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PC2 <br /> Cash Contributions, Loans Received and In-Kind <br />Candidate or Political Comnfittcc Name: Committee ID Number: <br />Write-in Jim Torrey None Page 2 of 2_ <br /> <br />Election: [] Primary 20__ [] General 2004 [] Other__ <br />Report: [] 1st Pre-election [] 2ad Pre-election [] Post-election [] 20_. September Supplm~ntal <br />SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS <br /> CODE 1: Contributor Type CODE 2: Contribution Type <br /> B Business Entity CA Cash <br /> C Political Co~afittee (includes business and union PAC0 CO Cosigner Obligation <br /> F Candidate's Immediate Family (includes candidate) IK In-Kind <br /> I Individual LR Loan Received <br /> L Labor OrganiTation <br /> O Other <br /> P Political Party Committee <br /> <br /> Line # Name and Address of Cont#butor Amount of In-Kind Purpose <br /> Contribution (see manual for suggested purpose codes) <br /> Occupational Information or Contributor Code I I ! Code 2 <br /> Date Received Contributing Committee's ID# Aggregate <br /> <br /> Jeff Miller <br /> 1. 450 Country Club Road $ 16,200.00 <br /> Eugene, OR 97401 <br /> <br /> 09-27-04 Insurance agent $ 16,400.00 I LR <br /> <br /> 2. $ <br /> <br /> 3. $ <br /> <br /> 4. $ <br /> <br /> 5. $ <br /> <br /> See Page Totals (Add all amouats with the same Accounting Period Totals (Complete only for last page and <br /> <br /> Instructions contribution type. Do not include aggregates.) transfer these amounts to the Smmnary Statement, PC 1.) <br /> on Back and Cash (CA) $ Cash (CA) $ 8.400.00 <br /> in Campaign ~ o~ sum~ s~, Co~ A, t~ l <br /> Finance <br /> Man~al In-mad (IK) $ ,., In-Kind (~K) $ ~ <br /> Eat~ on Smnm~y Statement, Colmm A, Liaes 4 and 9 <br /> <br /> PC 2 Loans Received (LR) $16.200.00 Loans Received (LR) $16.200.00 <br /> Fair oa Summa~/Stamamt, Column A, Li~ 2 <br /> <br /> <br />