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<br />PC 4A Other Receipts <br />please type or print legibly in black ink; list only one entry per line <br /> <br />rev 1/06 <br /> <br />J.. name of committee use full name <br /> <br />committee ID number <br /> <br />~-~~-~~---r~-------- <br />! 1 1 <br />_____~_ pa~e-===_o!===--==-= <br /> <br />Andrea Ortiz for City Council <br /> <br />o Primary 20___~ <br /> <br />o General20~ <br /> <br />o other: <br /> <br />01 st pre-election <br /> <br />o 20illi_Sept. Suppl. <br /> <br />o Report of Initial Assets <br /> <br />o 2nd pre-election <br /> <br />o Post-election <br /> <br />Othe....Reeeipt..Transaetlon...vpeCodes <br />EL~ Exempt Loan Proceeds <br />FM Items Sold at Fair Market Value <br />IN Interest/Investment Income <br />OM Miscellaneous provide a description <br />RF Refunds and Rebates <br /> <br />date received name required for codes EL, OM and RF <br />optional for codes FM and IN <br /> <br />other receipt transaction <br />type code <br /> <br />other receipt amount <br /> <br />o <br /> <br />9/2/2005 - ! Pacific Cascade Federal Credit Union <br />9/1/2006 i Eugene, OR <br />I <br /> <br />IN <br /> <br />, $ <br /> <br />0.17 <br /> <br />i <br />I <br />I <br />1$ <br /> <br />. <br /> <br />. <br /> <br />$ <br /> <br />o <br /> <br />. <br /> <br />:$ <br />I <br />1$ <br />I <br />I <br />I <br />; <br /> <br />. <br /> <br />I <br />i$ <br />I <br />i <br /> <br />. <br /> <br />:$ <br /> <br />. <br /> <br />. <br /> <br />1$ <br />I <br />'&ECEIVED <br /> <br />. <br /> <br /> <br />page totals <br /> <br />accounting period totals <br /> <br />add all Other Receipt T~ansaction Type Codes specified L ~ complete only for last page and transfer these amounts to the Summary Statement, PC 1 <br />codes FM;TN;OM~RF-- ~--~--~- -- ~--code EL~--I- codes FM]N;OM, RF -- code a-- ---~-- --~ -- ---~- <br />$ 0.17 $ i $ 0.17 $ <br /> <br />---~~--~---~-----~- -----~~-~--~-1- <br />I enter on PC 1, Column A, Line 13 enter on PC 1, Column A, Line 14 <br /> <br />PC4A <br /> <br />see instructions on back and in Campaign Finance Manual <br />