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Commonwealth of Pennsylvania
CAMPAIGN FINANCE REPORT PAGE 1 OF(COVER PAGE)
(NOTE: This report must bs clear and legible. It may be typed or printed In blue or black ink.)
Filar IdentificationNumber:
of flltno Commit!**, Candidate or Lobbytl:
of S<&h .SU**1
City:
//'*/ '
Zip Coda:
TYPE OFREPORT
(place X tothe right ofreport typo) X
N«m« ol Offloa Sought by C«ndldil»:
.'•• POSY
Pg.JOr ' ! ';TERMtMXffbl**>
DATE OP ELECTIONMO.
Numb*rOlfic P«rty
Cod*
(SEE INSTRUCTIONS FOR CODFSI
Summary of Receiptsand Expenditures from: £013
DAV
To
A. Amount Brought Forward Frnm Last Report
3. Total Monetary Contributions *nd Receipts (From Schedule 1}
C. Total Funds Available (Sum of Lines A *nd B)
>, Total Expenditures (From Schedule III)
E. Ending C»sh Balance (Sublncl Line D from Line C)
:. Value of In-Kind Contributions Received (From Schedule II)
i. Unpaid Debts and Obligations (From Schedule IV)
30-seCO
-&x -D
;oo c.0
CO
ffiffiggfoj^e^fffi^^I »w**f lor affirm) th«l lhl> r«po/(, including lha utachad ichadul**, on p«per or compulir dltkatte, *r» to 1h* bin o( my knowledge «nd b«IUI iru*,cornet »nd completo.
My eommlttlon explM O . D A Y D»yt!m* T«l*phone Numbir
J8B»CTP^I *w*»r lor alflrm} th*l 1o 1h* b»»l of my knowtadgv ind belief thlt politic*! eommltt** ha* not vfol»t*d iny-proviilon* ol lha Act of Juna 3, 1937-.t. 133.1, NO. 3201 .. .m«,d.d. COMMONW£ALTH OF PENNSYLVANIASworn to *nd iubtcrlb*d before rne IM>
f?T.4^-
Notarial SealDiagnaplLUb, Nfctary PublifrfrtrAHidflrai Mnrl-nnmaru rAinJ^J1oi gomery
My Commission Expire ; March 16,-*-»^aj M ••...-—_ _i'.!^"
BfffiyEHNSYLVANI* ASSgCIATION OF NOT
My oonwnl**lon
Department of State • Bureau of Commisftions, Elections and Legislation210 North Office Building • Harrl&burg, PA 17120-0029 • (717)787-5280
DSEB-S03 17-99)
SCHEDULE I
CONTRIBUTIONS AND RECEIPTSDetailed Summary Paga
PAGE z OF
INftme of FIHnfl Committee or Candidate
frwnte &jr 5o?h
Reporting Period
From
reriofl -i t i
/ / / / !» T./3fefyk3
TOTAL for the Reporting Period$
C* 9S
ISContributions
All
Received
Other Contributions
from
(Part
Political
B)
Committees
TOTAL for
$fBS§
(Part A)
the Reporting Period (2)
T '.TAtkMJfcVT iLBfcjIwe•t' flfiSJSSa***
* *i$o.oo* MrfW.OO
$/i1. 4 1 ' oo
Contributions Received from Political Committees (Part C)
All Other Contributions (Part D)
TOTAL for the Reporting Period (31
. 00
$ 3-7^300.. 00
I-T3i-.aV * dfft?7™^5^> -'," , |t t J. .^^ifK-Vi^-i r- ifllf?-^WW^^?ii£rW
TOTAL for the Reporting Period (4)
TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURINGTHIS REPORTING PERIOD (Add and enter amount totals fromBoxes 1 , 2, 3 and 4; also enter this amount on Page 1, ReportCover Pago, Item B.)
$ .60
DSEB-502 17-89)
PAGE OFPART A
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEES$50.01 TO $250.00
Use this Part to Itemize only contributions received from political committeeswith an aggregate value from $30.01 to $250.00 In the reporting period.
Name of Filing Committee or Candidate
ofReporting Perjod
From 1
Perk
hiDATE AMOUNT
Full Nama of Contributing Commit!*
MgrEATC
/=*?.QV
Mailing Additit
aM33/?ffcl 5^—_— IP <U w luiiiIT?*ti7TMFull Nama of CoMrlbutlnp Commhtaa
(t.flwsvl^a^ia U/^ k/ /yoJ Cvwnfftfe $
Full Ntm* of
Mailing Addrast$
Zip Coda (Piu, 4}
Full Nam« of CoMflbtJno Commlttaa
$MatllnoAddrasso $CITV
Zip C00« (PlUt 4»
ull Nama of Contributing Commlttaa Ki:rio3a KSTCTTiSI M1} V.f ;1SJI
Hailing AVdrVma$
Zip Coda |PiU> 4)City
$
Enter Grand Total of Part A on Schedule I, Detailed Summary Page, Section 2.
DSEB-BOJ (7-99)
PAGE TOTAL
$
PART B PAGE_/|_
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to Itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
Name of Filing Committee or Cindldite
nd** of t&-=A 6Reporting Period
From \
DATE AMOUNT-DAY
CIlyDAY -Y6AJL
Full Nam*, of Contributor
Mailing Address
MO. DAY;$ /QQ.QQ
7 •MO. VEAR.
Zip Cod* (Plut 41 MO. DAY' YEAH
Pull Nama of ConUH^utor
"3>c*. V 1 a ^P-MO.
Mailing Addrati DAY- -
City Zip Code (Pluj 41 YEAR
Full Nam* of Conirlbi/loi -MOr - - -DAY -YSAR-,$
Mailing Addrass YEAR$
ztp coda (Plus 4) OAY
j <£ <?&£>- $Full Nama.ot Contributor Jdfl, . DAY
$ toa.ooMailing A«Ji*«t» MO. DAY EAR
W Zip Coda (Plus 4}1 $
YEAR"MO. DAY
Full Nam« of Conributor
Mall Ing Address
MO; DAY YEAR
MO, DAY:- . YEAR:
ity Zip Coda (Plot 4> MO. YEAR-
$ull N**n* of Conlrlbulor
F.MO.
Mailing AOOro** -MO. DAV '
city zip Coda (Plus 41 DAY
$PAGE TOTAL
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
DSEB-607 (7-99)
$ l&'&.oc)
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to itemize alt other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
Name of Piling Committee or Candidate
fReporting Period
From MJ//3 To i
DATE AMOUNTFull Nome of Contributor
$ c?DMtTiirfg Address
$Cfty zip co« plus 4)
$Full Narne^of $
$
CTty Zip coce (Plus $Full Name ol Contributor
$ 2SO-&0Milling Address
uJ. t$ $city Zip COO* (PltU 4)
$Full Nam* of Comribu*'m35m $
$
city
$
Foil Nwn* of Comributor
City Zip coot {Plus 4)
$$
ZIP coat (Ptus 4)
$Full Name of Contributor "
<rta nWuti llna
4O $City Zip Coat (Plus 41
$Full
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
PAGE TOT**
$ 1/00DSEB-502 C7-99)
PAGEPART B
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
OF
Name of Filing Committee or Candidate Reporting Period
From ////O To
DATE AMOUNTFull DAY-
Clly Zip Cpd« -MO. • PAY" YEAR
$
Pull MO. .
PAY YEAR
Full
Win mo Aoorns MO- DAY
City Zip Cod* (Plus <4) "DAY VEAH
$Full ;OAY: l.YEAB'
PAY:-" YEAR:
City Stftrf Zip Coda (Plus 4) DAY YEAfr
$
Full Nam* of Contributor PAY YEAR
"MO. PAY YEAR$
City Zip Coda (Plut 4) PAY
PAGE TOTAL
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
DSE0-S02 (7-9OT
PAGEPART B
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this part to itemize all other contributions with an aggregate value from$50.01 to $250.00 In the reporting period,
(Exclude oontrlbutions from pontloal committees reported In Part A.)
Name of rillrtg Committee or Candidate Heporung penoc
From I To
DATE AMOUNT
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2
OSES-502 (7-991
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part A.)
Nsme of Filing Committee or Candidate Reporting Period
From
DATE AMOUNTFull Name of Contributor
Mailing Address$
city JJ Zip COd« (PIUS A)
$Full Name of Contributor
~Yh*#*i^ -—-— fcpj ^^^sa itMailing Addresf
$Zip coda (Plus 4)
$Full Name of contributor / ,
01*$ 2 T*U/5K / /sr $Mailing Address $City
State up coqe (Pius 4)
$Full Namof Contri
$
Maflins Address $Clty
IJr2lp (.OO* (PIUS Of
$Full rtan* of Contributor
*5Mailing Address
lcr^-7 r W $City , 1 , i
HillZip Code (Plus 4)
$Full Name of Contributor
Ann u)« 5 t OO - O OMailing Address
$city Stata
tZip COS* (Pius 41
$Full Name of Contributor
. at)Mailing Address
1401$
city Zip code (Plus 4]
Full Kama of Contributor,,
coh/oMailing Adoresa
$ ? 50. 0-f)$
Zip COdt (PIUS 4)
PAGE TOTAL
Enter Grand Total of Pan B on Schedule 1, Detailed Summary Page, Section 2. $DSEB-SO2 (7-991
ALL OTHER CONTRIBUTIONS$50.01 TO $280.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
{Exclude contributions from political committees reported in Part A.)
Name of Filing Committee or Candidate
ofReporting Period,
From
DATE AMOUNTFull Name of Contributor
$
Mailing Address
$City Zip code (Plus 4)
$Full Name of Contributor" $
Address
$City State Zfp COM (Plus 4)
$
$City Zip tone (Pius «J
$
Fult Nam* of CenulbutorV
Mailing $City
\zip coat (Pius
$Full Name of Contributor
Mailing Address
H $cfty Zip COte (PIUS 4)
$Full Name of Comrlbuttor
rfMaTTTng
f\j I $city Zip code (Plus A)
$Full Name of Contributor
Melting Address
o $Ctty zip cfloe IPIUS
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.DSEB-502 (7-99)
PAGE TOTAL,
$
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
RmComnmte Reporting Period,
From ) I) I )?) Tol
DATE AMOUNT
$City Zip C<M« (PIUS 4)
$Full of Contributor
$MatUng 4 \
city ip cooa (Pius 4)
$Full NMM
Mailing
Con^Aoki7c/6fl^) $
City zip code ,(PIUS A)
$Poll Nam* of Contributor ,
1/9. 6erar- d $Malting
$ /oo.ooCity Zip COO* (PIUS 4)
Full Name of Contrll
$City
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
PAGE T9TAL
* -1350
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part A.)
Name of RHng Committee or Reporting rertoo
From V ] V M IS To/
DATE AMOUNT
Full Nam* of Contributor$
Walling $City .
1300-7- $Full Nam* of Contributor
Malting$
crty
-Aip coo* IPIU* 4)
$Full Name of Contributor
MalTtng
3T1$
Ctty Zip Cod* (PIUS 4)
$Full of Contributor
c*oi-e\g n
city Zip code (Plus 4)
$Fall Nvme of Contributor./
*Mailing
$CRy 'tR*6. Z*P Code (Plus 4)
Full HMM of$
a $
Clfy Zip Code (Plus 41
$Full turn* of Comrlbmor
.._."nMilling
^aaajp^ \
Ztp COdt (PIUS
$Full
nil$
city - Zip COOt APIUS 4)
$PAGE TOTAL
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
ALL OTHER CONTRIBUTIONS$50.01 TO $250.00
Use this Part to Itemize all other contributions with an aggregate value from$50.01 to $230.00 In the reporting period.
(Exclude contributions from political committees reported in Part A.)
Name of Filing Committee or neponing
From _
renoi
\\\o
DATE AMOUNT
Full Nam* «* Conutbutor
in.«awa»*»»
MaWny Attdret*
City
$zip COM &»iu» 4)
$Full Nam* of Contributor
ft-stSB3£&& BBBSBHii BBBHSMB
$Bulling A
$lip Coda (Plus 4)' ^3S?:cfiy ts $
Full N Contributor
M»iung $Zip Cod* (PIUC 4)
\°; i a.1*- $Full Name of Contributor
Ntalllng A$
Zfp Code (Plus 4}
Full of Contributor ,/,
H * UMailing AMrou
Ctty zip cad« (Pius 4t
/Sf 9^ -^SSE^S E90Sa
Full Name of Contributor /i ,
r.^Qfiim BeSBIBB
$
CT $Full Nairn of Contri
flnr. fcbv * /CO$
Zip Code IPlus 4)
$Full Name of Cemrlbutor
WQ$
Zip 6«<f* (•!«» 41 mama m&mctty$
PA<iE TOTAL
Enter Grand Total of Part B on Schedule 1, Detailed Summary Page, Section 2. $
ALL OTHER CONTRIBUTIONS$50.01 TO $260.00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 in the reporting period.
(Exclude oontributtons from political committees reported In Part A.)
Name of Rung Committee or Candidate
ofneporung renqa
From _
DATE AMOUNT
Enter Grand Total of Part B on Schedule I, Detailed Summary
ALL OTHER CONTRIBUTIONS$50.01 TO $250,00
Use this Part to itemize all other contributions with an aggregate value from$50.01 to $250.00 In the reporting period.
(Exclude contributions from political committees reported in Part A.)
Name of riling or Candidate
ofReporting Period
From
DATE AMOUNT
Enter Grand Total of Part B on Schedule I, Detailed Summary Page, Section 2.
/ -ifPARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
of
PARTS
All Other Contributions$50.01 TO $250
Use this Part to Itemize alt other contributions with an aggregate value from$50.01 TO $250 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 En the reporting period.
(Exclude contributions from political committees reported In Part A.)
of T
PARTS
All Other Contributions$50,01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
0 O £ A
'
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
& To <:
'ItpPARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
\\OO
PARTS
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
*? of
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
A
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
& f To-^X
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 in the reporting period.
(Exclude contributions from political committees reported In Part A.)
g>-f-
PARTS
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period,
(Exclude contributions from political committees reported In Part A.)
PARTB
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contributions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
o f
PARTS
All Other Contributions$50.01 TO $250
Use this Part to Itemize all other contrfbutions with an aggregate value from$50.01 TO $250 In the reporting period.
(Exclude contributions from political committees reported In Part A.)
PAGE
PART C
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this Part to Itemize only contributions received from political committeeswith an aggregate value over $250.00 in the reporting period.
9f
Name of Filing Committee or Candidate Reporting Period
f i l l IFrom s To/j£MiDATE AMOUNT
Full Nam* of Contributing Committv* /? j/i
•rwo^eu Ktet'ur rftt-Mailing A<fitr**s ' / "
Hoo /Zip Code (Nut 4)
Full Nam* o( ContrlbutloB. CorWAltt**
$Maing AiMr««
$City Zip Cod* (Plu* 4)
Full (ton* of Contributing Commit!**
Mailing Add r« si/ooo
CTty*
$Zip Coda (Pli» 4)
A/ $Full Namfof Contributing Commit t»»
$Zip Cod* (Plus 4)
19/0 1 -Full Nam* of Contributing ComrnUU*
*
ZIp"Cod« iPlus 4)
$
$Full N*m* of Comrlbutlng Commltt**
1 140 £ Juca /Mailing A*Jr«s*
M,Cltv Zip Cod* (PluB 4)$
Full N*m» of ContrlbuttnjKCommlltaa
/3 $ 1000- OQaling Addr*»
Cod* IPIUI 4)
2-ull Nkm* of Contributing Commit!**
*fllng
Zip Cod* (Plu* 41
$
$PAGE TOTAL
Enter Grand Total of Part C on Schedule 1, Detailed Summary Page, Section 3,
DSEB-502 (7-99)
PAGE OFPART C
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this Part to Itemize only contributions received from political committeeswith an aggregate value over $250.00 In the reporting period.
9f
Name of Filing Committee or Candidate
ofReporting Peered.
From / // / / "*> To'
DATE AMOUNTFull
lyf~U /x^C-ffXsUTno Add.
Com MOi -DAY
Maiing A*f<tr«««~100
MO. - bAV YEAR:
\($
Zip Coda (Plus 4) MO. DAY, VEAH
Full Nam* of Contributing CommHt**ting Comm
P/KLMO; >- £,; DAY:
Mailing Ad0r*ts MO, YeAft "
c"vStftt* Zip Coo* (Plu* 41 -MO. DAY:
$Full Nam* of Contributing Commit!** MO. DAY
JSMailing Add rot. 'MO.
11 at 1?)c»y Stat*. Zip Corf* (Ptut 4) MO.- DAY YEAfl
$Fvll Namp of Contr)buil*P
IAd
ltim MQ. DAY YEAR
r* $Miffing Addr*«« DAY
city Zip Cod* IPIu* 4)
r?m -•DAY- -YEAR
$Full N«nw of Contributing ComnWjee
o?MO. YEAR
Mailing Addr*><
CTty
-Md. -YEAR $Zip Cod« (Ptu> 4) -Mb. DAY YEAR $
Full ibuting Comm
o f "MO. h DAY YEAH
/C,M.I ling Addr**»
State I Zip Cod* (Plui At
DAY YBAfl-
Y •MO. , YEAR $Full H|m« of Contt
.ftn?w*nailing Addr»s>
Full H|<n« of ContitfMitlna Commit t**
iMO. ' V DAY
Enter Grand Total of Part C on Schedule I, Detailed Summary Page, Section 3,
PAGE TOTAL
D5EB-5O2 t7-99)
PART C .— feZ^!
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this.Part to Itemize only, contributions received from political commineeswith an aggregate value over $250.00 in the-reporting.period.
Nama of Filing Committee or Candidate Reporting Period
From To
DATE AMOI»WTF«lt Name Off Contributing
Full NMM of Contrib
_Mailing Addmi«
Nam* of Contributing Commit***
^ •Address
ull Nem« of contributing Committee
Fuli Nwn*' of Contrlbut.
ull Name of Contrlbutlno Commm
nter Grand Total of Part C on Schedule I, Detailed Summer"1
PAGE OFPART C
CONTRIBUTIOIMS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this Part to Itemize only contributions received from political committeeswith an aggregate value over $250.00 In the reporting period.
Name of Filing Committee or Candidate Reporting Period
From To
DATE AMOUNT
Full N* g Committee MO; 'DAY ' YEAR;
Mailing Addr«*3 MO. .1 DAV; YEAR
At?Sl Zip Coda (Plut 4) MO. =OA¥ $
Full Nama at Contflbirttng Commltt* MO. WEAR •
-*?a n g A«dr*.» MO. r-DAV YE Aft $
Zip UOO* V\Ut 4) MO, • DAY YEAR
Full Nam* of ConlilbutAig Commit!** MOi DAY YEAR-
ailing Adtfr*33 MO. YEAR.$
City
rr&wfar oT Con tf 1 bulMo
Zip C0d» (PIUI 4) MO. DAY YEAR'$
Commlu**
f
MO; •OAV-
a $«-««*-*•«• MO.. .-DAY
City Zip Coda (Pius 4) -MO. OAV -YEAH $Full N»mr,*iLCpnlflbutlng Commllt«e
Making Address
DAY : YEAR '
±1
cTiy
MO,- PAY^ YEAR
Zip Cod* (Plui 4)£CL
$:MO. DAY-.
$Full Nam* of Contributing CommlltM MO. DAY YEAR
/3Maing Address MO.': DAY
tod. (Plus 41 MO. DAY YEAR -
Full Name of Contributing Cammttt**
Mailing AcfdrW
5<2:
• Sfajy^MO. DAY YEARV
MO. DAY; ••YEAR
City Zip COO* IPIU» 4) MO, YEAR:
Full Nam* of Contributing Commit U MO. DAY
$Maiing Adtfias* MO. DAY YEAH:
\ yZip cod* (Plu* 4}
-loo g- MO.- DAY- -YEAR $
Enter Grand Total of Part C on Schedule I,
DSEO-B02 (7-99)
Detailed Summary Page, Section 3.
PAGE TOTAL
$
PART C^7 *j^ **•
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this Part to Itomfze only- contributions received from political commineeswith an aggregate value over $250.00 in the-reporting period.
tome of Filing Commrttee or Candidate
f"Reporting Period
From I I n \t? To J3DATE AMOUNT
Full N*mft Of Contributing C«nmm««
Mailing AOdrt**
Zip Cod* Ipfut 4}
Full Nwn« of Contrlbullnfi Committee
>cfMailing AdOreSS
Zip Code {Flux 4)
kip Code Plus 4)
ull Mam* of Contributing C«nmlH«p
PAGE TOTAt
nter Grand Total of Part C on Schedule I, Detailed Summary P«a«
PART C --^L
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEESOVER $250.00
Use this.Part to Itemize only- contributions received from politioal committeeswith an aggregate value over $250.00 in the .reporting. period.
Name of Filing Committee or Candidate
of"Reporting Period
From To
DATE AMOUNT
Full Nam* of Contributing Committ** '
Mailing aovss
CltvZip Cod* (Plus
$
Full Name of Conttltnnlna Committee
tfttM Safer n $Mailing A0or*»
City Zip Cod* (Pluc 41
$Full N«n« Comroltt**. " >,"
*Mailing Address
SWta Zip Cod« (Plus 4f $:ul N«ma of Contributing Commin»n
$
$Zip Code (Plus 4)
$Full Nam« of Contributing Committeeom
lMailing Addrax*
$Stale Zip Code [Plus 41
$ull Neme'of contributlna
MaiHiig Address
m &***- Tf7=K B/W . $p oda *ius 4)
$Full ftona of Contributing Commltt**
Mail I f ' Address
aState. Zip Code (Plus 4T
$Tull N*mtt of Contributing
flailing
$Zip C*da U»I» 41
$PAGE TOTAT
nter Grand Total of Part C on Schedule I, Detailed Summarv Pnrm R,,r+t«^ ^
PARTC
Contributions Received From Political CommitteesOver $250.00
Use this Part to Itemize only contributions received from Political Committeeswith an aggregate value over $250.00 In the reporting period.
of
mwmimtmm
-TinckK8teH
SPfirt1, \
PART D
ALL OTHER CONTRIBUTIONSPAGE OF
OVER $250.00Use this Part to Itemize all other contributions with an aggregate value of
over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C.)
Name of Filing Committee or Candidate Reporting PeriodkuiFrom I]
DATE AMOUNT
Full Name of Contrl$
Mailing; Add reii
w Stal« Zip Coda (Plut 4)
Employer Nama
Erfiptoyar Mailing AddreVi(Principal Place of Bustnes*
Oeoupatton
Full Name of Contributor \($ ur $ £000Mailing Adoreia -Mo* 71
$
State Zip Code IPIu» 4}
Employer Nam* Occupation
Employer Mclllng A<fdra*mf principal Plac* of Butincn
Employer Mailing Addr*s/prlnctp»l Place of Bu*ln«
Full Nam*/ of CfiHIbutor $Mailing Addr.** 'MO;. -.Y6AB.-*! $City
I
Zip Code (Plus 4)$
Employer Name
^nptoyer Milling Addrets/Prlnclpel Planar/of Bu«fi)es«
Occupation
Employer Mailing Addr>*t/P(tnolpV Plao« of ButIrM>»
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3.DSEB-502 (7-M)
., i^ _-, .* 0(VtOuU
PART D
ALL OTHER CONTRIBUTIONSPAGE OF
OVER $250,00Use this Part to Itemize all other contributions with an aggregate value of
over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C.)
Name of Filing Committee or Candidate
of ^o^HReporting Period
From To
DATE AMOUNTFull Nema of Contrlbgtor MO/
$ 060. 0VMailing Addrcts
~P/~-Mh. 'DAY-' YfSAR
SteU Zip Coda iplut 4) MO. bAY- YEAR
$Employer Name Occupei Ion
Employer Mailing AddrvcifPrlnclpal Place of Business
Full Name of Contributor t- MO.
22.DAV YE Aft
Mailing Address MO.
City Zip Code (Plu» 41
Woo*}-MO. DAY.. YEAR
Employer Nam* Occupation
Employer Mailing AddrassfPrincipat Placa of Buslno*
Full Name of Contributor MO. - PAY--- YEAR
Mailing Address MO. PAY YEAR
$City Zip Cod* (Plul 4) _Mfii :OAY YfiAR:.
:mploy«r Nam* Occupation
Employer Mailing Addr*is/Prinolpal Place of Buv1n««»
Full Hmte ol Contributor MO. DAY YEAR
Meillng MO. DAY- YEAR$
VilleAOi/aSlat Zip Code (Plus 4) MO. DAY- .YEAH
Employer Nam« Oocupatton
:mployw Mailing Addr*i»JPrlnelpal Place oTBu*lne»*
Full Nam* of Contributor MO. DAY YEAH$ O O
Malting Addr**s MO. - DAY ••YEAR $Zip Cod* (Plui 4) MO. VDAY YEAR $
InXpToyM Nam»7
Emptoyer MVuing AddreeafPrlnolpM Piece of Business
F AEnter Grand Total of Part D on Schedule I,
OS6B-502 (7-9fl)
Detailed Summary Page, Section 3. 1 A^ -«^
PAGEPART D
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to Itemize all other contributions with an aggregate value ofover $250.00 In the reporting period.
(Exclude contributions from political committees reported In Part C.)Name of Filing Committee or Candidate
ofReporting Period
From To
PATE AMOUNT
Full Nam* of Coniflbutjr,
/-.MfY DAV " "YEAR
Mailin SJ \. Mn. •DAY
cTTy$
Zip Code (flu* 4) MO. DAY
Employer Nam* Occupa
Employer Mailing Add(**«fPrincipal Plan* ol Builneit
Sf -&AJFI. f hi Id,MO. :— DAY YEAR
OMailing Address -~
/fo>-MO.- YEAR:
$Zip Cod* (Plu« 4)
190/0 -MO. DAY YEAfl'
Employer Name Occupation
Employe AdduiafPrmelpal Plae* of Bus In* nal Plae* of Bus In*
ute r/-Full Ntma of Contributor MO, DAY
A<Mres* .MO. DAY YEAR:
Zip Code (Plus 4»Jl
CTfT
3
MO. DAY YEAR_-$
Employer Occupation
mployor Mciling Addf*i*fPrtnclp«l Pl««* ol Bu*in«»*
, P-4-Full Ham* ol Contributor' DAY YfiAR
Add.*»
JtoaC?MO. DAV,, YEAR
Zip Cod* (Plui 4)rt? $
DAY-
Emloyer N»me
EmployBi MBllIng Addr«««/Prlnelpel PlaQ* of Buitn»»i
;ull Nwn* of Contribu MO. DAY
7
YEAR
MO, DAY 'YgAJI-
19Zip Cade (Plus 4) MO. - DAY YEAR
$Occupation
•mplovor M*iung AddrefsTPrlnolpal Ploco ouBusin*ss
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3DSEB-SOa (7-99)
IPAGE TOTA'. 1 Q ,
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)| Name of Filing Committee or Candidate
of :Reporting Period
From To
DATE AMOUNTFull Name of Contributor
$ SffO.OOMailing Address $City Zip Code (Plus 4}
tttffa ~ $Employer Na .
-\nEmployer Malting Address/Principal Place of Business
r NMailing Address ,') ffytfr
State Zip Cod* (Plus 4)
Employer Nome
Employer Place of Business
Full Name of Contributor
fMilling Addr**» $city .
Phkctt IphZip Codt (Plus 4) $
Employer Name Occupation
Employer Mailing Address/Principal Place of Business
Full Name of Contributor
7 $ 1000.0*0Matting Address $Cit r/ Zip Cods (Plus 4) $Employer Name Occupatio
Employer Mailing Address /Principal Piece of Business
Full Name of Contri
$Mailing Address , ,
de (Plus 4} $employer Name
At(
Employer Mailing Address/Principal Place of Business
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3. I PAGE TOT*'
$
PART DALL OTHER CONTRIBUTIONS
PAGE OF
OVER $250,00Use this Part to Itemize all other contributions with an aggregate value of
over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C.)
Name of Filing Committee or Candidate
*:* of :Te»v/("Reporting Period
From 1 l l *> To
DATE AMOUNT
Full Nam* of Contributor j*
Kfinon 1 *}la.usMO.-
Mailing Addres*-zoosrrhs-MMb. DAY
U-ZJp Cod* (Plu* 4) MO. DAY
Employer Name Occupation
Employer Mailing Adth*ciJPrlnclpal Place of Bui(n*t*
Full Contribute* MO; - DAY YEAR
Milling Addrei : MO.- DAY. ; YEAft :
city , 'Zip Code (P!u« MO, DAY YEAR-'
$Emoloyar
CohenOccupation
Employer p*l Pl»ce of Busi _ . _
i*-, fit j?/£>3>Pull Nimo of Contributo
r^^— >
1 •MO;.- DAY YEAR
Mailing Addr«it
£-510MO.; DAY:- YEAR
Zip Cod* (Ptui 4) -Mb. DAY YEAR $Emoyef Nam*pjoyef Occupation
Employer Malting Xddr*s«/PrinaIpaLPIaoe of Bu*tna»i
Full N MO. DAY-.
Mailing Addran MO. DAY i YEAR$
"*Zip Code (Plus 4} M0n DAY--,
$Employer Nam* 0«cupatlon
Employor Malline Addr«i>JPrlnclpal Placa of Bualnect
Nam* of Contributor MO... DAY YEAR
Mailing AdiJr««« MO, DAY vYEAR $City m Zip Code iPlus 4)
£>&!)£>[>MO. -. DAY
$Emplowir Nam*
Employer Melting AddfetsfPrlnolpal PUcf of Boi
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3.OSEB-602 <7-d9)
.^j /^/vi
ALL OTHER CONTRIBUTIONSOVER $260.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate Reporting Period
From
DATE AMOUNTFull Name of Contribut
Mailing Address.
c»r St«t Zip Code Plus 4>
$Employer Name
Employer Mailing Address/Principal Place of Business
Full Name of Contributor
$ tVQO.OOMailing Address
4City swe Zip Codt (PlUS 4)
$Employer
Employer Ma
1ling Address7princij(at. Place of Business
Full Name of Contrlbut'Contributcar; To/7 3-
Milling Address
fat- $city
FLZip COdl tPIU» 4)
$imployer Name Oceuiwtlon
Employer Mailing Address/Principal Place of Business
Full Name of ConuWbuar
•3)3 1/ i $Mailing Address ILame $
cityZip Code {Plus 4}
$Employer N«me Oeoupatlon
Employer fflallUM AddrenfPrlneipal Piece of Business
Full Name of Contributor
$Mailing Address
City State Zip Codl (Plus 4}$
Employer Name
"Tr/o/oOccupaton
Employer Mailing Address/PrinWpal Place o! Business (/
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3. -<L(rfrf}
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize alt other contributions with an aggregate value ofover $280.00 In the reporting period.
(Exclude contributions from political committees reported (n Part C.)Name of Filing Committee or Candidate
ofReporting Period
./From J To
DATE AMOUNTFull Name of Contributor
Mailing Address
$Ztp Cod* (Plu» 4)
$Employer Name
Employer Mailing AddressJPrincioal Place of Business
Full Name of Comtlbutor
Mailing Address itfoe/fa $
MlZip Cod* (PIUS 4}
$Employer Nwn*
Employer Mailing Address/Principal Place of Business
fOKnn bW Ck.**, . PS)Fall Name of contrUunor $Mtillng Addressng Address f\ 1
)i fltitui^ Wund 73. bfe $City zip coda (Pius 4) $Employer Name
Employer Malting Address/Principal Place of Business
Full Name of Contributor
/•*> $Mailing Address
$State
frZip Code {Plus 4}
$Emloyer Namecmpwyvr name • » / I f
Qei'pVQ^ vwta. g ftwaeetatJEmployer Mailing AgdressfPrinclpat Place ot.6uslness
Occupation
Full Name of Contributor
Milling Address $city Zip Coda (Plus 4} $Employer
•d?rame Occupaton
Employer Mailing AddressfPrincipat Plvee of Business
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3.IP AGE TOT Af
$
ALL UTHER UONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributfons from political committees reported in Part C.)Name of Filing Committee or Candidate eporting
From '
eriod
ToDATE AMOUNT
Employer Mailing Address/PrlnclpsJ Place of Business
l(*\t fd . fait lib t
Employer Mailing Address/Principal Place of Business
Full Name of Contributor
1*0 VMailing Address
City Zip Coda (Plus 4)
)6»V7 $Emptoyer Name
Employer Mailing Aooress/Prindftal Place of Business
Si.
Maillng Address
City Zip Code Plus 4)
Employer Nam
Employer WUIHhgAddress/Prtncipai Place of Business
iur7 "JFY^ ^W^ j 6^-730I xF f • * > _l ~
Enter Grand Total of Part D on Schedule I. Detailed Summary Page, Section 3.DSEB-S02 (7-99)
ALL UTHER UONTRIBUTIOIMSOVER $250.00
Use this Part to itemize all other contributions with an aggregate valueover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)
of
Name of Filing Committee or Candidate Reporting Period
From I 11 Jl "*5> To
DATE AMOUNTFull Name of Contributor
Mailing Address
city state Zip Code (Plus~4T
$
$
$Employer Name
6.Employer Mailing AddressfPrincipil Place of Business
'.i "Dr. tWedn ,«
, [AFull Name of Contributors.
iailina Address$
City State Zip Code (Plus 4)
$Employer
Employer Mining Addr««stf*rinojMl Place of Business
6V. t* IQ60S
State Zip Code (Plus At
Employer Mailing Address/Principal Place of Business
Fall Name of Contributor *Mailing Ad
l to $city Zip Code (Plus 4) $Employer Name Occupatt
Employer Mailing Address 01 businecs
Enter Grand Total of Part D on Schedule 1, Detailed Summary Page, Section 3.DSEB-5O2 17-99}
|r*ASEJOt>
$
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to Itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate Reporting Period
From IMADATE AMOUNT
Full torn* of Contributor
S&ulMtiling Address $
State Zip Code (Plus 4)
$Employer Name Occupation
Employer Mailing Address/Principal Place o! Business
Full Name of Contributor
Mailing Address$
City Sute Zip Code (Plus 4)
$Employer Nam.
Employer Mailing Address/Principal Place of Business
Full Nainjk of ^Contributor 'ainjk of Contributor '
Robert \*\/inMttling Address A .
KCftd
PA-Zip Code (Plus 4)
Employer Name
ftEmployw Mailing AddrfiSs/Prinelba! Place of Business
Enter Grand Total of Part D on Schedule 1, Detailed Summary Page, Section 3DSEB-502 f7-S9)
• PAGE TtOTAL
• |$ .gflpp-
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
{Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate
0$Reporting Period
From / // It
DATE AMOUNTFull Name of Contributor
Mailing Address$
C'ty State
PAZip Codi Plus 4}
$Employer Name Occupation
Employer Miling Address/Principal Pl«ee of Business
Full Nwne of Contributor
> ft}* $Mailing Address
$City State Zip Code (Plus 4)
$Employer Name Occupation
Employer Mailing Addresv/PrinelHl Place of Business
Employer Mailing AddressrprinejMl Place of Buslnesi
TrcrinejMl Place
/hi k ,Ftril Name of Contributor
Mailing Address$
Zip Code {Pius 4)$
Employer Name
Employer Mailng AMreatfPrlnslpal Piece of Business
Full of Contributor
$
$Zip Code (Plus 4} $
Employer Name &v]
Employer Mailing Address/Principal Place of Business
0-1 Mo**,, &f Wo/Enter Grand Total of Pan D on Schedule 1, Detailed Summary Page, Section 3.
DSFS-5O2 (7-99)
PAGE TOTAL$
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate valueover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Pan C.)
of
Name of Filing Committee or Candidate Reporting Period /
From / /} // C*> To
DATE AMOUNTFuji Nam* of Contributor
Mailing Address ,
/%// n sZip Code (Plus 4}
VS" $Employer Name Occuutioncuut
Employ*! Mailing Addr«ss/Pn lace of Business
Full Name of Contributor
Mailing
40 $City lus 4)
$Employer Name Occupation
Employer Address/Principal Place of Business
Full Name e* contributor
Mailing Address
9,00 o $Zip Codi (Plus 4)
$Employer Name occupation
Employer Mailing Addr«$s/Prineip«l Place of Business
full Name of ComrjHitor
Mailing Address$
Zip Code (Plus 4)$
Employer Name Occupation
Employer Mai Una Address/Principal Place of Business
Full Contributor
Mailing Address
City State Zip Code (Plus
Employer Name
Employer Mailing Address/Principal Place of Business
Enter Grand Total of Part D on Schedule 1, Detailed9 rr-as)
« IP AGE .TOT*?Summary Page, Section 3. I / / 51 —
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate Reporting Period
From
DATE AMOUNTfull Name of Contributor£1 $Mailing Address
City Zip Cod* (Plus 4)
$
$Employer Name
Employer Mailing Address/Pri
Full Name b< Contributor
Mailing Address
ICity State Zip Code (Plus 4)
$Employer Name Oceupatl
Employer Mailng Addres*/PrinolpaJ Business
Full Nam of Contrlbwor^
Mailing Address
fO $Zip Code (Pius 4) $
Employer Name Occupation
Employer Mailing Address/Principal 'Place of Business~Full Name of Contributor
Mailing Address
J o/ ; La $City Zip Code (Plus 4} $Employer Name Occupation
Employer Mailing Addrass/Principal Place of Business
00Full Name of Contributor
Mailing Address
"Zip Code (Plus 4}
Employer Nama
Employer Mailing Addrecsfprlnclpal Place of Business(•II1B9* ,n
10- 0e>Enter Grand Total of Part D on Schedule 1, Detailed Summary Page, Section 3.
PAGE TOT*«
$
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)Nvne of Filing Committee or Candidate Reporting period
From
DATE AMOUNT
Full Name of Contributor
Mailing Address
jg/agCity State Zip Cod« (Plus 41
Employer Name
Employer Majiing Ad*«/Principai Pl«« ol Business
of Comrtbuto
Matting Address / /
fa ncity State tPlus
$Employer Nam*
Employer Maifinfl AddressTPrincJba! Place of/Business
Iff. "Fall Name/of contributor, $Mailing Address
city IZip Code Plus 4}
\Occupation
Eroptoysr Mailing
ftrfl Name of Contributor
MaJling Address
city «e Zip Code (Plus 4)
Employer Name
Employer Mailing AddresslPrineipal Place ol Business
Tu)0Full NMM of CaKtribittor V
Mailing Address
Zip Coda (Plus 4J
Employer Name
Employer Mailing Address/Principal Place ol Btafftess
icn ft\ftrV, TZor 16 fcd CoEnter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3 PAGE TOTAJk
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
{Exclude contributions from political committees reported In Part C.)Name of Filing Committee or Candidate Reporting Period
from l To LDATE AMOUNT
Full Name of Contributor
Moling Addras* ,/} \*
e.Stn* Zip Cod* (PIU* 4>
$Imploye/ Name
Employer aling A4drfts*fPrfnolpai Place of Business
Name of Contributor
$Mailing Address
City Zip Code {Plus 4)
JtffoJ - $Empteytr Oeeupctton
Empoyer Mailing Addren/Prlncipii Plac« of Business
Full Name of Contributor
Mailing Address
8b(o U $Zip Coda"(Pius 4)
$Employer Name
EmoioywM«l!i»grAddress/Principal Place of Business
OecupatloR
Mailing Addrusling, A
70 $Zip Code (Plus
pyf? - $Empl Occupation
ceoIwoToyer" Mailing AoeVftssfPrlncipaT Place of Business _ _ ~ ~ "
U3.iMflytet-c&' U(XV~ \fA 1 ~IHO IFull Name of Contributor
mi&m $t>r i ii iailing Address
$City State Zip Code (Plus 4)
$Employer name
-'ft
eeupauan
Employer Mailing Addrevs/Prlnelpai Place of Btnlnes* (*/
Enter Grand Total of Part p on Schedule 1, Detailed Summary Page, Section 3. IPAGE,TOT"$ /b,etO-rt>
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
{Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate Reporting Period
From ill
AMOUNTRtll Name of Contributor
Mailing Address
$ 10.900. .00City .
111 IISt Zip Code (Plus 4)
Employer Nam*'
Employer Mailing Address/Principal Place of Business
•86Z.n t i
J 1 HvWjdh
Employer Mailing Address/Principal Place of Business
Rill Nvme ot Contr butor
XMilling Addr«*s
Zip Code (Plus 41 $CmplDyw Name'Employer Mailing AtfdressfPrinclDal Place of
RuH Name of Contributor
Mailing Address
city Zip Coda (Plus 4)
$Employer Name
Employer Mailing Addresa/Prlnelpat Place of
t3D ^ -\* - i_
^G>roup
city Zlp.Codc {Plus 4>$
Employer Name
Employer Mailing AddresslPrincipal Place of Businass
EnterPAGF
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate value ofover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)Name of Filing Committee or Candidate Reporting P
From
DATE AMOUNTFull Name of Contributor .
Or hHailing Addres
$Zip Code Flu* 4)
$Employer Namv Occupation
Employer Mailing Addresa/Printtlptl Place o Business
Full Name of Contri
Mailing Address $City Zip Code (Plus 4)
$Employer Name Occupationccupat
mEmployer ailng Address/Principal Place of Business
Full Name of Contributor
Mailing Address
$City Zip Code (Plus 4)
$Employer Name
Employer Mailing Addresprlnclpal Place of Business
Full ibotor
NtaiUng Addres:
]0\city Zip Code (Plus
$Employer Name
Employer ipa
o r lf «v ss M .Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3. IPAGE TOTAL
$ _/0/-7.50-
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate valueover $250.00 in the reporting period.
{Exclude contributions from political committees reported in Part C.)
of
Name of riling Committee or Candidate Reporting Period
From To
DATE AMOUNTFull Name of Contributor . I
AJei C).Mailing Address
(n Iff Al $City State zip code plus 4)
$Employer Name Occupation
Emptoyer Mailing Address/Prlneiparlaeft of Business
Full Name of Comrtbutor'
Mailing Addrass$
City State Zip Code (Plus 4}
$Employer Name Occupation
Einployer MaiUrlg Address/Principal Place of Business X
Full N Contributor
$Mailing Address
$Zip Cods (Plus 4)
$Employer Name Occupation
Employer Mailing AddressfPrinclpBl Place of Business
' W fh
Employer Mailing Address/Principal Place of Business
Full Name: of Contributor
$Address
4??0City Zip Cdi (Plus 4)Cpdi (Pl $Employer Name
Employer Mailing Address/Principal Plac« of Business
Enter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3. PAGE TOTAL
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize al! other contributions with an aggregate valueover $250.00 in the reporting period.
{Exclude contributions from political committees reported in Part C.)
of
Name of Filing Committee or Candidate
tt-f-Reporting Peji
From To
DATE AMOUNTFull Name of Contributor
$iling Address
10 • , $
City State Zip Code (Plus 4)
$Employer Name Oceupstlon
Employer Mailing Addr«ssfPr)netpal Place of Business
Name of Contributor
&*€>. H)Mailing Address $City Zip Code (Plus 4t
$Employer Name Occupation
Employer Malting Addrass/Principal Place of Business
Employer M«umg Aaaressfpftncipai Place ot
full Name of Contributor
Mailing Address
Tdll $city Zip Code (Pius 4)
$Employer Name
Co rOccupation
Employer MalllngAddrevt/PrlneiMl Plage of Business
Full Name of
Mailing Address
fo $city Zip Code (Plus 4} $Employer Name
vc\nEmployer oressnrtneipai fiaea Qt eiainass
Enter Grand Total of Part D on Schedule 1, Detailed Summary Page, Section 3. PAGE TOTAL$ 2500~
ALL OTHER CONTRIBUTIONSOVER $250.00
Use this Part to itemize all other contributions with an aggregate valueover $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)
of
Name of Filing Committee or Candidate
°SReporting Period
From _ To
DATE AMOUNTFull Nam* of Contributor
ML z- $Mailing Address
$Zip Cod> Pius 4)
$Employer Name
Employer Mailing Address/Principal Place of Business i \
Qr>osaFUH Name of
Mailing Address
<9p. r $City Zip Code Plus 4)
$Employer Name Occupctit
n
Full Name of Contributor
Milling Addreas$
Zip Code (PIUS 4>$
Employer .Nam« Occupatio
YEmployer Mailing Addre«s/Prlncrp»l_Plac« of Business
^ 00. i /) .
) i , W ) C>Full Name of Contributor
Mailing Addr«$
Zip Coda (Plus 4f
$Employer Name Occupation
Employer Mailing Address/Principal Place of Business
Full Name of Contributor
mAxMailing Address $City
/^farlf. ft
Zfp Coda (Plus 4} $Employer Na Occupation
Employer Mailing Address/Principal Place of Business
Enter Grand Total of Part D on Schedule 1. Detailed Summary Page, Section 3.? (7-99)
PAGE TOTAL
$
w i ncK WUNTRIBUTIOIMSOVER $250.00
Use this Part to itemize all other contributions with an aggregate valueover $250.00 In the reporting period.
(Exclude contributions from political committees reported in Part C.)
of
Name of Filing Committee or Candidate Reporting Period
From A To
DATE AMOUNTFull Name of Contributor
$ 500, frQMailing Addres*
$Zip Coda {Plus 4)
$Employer Name-
AOccupatoo
Employer Maling Address/Prlnolpal Place Btilneaa
Full Name of Contributor
Mailing AddTM~
Stat Zip Cod* (Plus 4)
Employer
Employer Malltng Addrnv/Prlneipal Business
ull Nami of Contributor
Addra* $*ty Zip Corf* (Plus 4)Zip Corf* (Pl
K/0'7? - $Employar Nam* Oacupation
Employ** Mailng Addr»««PrMwip«l Plaas of
Full Namn of Contributor
1?£>V)f>,/- r 7 . $Mailing Addrai*
$3ity ,
.(/aState Zip Code (Plus 4)
$jnployar N«m«
- \r Mailing Addr«s/f»rlnolp«l n«« of BuaJnes*Occupation
f rrsi
p/5 j
ill Nanw of Contributor
$aimg Addraax
^•37 $State Zip Code (Ptua 4)
Occupation
nloyar cB of Buslncaa
iter Grand Total of Part D on Schedule I, Detailed Summary Page, Section 3.-502 (7-99)
IPAGE TOTAL1
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250,00 fn the reporting period.(Exclude contributions from political committees reported in Part C)
S/a/y Ap
ftk?VW Coze/? d
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
-7000
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 in the reporting period.(Exclude contributions from political committees reported In Part C)
Of '
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.{Exclude contributions from political committees reported in Part C)
of
PARTD
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 in the reporting period.(Exclude contributions from political committees reported In Part C)
of-
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
100O
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
of:
fA/MctW «M<N
PARTD
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 in the reporting period.(Exclude contributions from political committees reported In Part C)
PART D
All Other ContributionsOver $250.00
Use this Part to itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
o f-
\&?O<*f(o
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 in the reporting period.(Exclude contributions from political committees reported in Part C)
of-
£?'
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported in Part C)
of
PARTD
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
of
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
PART D
All Other ContributionsOver $250.00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 In the reporting period.(Exclude contributions from political committees reported In Part C)
of
PART D
All Other ContributionsOver $250,00
Use this Part to Itemize all other contributions with an aggregate value over $250.00 in the reporting period.(Exclude contributions from political committees reported In Part C)
o f'
PART E PAGE
OTHER RECEIPTSREFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC.
Use this Part to report refunds received. Interest earned, returned checks and
prior expenditures that were returned to the filer.
[Name of Filing Committee or Candidate Reporting Per;od
From I il
Full Name
Mailing Address
^EAfl-^lfrfftOunT1City
D.,c,lplfor,
Slat* Zip Cod* (Plui 4) wot$
Full Naroa
Mclltng Addf»s*
0Clty
Zip Code IPluc 4}
P-tote-Receipt D»tcrlptlon
Full Nam*
M*Mtn0 Address
fOZip Cod* (Plut 4)
$
Full Matn
Mailing Address
CItyZip Coda (Plut 4»
FuM
M*lline Addre**
f 0city State Zip Cod* (Plus 4) :.iMQ^
±LReceipt OMcrlptlon
•ull N«m«
olAddr»*«
~»o £ faM^bU^Ztp Cod* (P)u« 4) \i•'••jjjQ?*
I9ooc) - ^^ \0«o«Ipt D«scrlpiion
Enter Grand Total of Part E on Schedule 1, Detailed Summary Page, Section 4.
PAGE TOTAL
$ "7(00 •
OSEB-60? (7-99)
PAGEPART E
OTHER RECEIPTSREFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC.
Use this Part to report refunds received. Interest earned, returned checks andprior expenditures that were returned to the filar.
75" Of^
Name orpiling Committee or Candidate
o-f-Reporting Period
From To
Full Name
Addraft>
SmounT
$
Zip Coda (Plut MQ; PAY
Full N«m«
City State Zip, Code (Plot 4> MO. DAY -YEAR
731 $Rooetpl Description
Full N»mo
Mailing Addr73-77
City
Receipt Description
Zi Code (PIu* 4) MO.:- --'.PAY--'- .Yt-AflL-
Full Name
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City/3"77
Zip Code (Plus 4) MO. PAY- YEAR Amount
$Receipt Description
Full Name
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City
(ecelpt Description
/>-?7State Zip Coda (Plus 4} MO.- •DAY'-;
$
ull Name
dialling Addresa
ToCliy
Description
State
MeZip Code (Plut 4) Mo: DAY
Enter Grand Total of Part E on Schedule I, Detailed Summary Page, Section 4.
PAGE TOTAL
$DSEB-B02 (7-99)
PART E PAGE
OTHER RECEIPTSREFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC.
Use this Part to report refunds received, interest earned, returned checks andprior expenditures that were returned to the filer.
OF
Name of FJlipg Committee or Candidate
ofReporting Pe/iod
To
Full Name
Mailing
R«c«lpt Dnseriptlon
Stvta Zip Cad* (Plus 4) OAV-
$
Full Name
Mailing Addrasa
City St»t* Zip Cod* (Ploi 4) -MO.- DAY YEAR:IAmounT
$ "7Receipt Dascrlplton
Full Namo
ng Address
YE API;.; I Amount'City
Racalpt D*tcription
st«t« Zip Cod* (Plu* 4) MO."
Full Ham*
MB) ling
City
Ra«*lpt D«*Qr1plIon
Stit* Zip Coda (Pluj 4) MO. DAY; YEAR ;.iAmoum
Full Nam*
Cliy Zip Coda (Plu» 4) DAY -YEAR'''I Amount
^^1$
Recftlpl Dfticiiplfon
Full N«ma
Mailing Addraas
IWnounT$
Cily Stat* Zip Coda IPtua 4} MQ. DAY YEAR;
Haeajpi Oaacrlptlon
Enter Grand Total of Part E on Schedule I, Detailed Summary Page, Section 4.
PAGE TOTAL
$ -DSEB-802 (7-99J
SCHEDULE II PAGE OF / y
IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVEDUSE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS
DURING THE REPORTING PERIOD.
Detailed Summary Page
Name of Filing Committee or Candidate
of
Reporting Period
From > To
TOTAL for the Reporting Period (1)
TOTAL for the Reporting Period (2) $
TOTAL for the Reporting Period (3) $I
TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THISREPORTING PERIOD (Add and enter amount totaJs from Boxes 1, 2.and 3; also enter on Page J, Report Cover Paoe, Item F.)
$
DSEB-SD2 (7-99)
SCHEDULE IIPART F
IN-KIND CONTRIBUTIONS RECEIVEDVALUE OF $BO,Ot TO $250.00
Name of Filing Committee or Candidate Reporting PBrf
DATE AMOUNTFull Name of Contributor
Mai Una Address
City
Description of Contribution:
Full Name of Contributor
Mailing Address
City
Detcrlption of Contribution:
Full Name of Contributor
Mailing Address
City
Description of Contribution:
Full Name of Contributor
Mailing Address
City
Description of Contribution;
Full Name of Contributor
falling Address
City
Description of Contribution:
rull Name of Contributor
Mailing Address
City
Description of Contribution:
Stale
State
State
State
Slate
Slat*
Ztp Coda (Plus 4)-
Zip Coda (Plus 4)-
Zip Code (Plus 4)-
Zip Code (Plus 4)-
Zip Cod* (Plus 4)
-
Zip Coda (Plus 4}—
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$
$
$
$
$
$
$
$
$
$
PAGE TOTAL
$
OSEB-50Z (7-99)
SCHEDULE II
PART G
IN-KIND CONTRIBUTIONS RECEIVEDVALUE OVER $250.00
PAGE OF
Name of Filing Committee or Candidate Reporting Period
/ / / /From
DATE AMOUNTFull Nam* of Contributor
Mnl lino Address .
city *^ .'Mill1 1
Employer of Contributor 1
^LoaStBt*
4Zip Cod* (Plus 4)
Employer Mailing AddrcssJPrfnclpal Plat* of Business
Full Name of Contributor
Mailing Address
Cfty Stale Zip Code (Plus 41
Employer of Contributor
Employ*' Mailing Addr*ss/Prlnclpal Place of Business
Full Name of Contributor
Melting Address
City
Employer of. Contributor
Stat* Zip Coif* (Plus 41
Employer Mailing Address /Principal Pl«o* of Business
Full Nam* of Contributor
Mailing Address
city Stat* Zip Code (Plus 4)
;mploy*r of Contributor
Employer Mailing Addrassf Principal Pise• of Dusinaic
Full Nam* of Contributor
Mailing Address
City
employer of Contributor
State Zip Coda {Plus 4)
Employer Mailing Add res *f Principal Place of Business
H
=^Mg,>;- .-?
9U'., ;D'AY^5
-1 -' DAY^'"
|-=KixeAftj1^
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$
$
Occupation
Description of Contribution
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$
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Description of Contribution
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$
Oecupstfon
Description of Contribution
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Description of Contribution
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$
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Occupation
Description of Contribution
PAQE TOTAL
*DSEB-502 17-99)
SCHEDULE 111PAGE OF
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From / / I / I S
To Vrtom Paid .
fflnnwMailing Add
MMirass /
Amount
Deacflptlon of Expunaiiura
Stala
PC.Zip Cod* (Plui 4]
To Whom Paid
(Urn V\fw/">a \~ AmountMailing Addr«» <
¥.00,0City Sta(* Zip Coda (Plut 4)
To Whom Paid Amount
D«icrlptlon of Expenditure
CTty- Zip Cod* IPlua 41
To Whom Paid Amount
Mailing Address
foLJBtcripnon 01 uxptnaitura
Ctty Stal* Zip Coda (Plus 4)
60191 -To Whom Paid
Mailing Addr««a
SI Amount
Detcdptlon of Eypandltur*
CTTy" Zip Coda (Plu* 4)
iwfo -To Whom Paid
Mailing AjjoVea
City
!S Amount
O«*cflptton of £xp«n<mur*
Zfp Coda (Plut 4>
Wool-
Mailing Addr«*a
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n:Jv Amount
Description of Expenditure
Zip Coda (PIui 4)
To Whom Paid
M
CTty Zip Coda (Plus 4}
PAGE TOtAL
$
OSEB-G01 (7-99)
SCHEDULE 111
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From J I/ II?
To Whom Paid
Mailing Address
toDescription of Expenditure
CiiyState Zip Code (Plus 4)
To Whom P«ld
Mailing AddressS
cty Zip Code (Plus 4}
To Whom Paid Amount
$Marling Address Descrpton o xpenonur*
City Zip Code (Plus 4}
To Whom Paid
/M(Amount
$ *\\? *OC>
Mailing Address DeserptOft o xpenonure
_fX
CitvZip Code (Plus 4)
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Mailing Addrass Description of Expenditure
( t y State
PLZip Code plus 4}
To Whom Paid
60mount
Address Description of Expenditure
wty
VW>Y) \e-r~Zip Code (Plus 4}
Description of Expend it ur*
,e Zip Code (Plus 4)
To Whom Paid
Hailing Addrass
foDescription of Expenditure
City n Zip Code (Pius 4)
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$
SCHEDULE 111
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate
of- 'SoReporting Period
From
To Whom Paid
Slate Zip Code (Pius 4)
\l
To Whom Paid
Mailing A
Amount
i
L&M- QHCity Zip Code (Plus 4)
Mtiling Address
City State Zip Code (Plus 4)
To Whom Paid Amount
$Mailing Address ' escription of Expenditure
City State Zip Code (Plus 4)
To Whom Paid Amount
State
ItrZip Code tPluc 4}
To Whom Paid
•Aalllng Address Description of Expenditure
MlZip Code (Plus 4)
To Whom Paid
Mailing AddcKs^• 6
City State Zip Cede (Plus 4)
To Whom Paid
$ )\.64-0.0i)Descrption of Expenoiwre
City Zip Code (Plus 4)
90(9 / -PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
SCHEDULE HI
STATEMENT OF EXPENDITURES
N a m o f Filing Committee or Candidate Reporting Peri
From
To Whom Paid
Mailing Address
Zip Codt, (Plus 4}
To Whom Pai
Mailing Address Description ot fexpenotture
State. Zip Code (Plus 4)
To Whom Paid Amount
SDescription of Expenditure
Zip Code Plus 4}
To Whom Paid
Mailing Address
Stne Zip C«de (Plus 4)
To Whom Paid
Rebecca.Mailing Address
s. s/Dascrptort of txpenaiturc
city Zip Code (Plus 4}
To Whom Paid
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city State Zip Code (Plus 4)
To Whom Paid
Milling Address
St«te Zip Code (Plus 4)
To Whom Paid
Mailing Addres Description of expenditure
Zip Coda (Plus 4)
PACT TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate
ofReporting Pe
From
To Whom Paid
Mailing Address
Amount
fysZip code (Plus 4}Zip code (Pl
I90V&-To Whom Paid
Mailing Address
ft/?- ItM an//** fe<~?City State Zip Code (Plus 4}
To WhomPald
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I Amount_$
Description of Expenditure
Zip Code {Plus 4) sTo Whom P
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Amount$AJUsrUWX Jj
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IOO-OOMailing Addre
City State Zip Code (Plus 4}
To Whom Paid , /\
mm /rr mjMailing Address */• -" /**> r/r^-f
Description of bxpendlture
/city State, Zip Code (Plus 4)
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Motlirig Address
Amount
State
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Malliog Address , 1 A "~7 /"l
L|0 '0Description of Expenditure
' f/»T//Ut/ JCity State Ztp Code (Plus 4)
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. IPAGE TOTAL
$
SCHEDULE III
STATEMENT OF EXPENDITURES
IName of
f
Filing
rWf
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7^-S 0
or Candidate
y ^S~O -S A -^*wt-/V / c ^
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"fcc/ckfState Zip Code (Plus 4)
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Mailing Address Descrption o xpenouur*
Zip Code (Plus 4)
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feAmount
$Malting Address tierption o xscnonurc
City State Zip Cod« (Plus 4>
To Whom Paid
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Description of Expenditure
Slate Zip Code (Plus 4)
333^0-To Whom P*id
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/U7A 0 _.
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rr \-\Z-I Amount
$/ / r " ^ s l f —
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Milling Address
"71 (pDescription of Expenditure
*Zip Code (Plus 4)
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. IPAGE TOTAL
$
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Fifing Committee or Candidate
of-
Reporting Period
From f / / ! / ? > To lfl&
To Whom Paid
Mailing Address\
A 1
/i 7Ctly Zip code (Plus
To Whom Pai
Zip Code Plus 4}
To Whom Paid
Mailing Addrscs/-
j
/Amount
3Zip Code (Plus 4}
To Whom PaidWhom
/IMailing Address
Amount
Description of Expenditure
A*Qfa}A0_City Slate Zip Code Plus 4}
To Whom Paid Amount
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• nDescription of Expenditure
0/7" //££ Gfit'/Ajt ff
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w Zip Code (Plus 4)
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Maitins Address Descrption o Expeneiure
Ci*y /? ,f h
Zip Code (Plus 4)
To Whom Paid Amount
$Mailing Address
-?HPDescription of Expenditure
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IPAGE TOTAL
$ Qinq
SCHEDULE 111
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From llll/?> To
To Whom Paid
A*Mailing Adress .
5r,escrpton o
City Zip Cod* (Pltw 4)
To Whom Paid
Mailing Address
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To Whom Pal
Mailing Address nscrpion o xpenouure
City Stats Zip Code {Plus 4)
To Whom Paid Amount
Mailing Address
"7|U - H1Description of Eimnditure
City Stater/t
Zip Code (Plus 4)
To Whom Paid
=wI Amount
$ .f&Address
1(005
escription of Expenonure
Str Slate ZIP Code (Plus 4J
To Whom Paid
Mailing Address
«ty ' '
Description of Expenditure
£Zip Code (Pius 4t
To Whom Paid
Malting Address
oeserpton o Expenoure
city State Zip Code (Plus 4)
To Whom Paid Amount
/oHailing Address
-Jib t>TDescription of Expenotttira
$City S*X* ZIp
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
SCHEDULE 111
STATEMENT OF EXPENDITURES
(Name of Filing Committee or Candidate
rfReporting Period
To
To Whom Paid
Mailing Address
Zip Code <Plus
To Whom Paid
Mailing Address$State Zip Code (Plus 4}
1900) -To Whom Paid
ii ZMailing Address
10Amount
Description of Expenditure
cty State, Zip Code (Plus 4} j
To Whom Paid
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Amount
3City Stete Zip Code (Plus 4}
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Description of Expenditur
/iState Zip Code (Plus 4)
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fi/flftt-PMailing Address
f>flctty Sine
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Wlfi ~To Whom Paid Amount
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CCD $Mailing Address Description of Expenoiture
City
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IPAGE TOTALEnter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
SCHEDULE III
Statement of Expenditures
^> /l
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SCHEDULE III
Statement of Expenditures
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SCHEDULE IV
STATEMENT OF UNPAID DEBTSUse this Section to Itemize ell unpaid debts and obligations
which are outstanding at the end of the reporting period.
PAGE
Name of Filing Committee or Candidate Reporting Penpa
From
Nama of uuisianatng Balance ot ueoi
Mailing Address
City"
DATEDEBTINCURRED
sim Zip Cod* (Plus
Daccription of Dafat
Nama of Cr*dltor Outstanding Balance or Debt
Mailing Address
cTty"
DATEDEBTINCURRED
st*i* Zip Cod* (PIui 4)
Dftficilption ol Debt
Name Ol Cradlior iUutstanding Balance of Debt
Mailing Addrvx
City
DATEDEBTINCURRED
St»l» | Zip Coda fPluc 4) IDaicrlption of Dabt
Nama of Creditor
Mailing' Addrotc
City
DATEDEBT1HCURBEO
Stala | Zip Code (Ply* 4)
Outstanding Balance of Debt
$
Oaccrlptlon of Oabt
Hama of Crmdlior
Mailing Address
Crly
Outstanding Balance of Debt
DATEDEBTINCURRED
Stata | Zip Coda IPluc 41
Oascrlpiion of Debt
Name of C(*ditor
Malting Addfcts
City
Outstanding Balance of Debt
DATEDEBTINCURRED
State | Zip Coda (Plus 4)
Dnicrlpllort of Debt
Enter Grand Total of Unpaid Debts on Page 1, Report Cover Page, Item G.PAGE TOTAL
$ 0
OSGB-502 C7-99)