10/25/2004 16 :47 FAY 3198333119 CAMPAIGN FINANCE 2001/001

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

E IN KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 06/97)1 CONTRIBUTIONS

2
CHECK THIS BOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MM/DD/YR) OF CONTRIBUTOR ' (if applicable) CONTRIBUTION VALUE CONTRIBUTION

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"Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page / of
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage). (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter `not applicable' in the relationship column .