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<br /> PC 1 <br /> Summary Statement of Contributions and Expenditures Rev. 12/03 <br />Please type or print legibly in black ink. Page 2 of2 <br />Candidate or Political Committee Name: I Committee 10 Number: <br />Andrea Ortiz for City Council N/A <br />D Original D Primary 20_ D General 20~ o Other <br />D Amendment D 1 st Pre-election D 2nd Pre-election D Post-election D 2005 September Supplemental <br /> LOAN SUMMARY FOR OFFICE USE ONLY <br />21. Beginning Outstanding Loans 0.00 <br /> (line 29 of previous report) <br />22. Loans Received (Non-Exempt) 0.00 <br /> (line 2) + <br />23. Loans Received (Exempt) 0.00 <br /> (line 14) + <br />24. LOANS RECEIVED SUBTOTAL 0.00 <br /> (lines 21 + 22 + 23) = <br />25. Loan Payments (Non-Exempt) 0.00 <br /> (line 7) <br />26. Loan Payments (Exempt) + 0.00 <br /> (line 18) <br />27. Forgiven Loans + 0.00 <br /> (Total loans forgiven during this accounting period) <br />28. LOAN PAYMENT SUBTOTAL 0.00 <br /> (lines 25 + 26 +27) = <br />29. TOTAL OUTSTANDING LOANS 0.00 <br /> (line 24 minus line 28) = <br /> PERSONAL EXPENDITURE SUMMARY <br />30. Beginning Outstanding Personal Expenditures 0.00 <br /> (line 36 of previous report) <br />31. Personal Expenditures + 0.00 <br /> (Accounting Period Total from PC 3A) <br />32. PERSONAL EXPENDITURE SUBTOTAL = 0.00 <br /> (lines 30 + 31) <br />33. Personal Expenditure Reimbursements 0.00 <br /> (Total expenditures on PC 3 with purpose code R) <br />34. Forgiven Personal Expenditures + 0.00 <br /> (Total personal expenditures forgiven this acctg. period) <br />35. REIMBURSEMENT SUBTOTAL = 0.00 <br /> (lines 33 + 34) <br />36. OUTSTANDING PERSONAL EXPENDITURES 0.00 <br /> (line 32 minus line 35) = <br /> FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD <br />37. Ending Cash Balance 278.02 <br /> (line 20) <br />38. Accounts Receivable + 0.00 RECEIVED <br /> (Accounting Period Total from PC 5) <br />39. SUBTOTAL = 278.02 <br /> (lines 37 + 38) SEp 2 0 2005 <br />40. Total Outstanding Loans 0.00 <br /> (line 29) CITY RECORDER <br />41. Outstanding Personal Expenditures + 0.00 <br /> (line 36) <br />42. Accounts Payable 0.00 <br /> (Accounting Period Total from PC 6) + <br />43. SUBTOTAL = 0.00 <br /> (lines 40 + 41 + 42) <br />44. BALANCEIDEFICIT = 278.02 <br /> (line 39 minus line 43: indicate + or - balance) <br />I, Tamara E. Miller (name of candidate or 6derebY certify that the above <br />statement and the attached supporting reports"are true and correct. <br /> ~ Dalo '~n'~ rh <br /> ~ 'T U\ <br /> .7" , <br />Signature of candidat(Qr treasur~ <br /> - <br />