African American Leadership Coalition__9693__scanned

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

COMMI TT F7~ E :' NAME ( M u s t b e ame a s o n S t a t e me n t o f r g a n r a n o n )

I MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r . a( 1 ) S t a t e w i d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e

( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co mmi t t e e( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s

CANDI DATE COMMI TT EES O~ i ~. ' s

Ca n di d a t e Name ~ f ! ; ' ~ . M1 4; - UP

O f f i c e S o u g h tO . 6 7 0 0 4

OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t )

L a t e f i l e d r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l an d c r i mi n a l p e n a l t i e s .

E E I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLL OWI NG SENTENCE :AMF I L I NG A i Cf - - 4 ' 6 ' V ' - / , V , 2- 0 6 , 9 , REPORT FORANI A ( 1 ) ELECTI ON l ( 2 ) NON- E L ECT I ON YEAR .

( r e p o r t d at e ) I n d i c a t e o n e

CHECK I F AMENDMENT TOREPORT DATED

Ch e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h No t i c e o f D i s s o l u t i o n Fo r m DR- 3 .

( Yo u must c o nt i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f Di s s o l u t i o n i s f i l e d . )

STATEMENT OF CASH ON HAND

ON HAND a t t h e b eg i n ni n g o f t h e r e p o r t i n g p er i o d . ( T h i s i s t h e t o t a l o f a l l mo n i e s h el db y t h e c o mmi t t e e . Th i s amo u n t MUST b e t h e s ame a s t h e c a s h o n h an d a t t h e e n d

o f t h e l a s t r e p o r t i n g p e r i o d , o r must b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD TOTAL MONEY TAKEN I N THI S PERI OD

Sc h e d u l e A: Cash Co nt r i b ut i o ns t o t a l ( A t t a c h Sc h e d u l e A) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . .

Sc h e d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sc h e d u l e H : T o t a l Sa l e s o f Ca mp a i g n Pr o p er t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t ees On l y )

SUB- TOTAL . . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI OD

Sc h e d u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B) ( ' " a l s o s e e d eb t s an d l o an s b e l o w) . . .

Sc h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b a l a nc e must

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORM

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* U NPAI D BI L L S ( F r o mSc h e d u l e D- At t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - At t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

" OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - At t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

NDI DATE COMMI TT EES ONLY :

NSUL TANT BREAKDOWN ( Sc h e du l e G At t a c h e d? ) YES NO

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