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PC <br /> Cash Contributions, Loans Received and n-Kind <br /> <br />Candidate or Political Committee Name' Com,'rnttee ID Number' <br />Andrea Ortiz for C,ty Council N/A Page 4 of 4 <br /> <br /> lec ,on [] Primary 20 04 [] General :0 [] Other <br />Report [] 1st Pre-electron [] 2nd Pre-elect~on [] Post-election [] 20 September Supplemental <br /> <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 Cormmttee (includes buszness and umon PACs) CO Cosigner Obhgatzon <br /> F Can&date's lnm'~edlate Fannly (includes can&date iK In-Kind <br /> i Indn,ldual LR l.oan Received <br /> L Labor Organizatmn <br /> O Other <br /> P Political Party Comrmttee <br /> <br /> Amount of ln-K~nd Purpose <br /> Line # Name and Address of Contnbutor <br /> Contnbutton (see manual for suggested purpose codes) <br /> Occupational <br /> Information <br /> or <br /> Oontributor <br /> Code ~ I Code 2 <br /> Date Received Contributing Committee's ID# Aggregate <br /> <br /> Lola Fritz <br /> I 3774 Pine Canyon Drive $ 250.00 <br /> Eugene, OR 97405 <br /> <br /> Hospital Operations Director $ 250 00 I <br /> 3/29/2004 <br /> CA <br /> <br /> Wilham C. Robertson <br /> 2 97t Fayette $ 100.00 <br /> Eugene, OR 97404 <br /> <br /> Retired $ 100.00 i t CA <br /> 3/29/2OO4 <br /> <br /> R~chard Kozak <br /> 3 2684 City View Street $ 100,00 <br /> Eugene, OR 97405 <br /> <br /> 3/29/2004 <br /> Physician $ 100.00 I CA <br /> <br /> Constance Monch <br /> 4 2986 Flintlock Street $ 100.00 <br /> Eugene. OR 97408 <br /> <br /> 3/31/2004 <br /> Retired $ 100 00 I CA <br /> <br /> Miscellaneous Cash Contnbutlons $50 and Under <br /> 5 $ 600.00 <br /> <br /> 2/6/04-4/1/04 $ 600.00 I CA <br /> <br /> See Page Totals (.Add all amounts with the same Accounting Period Totals (Complete only for last page and <br /> Instructions contnbutlon type Do not mclude aggregates ) transfer these amounts to the Summary Statement. PC 1.) <br /> on Back and <br /> in Campaign Cash (CA) $ 1,150 00 Cash (CA) $ _ 2,700.00 <br /> <br /> Finance Enter on Sumrnary StatemenL Column A, Line 1 <br /> Manual in-K~nd (IK) $ 0,00 in-Kind (IK) $ 454.90 <br /> Enter on Summary Statement. Column A Lines 4 and 9 <br /> <br /> PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ 0 00 <br /> Enter on Su.mmar5 SmtemenL Column A, Line 2 <br /> <br /> <br />