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PC2 <br /> Cash Contributions, Loans Received and In-Kind ,:0, <br /> <br />Candidate or Political Committee Name: Committee tD Number: <br />Nancy Nathanson for Mayor Page 4 of 18 <br /> <br />Election: [] Primary 200_~4 [] General 2004 [] Other __ <br />Repot1: [-] let Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental <br />SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS <br /> <br /> CODE 1: Contributor Type CODE 2: Contribution Type <br /> B Business Entity CA Cash <br /> C Political Committee (includes business and union PACe) CO Cosigner Obhgation <br /> F Candidate's Imrnediate Family (includes candidate) iK In-Kind <br /> I Individual LR Loan Received <br /> L Labor Organization <br /> O Other <br /> P Political ParC Committee <br /> <br /> Ltne# Name and Address of Contributor Amount of In-g~lnd Purpose <br /> Contribution (see manual for suggested purpose codes) <br /> <br /> Date Received Occupational Information, Contributing Contributor <br /> Code 1 Cede 2 <br /> Committee's ID#, or Description ~f Code ~ ~s "0" Aggregate <br /> <br /> Henry Company <br /> <br /> $ 100.00 <br /> <br /> 5/12104 $ 100 00 B CA <br /> <br /> Hou§h-Tibbltts, inc <br /> 2 $ 100 00 <br /> <br /> 5/13/04 $ 100.00 B CA <br /> <br /> Gale Roberts Co. <br /> 3. $ 2OO.0O <br /> <br /> 5/13/04 $ 200 00 B CA <br /> <br /> Olsson Industrial Electnc <br /> <br /> 4 $ 500.00 <br /> <br /> 5/16/04 $ 500.00 B CA <br /> <br /> Rex~us Forest Byproducts, Inc. <br /> <br /> 5 $ 500 00 <br /> <br /> 5/16/04 $ 500 00 B CA <br /> <br /> See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and <br /> contribution 'type. Do not include aggregates.) transfer these amounts to the Summary Statement. PC 13 <br /> Instructions <br /> on Back and Cash (CA) $1400 O0 Cash (CA) $ __ <br /> ill Canlpaign Ente~ em Smnmary Statement Coltman A. t,me t <br /> Finance In-Kind (IK) $ __ In-Kind (IK) $ __ <br /> l~gtan~al t:.nter on Stroh'haO, Statement, Colurrm A, Lines 4 m~d 9 <br /> <br /> Loans Received (LR) $ __ Loans Received (LR) $ ~ <br /> PC 2 Enter on St,nmaaE~ Statement, Column A, Line 2 <br /> <br /> <br />