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<br />SEP-12-2005 07:38 PM <br /> <br />P.04 <br /> <br />c............'..........<I <br />I <br /> <br />Cash Expenditures and Loan Payments <br /> <br />, <br /> <br />pcl <br />Rev. 12/03 <br /> <br />- <br />':"1' f Idilh~ or Political CommiUI~e Name: <br />e J A--N"J<A <br /> <br />. ) (I:-P <br /> <br />fvt. Ctl~dJ/~lV!:ft <br /> <br />Committee In Number: <br /> <br />Page _~ of ~ <br /> <br />,,11'1,: 0 Primary 20___ 0 General 20 0 Other <br />~. \~ "I!:.____.__ 0 ~t Prc-election 0 2nd Pl"e-election 0 Post-election <br /> <br />I'l I, I'()~.a: (Om'~S (~ee back oftorm for Instructlollll and code definitions) <br /> <br />\ -.:\:Jlt 0 Other Advertising (yard signs, buttons, <.'tc.) <br />I. Ii' .llldc:~sl Advertising (Radio, TV) P Postage <br />'.".1, (\ml1ibutions R Reimbursement for Personal Expenditures <br />r 1Il1dl'alsing Event Expens(:s S Surveys and Polls <br />I ".'/)("1111 Opl.'1'Utiollal E"penst's (describe if over $50) T Travel Expenses (describe i::" over $50) <br />: I ',.-1 ,'~;( Paymell1 U Utilities <br />!. I',\\un', Brnchu1'l~s. Printing W Wages, Salaries, Benefitfl <br />'. "':'l~~l1\en\ Service!; Y Petition Circulators <br />I \..- ~f~:~paper and Other Periodical A.dvertising Z Preparation and Production of Advertising <br /> <br />, Payea's Name and Payee's Committee /00, <br />. ." U'Ile Check # if applicable PUf/;OS9 Exp, <br />, (as it appears On invoice, receIpt or check) Type <br /> <br />~20 orSeptembeJ Supplemental <br /> <br />EXPENDI1'UkE TYPES <br />CA Cash <br />LP LO~tn Payment <br /> <br />Amourt of <br />Ex~mditure <br /> <br />li1 <br />Paid <br />toM <br /> <br />''':/,. /0' .r- <br />, , . 1 <br />! <br /> <br />25' <br /> <br />(J )/tN # {'V^ Cv,yNIJ1JI"~ <br /> <br />c <br /> <br />CA' <br /> <br />$ jJ';~ 6r D <br /> <br />-l{'r <br />. '~r-; II ( -r~ <br /> <br /> <br /> <br />$ <br /> <br />o <br /> <br />.....w......._~""'....__ <br /> <br />2' <br /> <br />'7Cf-(-Of/fNtll- <br /> <br />i- (J .11-^ <br />fL' / "IIt1 <br /> <br />,\ <br /> <br />: 01' / <br />:" jlt/c/- <br /> <br />.... ~...~._._.~- <br /> <br />f(. <br /> <br />L{J $ /I ;'f-9. t 0 <br /> $ 0 <br /> $ 0 <br /> $ 0 <br /> $ D <br /> $ 0 <br /> $ 0 <br /> <br />" <br />\ <br /> <br />. !.... ~~_.._-- <br /> <br />iJ. <br /> <br />J <br /> <br />I <br />J <br />I <br />! <br />t <br />I <br />I <br />\ <br />\ <br />, <br /> <br />. . ..~._.,_...._--_.- <br /> <br />i <br />i <br />. ~....- ------ <br /> <br />~ i: L <br /> <br />I-age Totals (Add all expenditures with the same <br />expenditure typ~,) lQ~ 7 . uy <br /> <br />Cash (CA)~ $ <br /> <br />Loan Payment (LP) $ <br /> <br /> <br />Accounting Period Totals (Complete o111y for last page and <br />transfer these amounts to the Summary Statcmc:nt, PC I.) <br />Q/ ()OS- <br />'Cash (CA) ]I 1. $ <br /> <br />~:';;~='ittar~nl. r;lnm;; ~116 . fr <br /> <br />Loan Payment (LP) $'"- <br />enter on SUlhtnoty S~lt, Column A, Uno 7 <br /> <br />]'~ <br />, <br /> <br />. ;' .11:, !lnl1..~ <br />...,1<",-:1. and <br />, . ii' \ :'~\I M-l~ <br />II idlh.~\:' <br />-- 1.1~lIlal <br /> <br />,'\ . .\ <br />