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Amendment (Explain below)
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Committee Information
MAILING ADDRESS
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SEE INSTRUCTIONS ON RE
NAME OF FILER
Contributions Received
1/1 through 6/30
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Schedule A, Line 3
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Schedule C, Line 3
Add Lines 3 + 4
Monetary Contributions
Loans Received
SUBTOTAL CASH CONTRIBUTIONS
Nonmonetary Contributions
TOTAL CONTRIBUTIONS REC
Expenditures Made
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Schedule E, Line 4
Schedule H, Line 3
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EA
Add Lines 6 + 7
Total to Date
Schedule F, Line 3
Schedule C, Line 3
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Add Lines 8 + 9 + 10
Payments Made
03
7. Loans Made
8. SUBTOTAL CASH PAYMENTS
10. Nonmonetary Adjustment
11. TOTAL EXPENDITURES MADE
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Previous Summary Page, Line 16
12. Beginning Cash Balance
Column A, Line 3 above
13. Cash Receipts
Schedule I, Line 4
14. Miscellaneous Increases to Cash
Column A, Line 8 above
15. Cash Payments
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Add Lines 12 + 13 + 14, then subtract Line 15
16. ENDING CASH BALANCE
16 must be zero
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Schedule B, Part 2
7. LOAN GUARANTEES RECEIVED
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Outstanding Debts
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I.D. NUMBER
/i1/2 33 2—
PER ELECTION
TO DATE
(IF REQUIRED)
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
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Statement co ers period
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AMOUNT
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❑ OTH
❑ PTY
❑ SCC
SUBTOTAL $
Monetary Contributions Received " W 1 e °" °"
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
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IF AN INDIVIDUAL, ENTER
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CONTRIBUTOR
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CUMULATIVE
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Loans Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
(b)
AMOUNT
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DESCRIPTION OF PAYMENT
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'" Payments that are contributions or independent expenditures must also be summarized on Schedule D.
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.)
Unitemized payments made this period of under $100
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3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)
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