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PC 1 <br /> Summary Statement of Contributions and Expenditures kev <br /> <br />Please type or print legibly in black ink. Page 2 of 2 <br />Candidate or Political Committee Name: I Committee ID Number: <br />Andrea Ort~z for City Council I N/A <br />[] Original I [] Primary 20 [] General 2004 [] Other <br />[] AmendmentI []1st Pre-election [] 2nd Pre-election ~] Post-election [] 20 September Supplemental <br /> LOAN SUMMARY <br />21. Beginning Outstanding Loans FOR OFFICE USE ONLY <br />(line 29 of previous report) 0.00 <br />22. Loans Received (Non-Exempt) <br />(hne 2) + 0.00 <br /> <br />23. Loans Received (Exempt) <br />(hne 14) + 0.00 <br />24. LOANS RECEIVED SUBTOTAL <br /> = 0.00 <br />(lines 21 + 22 + 23) <br />25. Loan Payments (Non-Exempt) <br />(line 7) 0.00 <br />26. Loan Payments (Exempt) <br />(line 18) + 0.00 <br /> <br />27. Forgiven Loans <br /> + 0.00 <br />(Total loans forgiven during this accounting period) <br />28. LOAN PAYMENT SUBTOTAL <br />(lines 25 + 26 +27) = 0.00 <br />29. TOTAL OUTSTANDING LOANS <br /> = 0.00 <br />(hne 24 minus hne 28) <br /> PERSONAL EXPENDITURE SUMMARY <br />30. Beginning Outstanding Personal Expenditures 0.00 <br /> (hne 36 of previous report) <br />31. Personal Expenditures + 0.00 <br />(Accounting Period Total from PC 3A) <br />32. PERSONAL EXPENDITURE SUBTOTAL <br />(lines 30 + 31) = 0.00 <br />33. Personal Expenditure Reimbursements 0.00 <br />(Total expenditures on PC 3 with purpose code R) <br />34. Forgiven Personal Expenditures + 0.00 <br />(Total personal expenditures forgiven this acctg period) <br /> 35. REIMBURSEMENT SUBTOTAL <br /> (lines 33 + 34) = 0 00 <br /> <br /> 36. OUTSTANDING PERSONAL EXPENDITURES <br /> = 0.00 <br /> (line 32 minus line 35) <br /> FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD <br /> 37. Ending Cash Balance <br /> (line 20) 317.92 <br /> <br /> 38. Accounts Receivable <br /> + 0 00 <br /> (Accounting Period Total from PC 5) <br /> 39. SUBTOTAL <br /> (lines 37 + 38) = 317 92 <br /> 40. Total Outstanding Loans 0.00 <br /> (line 29) <br /> 41. Outstanding Personal Expenditures + 0.00 RECEIVED <br /> (line 36) <br /> 42. Accounts Payable <br /> (Accounting Period Total from PC 6) + 0.00 ~EC 0 ~ 2004 <br /> 43. SUBTOTAL <br /> (lines 40 + 41 + 42) = 0.00 <br /> 44. BALANCE/DEFICIT CITY R EC 0 R D ER <br /> = 317 92 <br /> (line 39 minus line 43: indicate + or - balance) <br /> <br /> I, ~'~(ff~- ~ (name of candidate asurer)cJnereby certify that the above <br /> statement and the attached supporting reports are true and correct ~--~-~-~' <br /> <br /> Signatur,~5t' candidate or treasurer Date <br /> <br /> <br />