1. PREVIOUS RECEPTS REPORTED FOR THIS ELECTION PERIOD 
				
				      (if this is the 1st statement filed for the
				primary election or an annual statement enter zero)
				
			 | 
			  | 
			  | 
			
				$ 
			 | 
		
		
			
				2. CASH CONTRIBUTIONS      
					THIS PERIOD FROM:
			 | 
			(A) Candidate's Own Funds | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| (B) Other Individuals | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| (C) All Other Sources | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| 
				3. LOANS RECEIVED THIS PERIOD (Schedule C, Section 1, Line 2)
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| 
				4. INTEREST & OTHER INVESTEMENT INCOME THIS PERIOD
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				      
				TOTAL CASH RECEIVED THIS PERIOD (Line 2(A,B, & C) Plus Lines
				3 and 4)
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				5. DEDUCT LOAN REPAYMENTS (Schedule C, Section 1, Line 3)
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| 
				6. NET CASH RECEIVED THIS PERIOD (Total Cash Minus Line 5)
			 | 
			  | 
			
				$ 
			 | 
			  | 
		
		
			
				7. IN-KIND CONTRIBUTIONS 
					      THIS PERIOD (contributions 
					      other than cash.) FROM:
			 | 
			
				(A) Candidate
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				(B) Other Individuals 
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				(C) All Other Sources
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				      TOTAL IN-KIND CONTRIBUTIONS (To Line 15 Below)
			 | 
			  | 
			
				$ 
			 | 
			  | 
		
		
			
				8. UNPAID PLEDGES  
					      THIS PERIOD FROM: 
			 | 
			
				(A) Candidate
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				(B) Other Individuals 
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				(C) All Other Sources
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
	
		
			| 
				      TOTAL UNPAID PLEDGES 
			 | 
			  | 
			
				$ 
			 | 
			  | 
		
		
			| 
				9. NET RECEIPTS THIS PERIOD (Lines 6 Plus 7 Plus 8)
			 | 
			  | 
			  | 
			
				$ 
			 | 
		
		
			| 
				10. TOTAL RECEIPTS FOR THE ELECTION PERIOD TO DATE (Line 1 Plus
				Line 9)	
			 | 
			  | 
			  | 
			
				$ 
			 | 
		
		
			| 
				 
					OTHER INFORMATION
				 
			 | 
			  | 
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			| 
				11. LOANS REPAID BY THIRD PARTIES THIS PERIOD
			 | 
			
				$ 
			 | 
			  | 
			  | 
		
		
			| 
				12. LOANS FORGIVEN THIS PERIOD 
			 | 
			
				$ 
			 | 
			  | 
			  |