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Cash Contributions, Loans Received and In-Kind <br />Candidate or Political Committee Name: Committee ID Number: <br />Kitty Piercy for Mayor n/a Pa~e 22 of ~ ~ <br /> <br />Electiom [~ Primary 2004 [] General 20__ [] Other __ <br />Report: [] 1st Pre-election [~ 2nd Pre-election [] Post-election [] 20__ September Supplemental <br /> <br />SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS <br /> CODE 1: Contributor Type CODE 2: Contribution Type <br /> B Business Entity CA Cash <br /> C Political Committee (includes business and union PACs} CO Cosigner Obligation <br /> F Candidate's Immediate Family (includes candidate) IK in-Kind <br /> I Individual LR Loan Received <br /> L Labor Organization <br /> O Other <br /> P Political Party Committee <br /> <br /> Amount of In-K~nd Purpose <br /> Line ¢¢ Name and Address of Contributor <br /> Contnbut¢on (see manual for suggested purpose codes,) <br /> Occupational Information or Contributor Code 1 Code 2 <br /> Date Received Contributing Committee's IDI¢ Aggregate <br /> <br /> Mary Gossart 30488 Fox Hollow <br /> 1 Rd, Eugene OR 97405 $ 100.00 <br /> <br /> 4/4/2004 Education Director $ 100 00 ~ CA <br /> <br /> Matthew Denms 4827 Old <br /> 2 Dillard Rd. EugeneOR $ 100 00 <br /> 97405 <br /> <br /> 4/7/2004 Professor $ 100.00 I CA <br /> <br /> Megan Moseley 61 W. 31st <br /> 3. Ave Eugene OR 97405 $ 100 00 <br /> <br /> 4~20~2004 ph, ys~cal therapists $ 100 00 I CA <br /> <br /> Mery Wendy Roberts 11537 SE <br /> 4 Flavel St Portland OR $ 100.00 <br /> 97266 <br /> <br /> 4/20/2004 Retired $ 100.00 I CA <br /> <br /> Michael Staszak 61 W 31st. Ave <br /> 5 Eugene OR 97405 $ 100 00 <br /> <br /> 4120/2004 physical therapists $ 100 00 I CA <br /> <br /> See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and <br /> lnstrucuons contribution type~ Do not include aggregates.) transfer these amounts to the Summary StatemenL PC 1 .) <br /> <br /> on Back and Cash (CA} $ 500 00 Cash (CA) $ ~ <br /> in Campaign ~mcr ca Sumnlar~ Stmrment, Cohimn A. Lute 1 <br /> Finance <br /> Manual In-Kind (IK) $ ~ In-Kind (IK) $ ~ <br /> Entel OI1 Summao Statement Cokwrm A L,mes 4 ~llld ') <br /> <br /> PC 2 Loans Received (LR) $ Loans Received (LR) $ ~ <br /> Enter on Sulnma~ Statement, Coltnnr~ A. Lille 2 <br /> <br /> <br />