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<br />Page 2
<br />
<br />RECEIPTS
<br />(Exhibit A)
<br />
<br />Include all money. property and things of value received during the period of time covered by this report. Attach additional sheets if necessary.
<br />
<br />Date
<br />received
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<br />Name and address
<br />
<br />Money'or thing
<br />of value received
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<br />Total amount received
<br />
<br />~,g 0(;),0 C?
<br />
<br />$
<br />
<br />PROMISES OR PLEDGES RECEIVABLE
<br />(Exhibit B)
<br />
<br />Include all things of value promised or pledged. Include things listed in previous report which still fall within this- category, Attach
<br />additional sheets if necessary.
<br />
<br />Date Name end address Thing promised end value
<br /> '-
<br />
<br />Total amount promised or pledged $
<br />
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