o w aC o d e' 6. E ( 3 ) 0 ). )

Page~- o f

FORI NSTRUCTOv S. SEEBACK OF FORM SCHEDULE

EXPENDI TURESB MONETARY

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COMMI TT EE NAME ( M u s tb esome a s o n S t a t e me n t o f Ol p an f z e do n )

IS C k s &b l i P &. H t r F ' t x ' f ' i A O n.. . 9 t S'. ~ ' a L owr t PCANDI DATE NAMEAND ADDRESSTOWHOM PURPOSE- AMOUNT

DATE I DNt MABER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i f l ( Di a bu r s e ~)WAS MADE( A I M I D ) I Y R ) ANDPAC

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