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�l L F-4� j A—Y---2! ci t <br /> 3 <br /> h1.G.1.. r., 55 requires Ihal the trrrrue rntr(i€atirlcvtllId address he reported, in alplraNtic.al order,for rxll receirAY over$50 in aealendur <br /> ccordc ofall receipts, bul tjeed onIV itemize Mose receipts over$50. �Iri iidditiort, the <br /> year. Cotruuittnev t7u-1sf fie,�p rleicaiirrd rrccouxLs rstuJ r <br /> occupation awl evtpl?y)ev ttrust he repor ied/ns•all contribute$200 or inorc,irr a calcznek"'year. <br /> (A"Schedule A. i2cce.iprtw" srtt:te:iata:crrt i sa�.ailsalale w€a nipletc,print and attaela to this report,if.additional pa;eN are required to <br /> report ail rcceiltts_ PICFI.w h1cludc Your c(rraar)a'sftcc narnas and a paage-eatartaber on each[)rage,) <br /> N ilnic and R€bidexil.i<al Address Occupation& Employer <br /> Date Reecive€t r•c( ssare€i) <br /> Amount (for contributions`of$200 or more) <br /> r <br /> . . <br /> 1 <br /> r <br /> _ _ <br /> ......... <br /> - <br /> _ <br /> Linc 9;'frtai l:eccihts ovct-'G50 (or iis(cci sibove) <br /> Line 10: Too at Rcc,c,ihts$50 and undcv- (nol. lis d abovtO <br /> Line 11: 'I'OTA1, Rt?:CEIPTS Ili THE 191?RNOD � Eutcr ou page 1, line 2 <br /> 1f you have itcrnizeci re.ecipi s or s5o asxl incw(k tbeni in line 1). .L.ine 10 should inciting only thosc receipts riot itemized above. <br />