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R e s e t F o r mCOMMI TTEE NAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )Cf " z e n s F c r St r t l i y xI MPORTANT : I n d i c a t e b y # t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) & a t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l C o m m i t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( t i ) C o u n t y PAC ( 9 ) C i t y PAC ( 1 0 ) S c ho o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TTEESONLY :Ca nd i d at e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )~~~~St v ~ v k K E , n u . b / ~ c ~ nO f f i c e Sou g h t D i s t r i c t ( i f Se n at e o r Hou s e )l gK/ a l 1 Qr _ A . ( e dp o y r , c e n f i - r 9g

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CASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amou n t MUST b e t h e s am e a s t h e c a s h o n h a n d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r mu s t be z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc h e d u l e A. Cash C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e du l e A ) ( ' a l s o s e e i n - k i n d b e l o w ) . . . . . . . . . .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 h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . _ . . _ _ _ _ _ _ . . . . .

( Sc h e du l e H a p p l i e s t o Ca n di d at e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEYSPENT T HI S PERI ODSc h e d u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) ( " ' a l s o s e e d e b t s a n d l o a n s b e l o w ) . _ . .Sc h e d u l e F : L o a n Re p ay me n t s t o t a l ( A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . , . . . . .CASHON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b a l a n c e mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . _ . . _ _ . _ _ _ _ _ _ . . . . . . . . . . . _ . _ . _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . _ . . . . _ . . . . . . . . . . . . . . . $

" ' UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" I N K I ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" OUTSTANDI NG LOANS ( F r o m Sc h e du l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEESONLY:CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e du l e H - A t t a c h Sc h e d u l e H) $

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' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) , I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o f __f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn f o r S c h e d u l e A )

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