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<br />Summary Statement of Contributions and Expenditures <br /> <br />Please type or print legibly in black ink. <br />Candidate or Political Committee Name: <br />~d.. (Ill' db('" ~ (0 \c."1,~ \ <br /> <br />o Original 0 Primary 20_ rn:Oeneral200 &{ <br />o Amendment 0 1 st Pre-election 0 2nd Pre-election <br />LOAN SUMMARY <br /> <br />21. Beginning Outstanding Loans <br />(line 29 of previous report) <br />22. Loans Received (Non-Exempt) <br />(line 2) <br />23. Loans Received (Exempt) <br />(line 14) <br />24. LOANS RECEIVED SUBTOTAL <br />(lines 21 + 22 + 23) <br />25. Loan Payments (Non-Exempt) <br />(line 7) <br />26. Loan Payments (Exempt) <br />(line 18) <br />27. Forgiven Loans <br />(Total loans forgiven during this accounting period) <br />28. LOAN PAYMENT SUBTOTAL <br />(lines 25 + 26 +27) <br />29. TOTAL OUTSTANDING LOANS <br />(line 24 minus line 28) <br /> <br />+ <br /> <br />+ <br /> <br />= <br /> <br />+ <br /> <br />+ <br /> <br />= <br /> <br />= <br /> <br />PERSONAL EXPENDITURE SUMMARY <br />30. Beginning Outstanding Personal Expenditures <br />(line 36 of previous report) <br />31. Personal Expenditures <br />(Accounting Period Total from PC 3A) <br />32. PERSONAL EXPENDITURE SUBTOTAL <br />(lines 30 + 31) <br />33. Personal Expenditure Reimbursements <br />(Total expenditures on PC 3 with purpose code R) <br />34. Forgiven Personal Expenditures + <br />(Total personal expenditures forgiven this acctg. period) <br />35. REIMBURSEMENT SUBTOTAL <br />(lines 33 + 34) <br />36. OUTSTANDING PERSONAL <br />EXPENDITURES <br />FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD <br />37. Ending Cash Balance (!) ,., "1 <br />m~2~ 0 .J <br />38. Accounts Receivable <br />(Accounting Period Total from PC 5) <br />39. SUBTOTAL <br />(lines 37 + 38) <br />40. Total Outstanding Loans <br />(line 29) <br />41. Outstanding Personal Expenditures <br />(line 36) <br />42. Accounts Payable <br />(Accounting Period Total from PC 6) <br />43. SUBTOTAL <br />(lines 40 +41 +42) <br />44. BALANCEIDEFICIT <br />(line 39 minus line 43: indicate + or - balance) <br /> <br />+ <br /> <br />= <br /> <br />= <br /> <br />= <br /> <br />+ <br /> <br />.-- <br /> <br />= <br /> <br />~ "i, 3 l <br /> <br />+ <br /> <br />~ <br /> <br />+ <br /> <br />t 3 ~~ ~~ <br />\? l,.~~ <br />'Sl.S~ <br /> <br />= <br /> <br />= <br /> <br />I, fl U ~r-l-~ t? ~rr ~ ~"- <br /> <br />statement and th attached supporting reports are true and correct. <br /> <br />o Other <br />o Post-election <br /> <br />PC I <br />Rev. 12/03 <br /> <br />Committee ID Number: <br /> <br />.Page 2 of 2 <br /> <br /> <br /> <br /> <br /> <br />. ".,','. <br /> <br /> <br />. RECE1V;EI1' <br />OCT.10 200G <br />C I TYRECQ.RIJER <br /> <br /> <br /> <br />(name of candidate or treasurer), hereby certify that the above <br /> <br />~~ /. &2~~ <br /> <br />Signature of candidate or treasurer <br /> <br />ID--/O'- t>b <br />Date signed <br />