FOI tllsTRUCrrO/S, SEEBACKOFFORM

FOR|U'
. DR.2
DISCLOSURESUMMARYPAGE (Rev.0296)

For Offtce Use Onlv

same as on Statementof Organization) Gomm.#

IMPORTANT:Indlcatetype of commltteeyou are rcpor{ng nn

@
( 1)statewide/LeglslattueCandidate PAc (3)state party (4)county^ocatCandidate
(2 )Statewide
{! )$unty P4c ( 6 )Baltorrssue/Franctrise
commineeiifcrrr-tycid;&.niiiil;ffie'
( I )SupportSlate of Candidates

7tz-7?z-?tzo s-/6-76
this report) DATESIGNED

Penalties Due For Late Fited Reports Range from $10 to $400

SEEINSTRUCTIONS
ONBACKANDCOMPLETE
T}.IEFOLIOUNNG
SENTENCE:
I A M F I L I N GA /7 REPORTFORAN/A (1) ELECnOH (2)NON-ELECT|ON
YEAR.
(report date) Indicateone @

trCHECK IF AMENDMENTTO REPORTDATED Local Commitees,enter Dateof Election

tr checkif this is ftnal (termination)reportand attachNoticeof DissolutionForm

(Youmustcontinueto file reportsuntila Noticeof Dissolutionis filed.)

.ASHoN HAND
atthebesinnins
ofrher"r":];:::h*,:,::::T
of all moniesheld by the committee.This amountMUSTbe the
sameas the cash on handat the end of the last reportingperiod, L
Q*. a.n^
guuNl)'Al
or mustbe zero if this is firstreportfiled.)............. ......................$ ozt. o7
ADD TOTALMONEYTAKEN!N THISPERIOD
ScheduleA: CashContributions
totat(AttachScheduleA) ................ *a-
ScheduleC: Fundlaidng Eventstotat(AttachScheduleC)................. -o-
ScheduleF: LoansReceivedtotat(AttachScheduleF)................. - O -
ScheduleH: TotalSalesof CampaignProperty(Attrach
ScheduleH) ............... - O
(ScheduleH appliesto Gandidates'Committees Onlyl
suB-TorAL.....$ 2, Olt cs7
SUBTRACTTOTAL MONEYSPENTTHIS PERIOD
ScheduleB: Expenditurestotal (AttachScheduleB) -o-
ScheduleF: Loan Repaymentstotal (AttachScheduteF) -o-
cAsH oN HANDat the end of this reportingperiod(if final report,batancemust
bezero)(AttachDR-3).....................:........ ...............$
_ 2, O2-/. 07 ,-/

UNPAID BILLS (From Schedute D - Attach ScheduteD)................ ...........$

lN KINDCONTRIBUTIONS
(FromScheduteE - AttachScheduteE)................. ............$ -o-
OUTSTANDING
LOANS(FromScheduteF - AftachScheduteF) ................ .................$ -O^
GANDIDATEGOMMITTEES
ONLY:
CONSULTANTBREAKDOWN (Schedule
G Aftached?) _YEs x No
VALUEoF cAMPAtcNPROPERTY(FromscheduleH - AttachSchedule
H) -o-
 FTOT|NSTRUCTIONS,
SEEBACKOFFORM POSI/Yii.q
CHECKONE:
'. l_ L.
IY --
D ' This is an initiaf* Statementof Organization li I -
tlliT-
m Thisis an ?tIODded* Statement-of Organization
' An initii"l statement
95 ilAr1 l Ll ?, lo For Office UseOnlv
of organization shourdbe frtedwithin 10 davsof the
?.I9*':f:.:1<ns. expehdlu,eir* mii iiJi iiiJii i"
" ", may Oiimpoid for tate_filed
withln30 ddysof a change. penalties "i"i'riii{a

COMMITTEE NAME (Requtredby taw)

|MPORTANT:Indicategpe of commifieoyou are reporfngfon

(llstatewlde'Leglsladvecandldate W
{2tstatewidePlc(3|sgt"e!fr (4pounty/Locatcandtdare {5}countypAc (6)BattoilssuefFEnchise
niillG Ul"t ondldat€ underpurposoof commitoel
COMMITTEE
TREASURER (This addressusedforail reminders COII'IUTTTEE
CHAIR (Ust additionalofficerson sepante page)
and
Name

,,r,,4*t- B*ftrc
MailingAddress MailingAddr6s
/t2 u.3"-'d*4 Pl Jot@e.
( n //, tq g/f/6/
Home t7 12 l_2
Phone 2_2' A8 70 Horne
Phone
QrL)-772 - /OAZ

PACs: INDICATE
PURPOSEOF COMMTTTEE

All CandldatesEnter:
OfficeSought: e,^ i f{ Distrisl:
PoliticalPaily (if appticable) YearStandingforElection:
Countyrlocal _ nq 6
Gounty: Dateof Etection: gb
6-l-
Candidate Name t Address or P.algnt Entitv (PAGs,if applicabtel,
Afffllate, or Sponsor

Nameof FinancialInstitution/Type
sq e/cs _ Bo"s
of

-Ap
city State
(urra /( , -To- S/r/a/
city / W
( o-r.rol / T.\ .S//o
DISPOSITION
OF BALANCEOF FUNDSUPONDISSOLUTIbN (StaEmed of intentrequiredby law for all commitFs, exceptstate parties
andcenhalcommitees.)
(1)DOMTEDTO
(2) DOMTEO TO LOCAUSTATE/I{,Af L POLffiCAL pARTy(mddine ons) C4TMNSFER TO ANOTHERCOMMTTTEE
OFTHISSAMECANDIOATE
(3) DONATEDTO (CANDIDATES
ONLY)
(8) RETURNTO PARENTENTtTyGENERALFUND(pACsONLY)
(9) OT}IER(PACSONtn, PLEAjiE BE SPECTF|C
(5) PARISANCONGRESSTOML
D|STR|CTFUND
STATEMENT
OF AFFTRMAN
.t am that t-amrequied to frte disdosurer,'r,rc ir the@mmineee@ives *ruoua*",
.aware iilc," *;;;;;;;;;;;;
'ir:"3'i,H::r;:'"P:::,ytr,":::?*y2ie315,:Xrs_?11f!!!?g ;;;;;":;r;L* ot r*e hund@ttdotra'
(fnes)underthedi&lastrelaw. yryg!" oice or ritni issue.
i ;*a,e thattat*nred
rcprtsarcsubjecr
tocMt,,"nafties
Ialso'incterhnainatatuiougnnetreasurerhonrayjiparesanon*repr,necandii#
"n;rso
lawfora@unteancltimelydisdosare
FiXrfF..Finaily:! afrm thatau@mmneeonc6i niveb@ninfomedoftheirapryinfirentandobligatione
t\
-,4%o
Signatureotfrczrturdr
s-/.4-?6
^r ,n DateSigned

* 5 '!b' ttl,
Date Signed