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PC 2 <br /> Cash Contributions, Loans Received and In-Kind <br />Candidate or Political Committee Name, Conamttee ID Number: <br />Tom $1ocum for City Counci~ Page 3 of 5 <br /> <br />Election: [] Primary 2004 [7~1 General 20__ [~ Other __ <br />Report' [] I st Pre-election [] 2nd Pre-election [~] Post-election ~ 20__ September SupplementaI <br /> <br />SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS <br /> CODE 1: Contributor Type CODE 2: Contribution Type <br /> B Business Enti~ CA Cash <br /> C Political Committee (includes business ai~d 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 Politmal Party Connmittee <br /> <br /> Amount of in-Kind Purpose <br /> Line Cf Name and Address of Contributor <br /> Contribution (see manual for suggested purpose codes) <br /> Occupational Information or Contributor Code 1 I Code <br /> Date Received Contrtbutin~ Committee's ID~ Agqregate <br /> 2 <br /> <br /> Gordon C. Gallic <br /> I PO Box 11077 $ '~00.00 <br /> Eugene, OR 97440 <br /> 04/I0/04 investor $ 100.00 I t CA <br /> Henry N. Eastey <br /> 2. 1985 Friendly Street $ 100.00 <br /> Eugene, OR 97405 <br /> <br /> 04/15/04 retired $ 100.00 ~ I <br /> CA <br /> <br /> David E. Carmichael <br /> 3. 150 Forum Bidg. 777 High Street $ 100.00 <br /> Eugene, OR 97440 <br /> <br /> 100.00 B [ CA <br /> 04/081O4 <br /> attorney <br /> $ <br /> <br /> George Myrmo <br /> 4. 2323 Shields $ 100.00 <br /> Eugene, OR 97405 <br /> <br /> 04ll 3/04 independent business $ 100.00 B CA <br /> <br /> Western Properties <br /> 5. 66 Club Road Suite 160 $ 100.00 <br /> Eugene, OR 97401 <br /> <br /> 04/13/04 Real Estate Brokerage $ 100.00 B [ <br /> CA <br /> <br /> See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and <br /> Instructions contribution type. Do not include aggregates.) transfer these amounts to the Summary Statement~ PC 1 ~) <br /> <br /> on Back and Cash (CA} $ 500.00 Cash {CA) $ 2,~50 00 <br /> in Campaign Enter on Sunm'~ry Statemem. £ olmnn a,. I me 1 <br /> Finance <br /> Manual In-Kind (IK) $ 0.00 In-Kind (IK) $ 0.00 <br /> Enler on St~nl-r~lr5 Statement. ( olumn a Lllle~ 4 and 9 <br /> <br /> PC 2 Loans Recewed (LR) $ 0.00 Loans Received (LR} $ 0.00 <br /> Epter on Sunmktry Statement, Coltam~ A 1 mc 2 <br /> <br /> <br />