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COVERPAGE

Recipient Committee Campaign Statement Cover Page


GOVemment
Cotle Sections

Type

or

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in

ink

QTY
Date of election if

L
N1 4 09
PaOe

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a

5 84216 64200

Statemeppppt
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Month DaX Year

of
For ORmial use

only

SEE INSTRUCTIONS ON REVERSE

through
An

D 9
2

0 76
Type
of Statement
Statement

Type

of

Recipient

Committee

e eompl cpmmmn

rb P

ceholtlec Q
Q
Rerall

Cantlidate Conbolletl Comminee

Pdmadly FOnnetl Ballot


Comminee

Stale Cantlitlate Election Comminae

Measure Pr Statement eelection annual Igaemi


Termination Statomenl

puanerly

SUtement

COnnolled t
Sponsorvtl
lNm LwnNNBPN 6f

Spacial Otlbyear Repon Supplemental


Preelection

am comMwe vend
General Pu rpvsa COmminee

Also

Ole

Form 410

Termination

Statement Atbch Form 495

Amendment

Explain below

Sponsoretl

Primarity
rum

FOnnetl Cantlitla el

Q Small COntrihulor COmminee Q POIIticalParrylCentral Committee


3 Committee Information
COMMITTEE NAME

OKCeFnltler COmminee

pbM1P O

D I NUM

ERGO

s Treasurer
NAME

IOR

S CgNDIDFTE MME IF NO

LOMMI1TEEl

REAS OF
I

ER

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f16

nn I o Sri

fBr nmrt Co p
t PO CIiY

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AREA

S A32 MAILII
CIiY
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Slo e u Fd
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TATE
ZIP

P
CODE

runa D
A AR

R l6

SINO ADDR BO Jn ANiE IZIP O RE S tl Si N CM 3 5 OE


nrrurr
E55 000

COUEIPHONE

PRONE CODE

OF ASSISiwrvi

iftEgSVRER IF ANV

ea

9r7GG
ZIP CODE

409 622 6474


MAILING ADDRESS AREA CODE PHONE CITY TATE ZIP

MAILING

IF DIFFERENT

NO ANO STREET OR PO BOX

CIiV

STATE

CODE

gREA CODEIPHONE

OPFIONAL

EMAIL ADDRESS

OPTIONAL

FAX

EMAIL ADDRESS

19G 86S Qn9


4

Verification
I nave usetl all reasonable

antler

penally

Dl

tliligencein preparingantl reviewingthis statement and to the esto myknowledgo omia ptl perjury untlerthel wsof the State pf Call that Neloregving is tm a co

the information mntainetl hereinand inthe attachedschedules is tmeantl

y Iceni complete

Eaeated

on

I A

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On

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FPPC Form afiD

leenuanrosl

FPPC FPPC Toll H B66 1866Rl5 ree Ipllne ASK Zj

Stab of Calilamla

Campaign Disclosure Statement Summary Page

TYPe

or

print

in Ink Statement cover

BUMMARV PACE

Amounts may be rounded ara to Ola a

period

f rvnm
SEE INSTRUCTIONS
NAME OF PILER ON

REVERSE

through

l10 3 L0
0

4
Page
LO NUMBER

Of
D

CYr IV CL
Contributions Received
1 2 3 4

52 rrrZ
ColumnA
rnuscsnoo o

Columns
onaveaa
rox

Calentlar Year

Summary

for Candidates

rlssl crvmscrveo IraoMAT

ponre

Runnin 9 in Bolh the Slate Prima ry and General Elections

Monetary Gontributions
Loans Received SUBTOTAL CASH CONTRIBUTIONS

scneewe q sees
ur smeame

mrovgh slap

to

Dale

e Linea

Ads tines LZ scneaWe

2g Contributions Received 21

Nonmonetary

COntribulions

C Lined

Expentlitures
Matle

TOTAL CONTRIBUTIONS RECEIVED

qae Lrnesa a

Expenditures Mdde
8 7
8

Expentliture
smedura E used
scnedwe

Limit

Summary

for State

Payments

Matle

Candidates

Loans Made
SUBTOTAL CASH PAYMENTS

w enact
23 Cumulative

Expentlitures Matle

am Lines s

oen auvnumml movm w msoq E

9 10

Accrued

Expenses Unpaid Bills

ed me5u scne
scnedme

Dale of Election

TotaltaUate

Nonmonetary Adjustment
MADE

C used

yy mmldtl
5

11 TOTAL EXPENDITURES

qm

Linos s tp

ti

Current Cash Statement


12

Beginning Cash Balance Receipts


Increases to Cash

s Prevro

sammaryaage
mmn c

a c is

13 Cash

Lme ve a 3ah

hl

To calculate Column 9 add amounts in Column Ato the

corzesponding
scneeme l area

amounts

14 Miscellaneous

s gmoun in this section maybe ditterentlrom amounts

15 Cash

PaYmenis

IUmnA C

Line

ve 9a

from COlumnBof your last s report Some amOpn in


Column A maY be

repprtedin

Column B

16 ENDING GASH BALANCE


Il this is
a

mrec Am uae tz d mea e Lina is la


zero

negative figures Thal should be


subtractetl from

previous
It this is
lletl

termination statement Line 16 must be

period
smeeme e Pon z

amounts

the first report

being

17 LOAN GUARANTEES RECEIVED

or this calendar year only carry over the amounts

Cash
18 19

Equivalents and Outstanding


Equivalents
AtlO

Debts
see mermcrons
on reverse

arwl
8 4

unea

and s

pr

Cash

Outstanding Debts

Gne Line2 gin COlumnasD ve

FPPC TOII Free

FPPC Form bfiO Januaryl05 FPPC 0 K 5 3 Helpline B661A 066@

Schedule A Moneta rY Contributions Received

Type
to

or

print

in inx
stacemem
pYara

e scReou A

pcW nm

may

a u e r tlollara

hot

pertm

from

DI

05
Pag
Lp

SEE INSTRUCTIONS ON REVERSE NgME OF FILER

1hroUgh

3 Z

NUMBER

YI
FULL

Tl
STREET

Larri2dsa
ADDRESS ANO ZIP COpE OF CONTRIBUTOR
IF qN

cJ 3D6
CONTRI6UTOR
CODES

NAME

INDIVIDUAL ENTER

AMOUN RECEIVED THIS PERI00

LUMUTATIVETOOATE CALENDAR YEAR

PER ELECTION TO DATE

RECEIVED

uaeal rv usoErvrEar Orcamnlmee

OLCUPATIONgND EMPLOYER
oveOEmsauane amv Iltsatr W wES51

DEL 1 JAN 3t

IF REQUIRED

IND COM OTH Prv scc


IND

COM OTH
PTY SGc

IND COM OTH


PTV SCC

IND COM OTH


PTV

SCC

mD
COM OTH PTV SCC

SUBTOTALS

Schedule A Summary
1 Amount received this

coRmM1amr coxs

period period

itemized monetary contributions

mamiaual IND

Include

all Schedule

ASUbtotals
unitemized

2 Amount received this 3 Total

monetary contributions of

less than

100

Recipienteomminee coM oNerman PTV or SCC OTH omen e g M1uameas entity PTY Political Party
small ntaM1m scc c comminaa r

monetary

contributions received this


on

period
TOTAL
FPPC Toll Free

Add

Lines 1 and 2 Enter here and

the Summary Page Column A Line 1

FPPC Form 460

Januaryl66

Helpline

B66lAS WFPPC

Z 5 3 fifi6

Schedule C

Type arprim

m Ink

NonmonetaryContributionsReceived

Amounts may be roundetl


rawholedollars

SCHEDULE C

from

ementcovfrsperiod Sta 9

l a n
z

SEEINSTRUCTIONSON REVERSE
NAME OF FILER

Lhrough

of Pdge
D I NUMBER

r
DgTE RECEIVED

na
FULL
Ilr

KizDSR
CONTRIBUTOR CODE IFAN INpIVIDUAL ENTER
OCCUPATION ANO EMPLOYER
Ilr saLr erv ememvEO sl

9 93DD
DESCRIPTION OF

NAME STREET ADDRESS AND CODE OF CONTRIBUTOR a cowmmEE use Fvi ro xoNaEn
ZIP

AMOUNT FAIR MARKET


VALUE

CUMULATIVE TO

GATE CALENDAR YEAR DEC JAN 1 31

pER ELECTION
TO DATE

GOODS OR SERVICES

pF REONREO

IND

COM
00TH p Prv
scc IND COM

I J

OTH PTV SCC


BIND

COM pores
Prv

scc

IND

COM
OTH PTV
SCC
Attach additional information
on

appropriately

labeled continuation sfieets

SUBTOTAL S

Schedule C

Summary
period
edod itemized

comdhmor code

1 Amount receivetl this

nonmonetary contributions
contributions of less than 100

Qnclude

all Schedule

Csubtolals
unitemlzed nonmoneta eriod
Column

II

mdimdnal IND

Recipient CDM

committee
or

2 Amount received this 3 Total nonmoneta

PTV P

li tical

contributions received this

Small scc convibutor comminee

aanyrv

scc

g business eniiiy

Add

Lines 1 and 2

Enter here and

on

the

Summary Page

A Lines 4 and t0 T0TAL


FPPC Form dfi8 iJanvaryl86
FPPC TOII Helpline 666IA5 WFPPL Free

2 6J 66612

SGHEDULEE

Schedule E Payments Made

Type
amounts
to

ar

print

in ink
rountletl

Statement

covers

may be

period

wnple mllara
from

7 rj

y
Page
I0

6EE INSTRUCTIONS ON REVER6E

lM1mugM1

af

FILEF nO NAME
CODES
OiP
GNS Cm GVG FIL

J
one

NUM6ER

rna rl5 l
If of the

zDSu Carr
following
codes

93a019
describes

accurately

the payment you may enter the code Otherwise describe the payment
MBR member communications RAD radio airtime antl

campaign paraphemalialmisc campaign consultants contribution explain nonmonetary


civic tlona ions

production

costs

MrG OFG
FEr
FNO

meetings

antl appearances

RFp
SAL TEL
TRC

refurnetl conMbulions

office expenses

campaign

workers salaries

petition circulating
pM1One banks polling aM survey research postage delivery antl messenger services

v f or cable airtime and candidate travel

FND fJD
LEG
Lrf

8linglballol fundraising events legal


defense

e canditla

fees

pmtluclion CGSIs lotlging and meals


meals
same

PCi

TRS
TSF VOT VJEB

spouse staff Vavel lotlging and


voter

Indepentlenl expenditure

supportinglopposing

others

explain

PpS PFm PKf

Iranster between wmmitlees of the

canditlatelsponsor

rampaign literature and mailings

professional print ads

services

legal acmunling

registration information technology

casts

interne

mail

NAME AND

ADDRE660F PAYEE CODE OR pESCRIPTION OF PAYMENT AMOUNT PAID

usoeuiEamrvumaeal pscomrninss

s
Payments
that
are

contrlbutlans

or

intlepentlent expenditures

must

also be

summarizetl

on

ScM1etlule

SUBTOTAL

Schedule E
1 Itemized

Summary
period
loans of under 100

payments made this period Include all Schedule E subtolals

2 Unitemized payments made this 3 Total interest 4 Total

paid

this

period

on

Enter

amount from Schedule

B Part 1 e Column
on

payments

made this

period Add Lines 1 2

and 3 Enter here and

the

Summary Page Column A

Line

TOTAL

FPPC Form 060 January105


FPPC To11 Nelpline 866 Free FPPL ASN

11 53 3 866

Schedule I Miscellaneous Increases to Cash

Type

or

pdnt

in ink Statem
tcov rs

scHeouiel periotl
a F

Amounts may be roundetl to whole dollars

rrom

SEE

INSTRUCTIONS ON REVERSE OF FILER

through

3 i2

Page
I D NUMBER

al

NAME

3aa 9is
DATE FULL NgME AND ADORE550F SOURCE
xreR pp ccmwines nlso in rvumaeRl

RECEIVED

DESCRIPTION OFftECEIPi

gMOUNT OF

IEiCASH NCREAS yO
f

Attach additional in ormation

on

appropriately labeled continuation sheets

SUBTOTAL

Schedule I Summary
7 Itemized increases to cash this

period
100
on

2 Unitemized increases to cash of under 3 Total of all interest received this


4

this

period Schedule H
Column

period

loans made to others

e
on the

Total miscellaneous increases to cash this period Add Lines 1 2 and 3 Enter here and

Summary Page

Line

14

TOTAL
FPPC Form 460

FPPC Toll Helpline B661ASN Free FPPC

05 January 53 06613