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COMMITTEE NAME (Must be same or, on Statement of OrganIzabon) (Rev . 0112001) REPORT
.
.S4-11~ AlE" o!ER °YIA-NN _roA SE'~JA TE For qe Use Only
Comm . t0
IMPORTANT : Indtcatc Typo of committee you ere roportln9 for:
Indexed
( ' ISral~u~ictn~ILC Is1,91NP CAndidntr ( 213tatewlde PAC (3 )St.nte Party ( a )County'Locol CandMate
Audited --,- --
( 5 )Count,/ PAC (6)30410! Issun,(Franchlaa Committee ( 7 )CoumdylClty ContrAl Commlttes
( s )support Slate of Condldnlos Computer -`_
CANDIDATE COMMITTEES ONLY:
Candidate Name PPII1Ir 0I Party
/a /o <-
SIGNAT RE OF TREASURER (or persorp U13i'10 ort) - TELEPHONE DATE SIGNED
Routine Penii Due For Late FiIQd Reports Range from $20 to $800
n Check(You
if this is final (termlnallon) report and attach Notice of Dissolution Form DR-3.
must continue to file reports Notice of Dissolution
County 8 Local Committees, enter
0lch Election is held
County In
until i Is filed .)