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P( Please Wpe or print legibly in black ink Page I of 2 C~d~date or Political Comm~ee N~me (~;name~ % M~l~ng Address as ~t Appe~s oa Smtemeat of Org~zafioa (s~et, route or box n-~ber, c~kv, sta~e, z~p code): Tmas~fs Name: [ Tdephone~nmber (day): Cormi~ee ID Nmber: ] Co~i~ee T~pe, Me,urn Number or Offloe: riginal D Prima. 20 ~ General 20 P Z D Other mendment ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election ~ 20 ~eptember Supplemental A2[OTALS FOR THIS ~U~ATFVE TOTALS ACCOUNT~G PE~O~ FOR THIS ELECTION CONT~gUT~ONS Cash Contributions tAccmmting Period Total from PC 2} 2. Loans ReceNed (Non-Exempt) + + (Accounting Period Total from PC 3 Total Cash Contributions 0,00 thnes 1+ 2) 4. In-Kind + + (AccountNg Period Total from PC 2 5. TOTALdines 3 + 4}CONTRIBUTIONS = ~ 0.00 = C~h Expendkures Lkccouafing Period Total from PC 3) 7. Loan Payments (Non-Exempt) + + tAccount~g Period Total from PC 3~ 8 TotaL(lines 6Cash* 7} Expendim res = ~ 0.00 = 9. In-Kind + ~ 0.00 + (Accounting Period Total from PC 2~ 10. TOTAL EXPENDITURES = ~ 0.00 = dines 8 + 9) CASH BALANC~ 11. Beg~,ng Cash Balance FOR OF[lC[ HS[ O~kY {l~e 20 of previous re~) . 12. Total Contributions + ~ 0.00 (l~e 5) 13. Other Receipts + tAccounting Period Total kom PC 4A) ~4 Lo~s Received (Exempt) + (Accounting Period Total kom PC 4A~ 15. CONTRIBUTION SUBTOTAL =2q03 ~So.oo (lines 11 + 12 + 13 + 14) 16. Total Expenditures 17. ~her D~sbursements + (Accounting Period Total from PC 4B) 18. Loan Payments (Exempt') + {Accounting Period Total from PC 4B) {hnes l~+ 17+ 18) 20. ENDING CASH BALANCE = {l~e 15 minus lh~e 19)