Sunteți pe pagina 1din 2

06/07/05 09 :46P P .

002

FOR INSTRUCTIONS, SEE BACK OF FORM FORM


DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev, 0712004) REPORT
COMMITTEE NAME (Must be same as on Statement of Orgenaation)
For t)tll~rW
Comm. *
IMPORTANT: Indicate by d type of commlifee you stn reporting for. Logged In
( 1 )State+wlde/Leglslatlvejjudge Standing for Ralenllon Candldab ( 2 )Slab PAC ( 3 )Slate Party Scanned
(I )County Central Commrttse (5 )CountyCandidate (13 )CRY CRWIdets (7 )School Board or Other
Political Subdhdabn Candidate (8 )County PAC (9 )City PAC (10 )Sdhod Boar, or Other Political Computer
Subdivnisfon PAC ( 11 -) local Ballot Issue Audllad
CANDIDATE COMMITT EES ONLY-
Candidate Name Political Parry (if applicable) U~L
I Late reports are subject to
possible civil and criminal .
Office Sought 1 district (it senate or House) penalties.

:Cf s"1_r ,2 32--/,9%0


SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION /(2)NON.ELECTION YEAR .


(report dale) Indipta by # Q

Local Committees. enter Dale of Election


(:]CHECK IF AMENDMENT TO REPORT DATED

County & Local Committees, enter County In


Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. which Election is held
(You must continue to file reports until a DR-3 is filed .)

STATEMENT OF CASH ON HAND


CASH ON HAND at the beginning of the reporting period, (Total of all funds held by the
committee. This amount MUST be the same as the cash on hard at the end
of the last reporting period or must be zero If this is first report filed.) ........... ... ... . . ....... . ... ... , $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) ..........
1
Salmdele . F) . . . . . . . . . ..5r2 .!r'. v.f..It a. . . . . . . .. .. . . . . . . . . . . .
Schedule H: Total Sales of Campaign Properly (Attach Schedule H) ... ......... .... ..... ..... . . ..... .
f3chedyle H yplie8112 Candidatos'Corrrmy!M Only)
SUB-TOTAL ..._$
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and bans below) .... U
Schedule F: Loan Repayments fatal (Attach Schedule F) .................... ............. ............. ......
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) ...... ......... ... ... ....... ... .... ... ...... ................ ... .. .... ... ... .... .. ... .... ... ..... . .. . ..... . $

"UNPAID BILLS (From Schedule D -Attach Schedule D) ............ .... ...... ........... . ....... ... ... ......... ....... .. $
'IN IGND CONTRIBVT10NS (From Schedule E - Attach Schedule E) . ................... ..................... . ... .. S
"'OUTSTANDING; LOANS (From Schedule F - Attach Schedule F) ... ... ............ ............... ... .............. . $
CANDIDATE CQMM/TTEE$ OH-Y
.
CONSULTANT BREAXaOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
06/07/0S OS!46P P .00a

For lrtstructfons, Sea Back of Form SCHEDULE


A MONETARY
s - MONEY TAKEN w RECEIPTS
(Rev . 07103)
Mrdid4q 's prraoral funds)
Q CHECK THIS BOX IF
AMENDING FORM

STATECAFIp1DATts NOM IF A CON TMBUTION IB RECeAIEO FROMASTATE PAC MMCA1 ACTION COYMTTTM USTTHE PAC IDENTIFICATION
MAIN-7t AND THE PAC CHECK HUUWR INTHE DESIONrITOD C=ra4W. AUSf OF 10NUMB ISAVAdABL>_ FROM T7rE KWAEMS ANDCAMPAIGN
OISCLOSURE BOARD.
lo" fnf°neom" copied b+oa' reh°Rs ana amtsmena for soKcRk+p oonMbusons or
by Paw+ a umn sba~
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT " IF FOR
RECEIVED (YMroRC") TO ATE' RECEIVED ' FU
@MOONR) AND PAC CHECK RAWOSWJ
NUMBER tNICpIIAE
-
9.r-. 1-05 IDS ..r ^- n N
Se.
10

S ,r-a
CKaI

9 ID*
CKS _rn -te
IDS O
CKS eC

CKS
.ih fir . c .f l , al
IDW ~

CK0

IDa
yr)ic.. )7'l Co o« tt .~ _ c l o se" Tc+

~ ~r
0 IDS : e..
"1Cg.f ~4n 1.q ! : o
CKS 7 .. I r
Nr
IDN

CK#
- _
IDO

CKO

I DO -

CKS

SUB-TOTAL
s
TOTAL (Ifasrpoge ofthisscheriwe)
Dlsdm" Iew npWras OarrdiMM oomlrifes lo atadoae the rsbMon4Dlp of aty rWaitys maldlq a mnMDlMon b IDs
oomrottton . Rmamnslap nlua! be slam 1o OrsINrd doorsof--arpWKV
m>trriglre) . Ifanaims ofcaddbu6or Is Me sane an coldidab, WIhemObod -IM6-) mind algnlgl <mAdwa bY
of-tol reirdlomldp, eear'rot b no Page-
' In the natmSorelip Collam. (for1SCIaduIe A)

S-ar putea să vă placă și