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PC2 Cash Contributions, Loans Received and In-Kind Candidate or Poi/t/cai Committee Name: Comm/ttee ID Number: Write-In Jim Torrey None Page ! of 2 Election: [] Primary 20__ [] General 2004 [] Other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-elect/on [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Polit/cal Committee (includes business and union PACs) CO Cosigner Obligation F Candidate's/mmediate Family (includes candidate) IK h-Kind I Individual LR Loan Received L Labor Organization O Other P Polit/cal Party Committee D'ne tl Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor I Contributing Committee's ID# Aggregate Code 1 ~ Code 2 Clark Roeder, DMD 1. 1717 Centennial Blvd $ 100.00 Springfield, OR 97477 09-28-04 $ 100.00 B I CA J.K. Pratt & Company 2. PO Box 40880 $ 100.00 Eugene, OR 97404 09-28-04 $ 100.00 B [ CA Arlie Air, LLC 3. 871 Country Club Road $ 8,000.00 Eugene, OR 97401c 10-05-04 $ 8,000.00 B I CA Dorothy Stedman 4. 1465 Roundup Drive $ 100.00 Eugene, OR 97401 10-05-04 Administrative assistance - insurance $ 100.00 I I CA June Cone 5. 2130 Olive Street $ 100.00 Eugene, OR 97405 10-08-04 Homemaker $ 100.00 I CA See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and l. ustmctions contribut/on type. Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1.) on Back and Cash (CA) $ 8,400.00 Cash (CA) $ Campaign ~r o~ s'~~ Sta~n~-n~, C~n A, L~e ~ Finance Manual In-Kind (IK) $ ~ In-Kind OK) $~ Ealt~ on ~ Statement, Colurml A, Lm~ 4 sad 9 PC 9_ Loans Received (LR) $ ~ Loans Received (LR) $ ~ Eater on Sun~n~ Statmnmt, Column A, Line 2