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Pc <br /> Cash Contributions, Loans Received and in-Kind <br /> <br />Can&date or Polmcal Cormmttee Name' Comnmttee ID Number: <br />Andrea Ortiz for City Council N/A Page 3~ of <br /> <br />Electron [] Primary 20 04 [] General 20 [] Other <br />Report [] 1 st Pre-elechon [] 2nd Pre-elecUon [] Post-elechon [] 20 September Supplemental <br /> <br />SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS <br /> <br /> CODE 1: Contributor Type CODE 2: Contribution Type <br /> B Bus~ness Entzty CA Cash <br /> C Poht~cal Committee 0ncludes business and umon PACs) CO Cosigner Obhgatmn <br /> F Can&date's lmmedmte Family 0ncludes candzdate) IK ln-K~nd <br /> [ Indzv~dual LR Loan Recmved <br /> L Labor Orgamzatlon <br /> O Other <br /> P Polmcal Party Corem/tree <br /> <br /> Amount of In-K/nd Purpose <br /> Line # Name and Address of Contributor <br /> Contribution (see manual for suggested purpose codes) <br /> Occupational <br /> Information <br /> Oontributor <br /> or <br /> Code ~ I Code 2 <br /> Date Received Contributing Committee's ID# Aggregate <br /> <br /> Andrea Orbz L <br /> 1. 189 Foch Street $ 16,16 <br /> Eugene, OR 97402 <br /> <br /> 3t2312004 <br /> Hospital Ward Clerk $ 954,90 F IK <br /> <br /> Bonny Bettman <br /> 2. 2191 Friendly Street $ 75,00 <br /> Eugene, OR 97405 <br /> <br /> 3/23/2004 <br /> Retired R.N. $ 75.00 I CA <br /> <br /> Carol Van Houten <br /> 3 768 West 10th Avenue $ 75,00 <br /> Eugene, OR 97402 <br /> <br /> 3/29/2004 <br /> Retired $ 75.00 I CA <br /> <br /> Jan Vandertuin <br /> 4. 455 West 1st Avenue, Apt. B $ 200.00 <br /> Eugene, OR 97401 <br /> <br /> 3/29/2004 <br /> Bike builder $ 200,00 I CA <br /> <br /> Gary Halvorson <br /> 5 2875 Adme Way $ 100 00 <br /> Eugene, OR 97403 <br /> <br /> Physician $ 100.00 t [ CA <br /> 3f29/2004 <br /> <br /> See Page Totals (Add all amounts w~ the same Accounting Period Totals (Complete only for last page and <br /> InstrucUons contribution .type Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1 ) <br /> on Back and 450.00 <br /> m Campmgn Cash (CA) $. Cash (,CA) $ <br /> <br /> Finance Enter on Summary Statemenk Column A Line 1 <br /> Manual In-K~nd (IK) $ 16.16 In-K~nd (IK) $ <br /> Enter on S/re]mary Statement. Column <br /> <br /> PC 2 Loans Recmved (LR) $ 0.00 Loans Recmved (LR) $ <br /> Enter on sun, m~ry statement, Column A, Lrae 2 <br /> <br /> <br />