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Summary State ent of Contributions and Expenditures Rev, 12/03 Please type or print legibly in black ink, Page 2 of 2 C,~andidate or Political.,Gpmrnittee Name: Committee ID Number: ~)rigi,al [] Primm7 20 _ ~[G,,era120~_ [~ O~her }'"].Amendment ~Llst Pre-election _ [_12nd Pre-election [] Post-election [] 20~ September Suppleraentai LOAN SUMMARY 21, Beginning Outstanding Loans ~ FOR OFFICE USE ONLY (lfn¢ 29 ofpi~vim~, r~pott) 22. Loans R~eived (Non-Exempt) / - (tine 2) + 23. Loans Received (Exempt) (tine 14~ 24, LOANg RECEIVED SUBTOTAL (lines 21 + 22 4.23) 25. Loan Payments (Non-Exempt) (hne ?) 26. Loan Payments (Exen~t) (Iiae 18) + 2'/. Forgiven Loans (Total loans forgive~ dufia.~ this accotmting period) + 28. LOAN PkYMENT SUBTOTAL {lines 25 + 26 +27) ' 29, TOTAL O[~TSTA~NDING LOANS ' 0ina 24 minus linc 28) --' PERSONAL EXP£NDITURE SUMMARY 30, Begim~ing Outstanding Personal Expenditures (line 36 ofpreviou~ r~port) . '31Persona[ ]3xpcndltures (Accounting Ped, o~[ Total from PC 3A) 32.PERSONAL EXPBNDITURE SUBTOTAL (lines 30 + 31) 33.P~rsonal Expert'&lure Reimbursements (Total expenditures on PC 3 with purpose code R) 34,Forgiven P~rsonal Expenditures (Total personal expendi~rm forgiven this ~c~tg. period) 35. REIMBURSEa~NT SUBTOTAL = ([in~ 33 + 34) 36, OUTSTANDIN~ PERSONAl, EXPENDITURES FINANCiAl- STATUS AT ¢l-O$E OF ACCOUNTING PI=RIOD 37~ Ending Cash 38. Accounts Receivable + (Acco..unting Petio~t Total from PC 5) ~ ~ 39. SUBTOTAL ' 40. Torn! Outstanding (line 29) . - · 4i. Outstandin$ P~rsonal E×penditt~res + (line 36) - 42. Accounts P~yabt¢ + (Accounting P. etiod Total from PC 6) _ 43. SUBTOTAL -- ~Iines 40 + 41 + ~2) (line 39 minus line 43: Arid{cate + ~ - balance) ~~f"r~rts are (name of candidate or treasurer), hereby certify that the above I, statement and the ~t~ac~(1 suI~_o.l~g repo~ true and ¢~r~ect.