Professional Documents
Culture Documents
Smith 6418434645
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FOR WS Tl?UCTfONS SEE BACK OF FORM
DISCLOSURE SUMMARY PAGE
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DR-2 I DISCLOSURE
(Rev. 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
iMa, ~ Comm. #
IMPORTANT : Indicate by f type of committee you are reporting for: Logged In
(t )Statewide/Legislobve/Judge Standing for Retention Candidate (2 )State PAC (3 )State Party Scanned
(4 )County Central Committee (5 )County Candidate (6 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate (8 )County PAC (9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC (11 ) Local Ballot Issue Audited
CANDIDATE COMMITTEES ONLY :
Candidate IN me - Political Party (if applicable)
Late reports are subject to
,
iJ
~4Vtic t~ possible civil and criminal
Office Sought District (if Senate or House) penalties.
'*UNPAID BILLS (From Schedule D -Attach Schedule D) . .... ... ...._ ......... .... ............. . ...... . ...... ..... ... ... .$ _
'IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) ..... ....... .... ...... ... . ... .., . ... . ... ... ., .,$
'OUTSTANDING LOANS (From Schedule F-Attach Schedule F) .. .... ... ....... .... ... . .......... ....... . .. .... ... $
CONSULTANT BREAKDOWN (Schedule G Attached?) -YES XNO
CANDIDATE COMMITTEES ONLY:
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $