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<br />FROM :EUGENE CHRMBER <br /> <br />FRX NO. :541 484 4942 <br /> <br />Sep. 12 2005 09:26RM P3 <br /> <br />Summary Statement of Contributions and 'Expenditures <br /> <br />Please type or print Jegibl in black ink. <br />Candidate or Political Conunittee Name: <br /> <br />PERSONAL EXPENDITURE SUMMARY <br />30. Beginning Outstanding Personal Expenditures ~ <br />(lino 36 of revious re art) '\"/ <br />31. Personal Expenditures + r:::>--- <br />(Accountil1g Period Tota] fl:om PC 3A) ..-IC/ <br />32. PERSONAL EXPENDITURE SUBTOTAL <br />(lines 30 + 31 <br />33. Personal Exponditure Reimbursements <br />Totalox onditl.lres on PC 3 with U ose code R <br />34. Forgiven Personal Expenditures <br />(Total orsonal ex enditul'es forgiven this acet . <br />35. REn0BURSEMENTSUBTOTAL <br />(lines 33 + 34) <br />36. OUTSTANDING PERSONAL '" ~ <br />EXPENDITURES -t::7 <br />FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD <br />37. Ending Cash Balance <br />(line 20 <br />38. Accounts Receivable <br />(Accountin Pallod Total from PC .5) <br />39. SUBTOTAL <br />(lines 37 + 38) <br />40, Total Outstanding Loans <br />(line 29) <br />41. OutManding Per50nal Expenditures <br />line 36) <br />42. Accounts Payable <br />Acoountlng Period Tota] from PC 6) <br />43. SUBTOTAL <br />(lines 40.... 41 + 42 <br />44. BALANCEIDEFIC1T <br />(line 39 minus line 43: indicate + or - balnnce) <br /> <br />o Original <br />o Amendment <br /> <br />o Primary 20_ 0 General 20_ <br />o 1 st Pre-election D 2nd Pre-clcction <br />LOAN SUMMARY <br /> <br />21. Begi1ming OUtstanding Loans <br />(tine 29 of revious re art) <br />22. Loans Received (Non-Exempt) <br />(lhle 2 <br />23. Loans RecelVed (Exempt) <br />line J4) <br />24. LOANS RECEIVED SUBTOTAL <br />(lines 21 + 22 + 23 <br />25. Loan Payments (Non-Exempt) <br />(line <br />26. Loan Payments (Exempt) <br />line 18) <br />27. Forglven Loans <br />(TotallollM forgiven durin this account in eriod) <br />28. LOAN PAYMENT SUBTOTAL <br />lines 25 + 26 +27 <br />29. TOTAL OUTSTANDING LOANS <br />(line 24 minus line 28 <br /> <br />0+0 <br /> <br />+ <br /> <br />'" <br /> <br />'" <br /> <br />PC I <br />Rev, 12/03 <br /> <br />Page 2 of2 <br /> <br />Committee ID Number: <br /> <br />o Other <br />o Post-election <br /> <br />o 20 September Supplemental <br />FOR OFFICE USE ONLY <br /> <br />+ <br /> <br />-t)- <br />-e- <br /> <br />+ <br /> <br /> <br />= <br /> <br /> <br /> <br />'" <br /> <br />= <br /> <br />+ <br /> <br />+ <br /> <br />+ <br /> <br />= <br /> <br />'" <br /> <br />-0-- <br /> <br />" .: <br /> <br />(name of candidate or treasurer), hereby certify that the above <br /> <br />~I, 2-/0)- <br /> <br />Date signed <br />