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FORM
FOFi INSTRUCTONS, SEE 13ACK OF FOAM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 0112001) REPORT
an¢eCon) ~-
COMMITTE E NAME (Must be same as on Statement of O
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For Office UMR01
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you are reportn9 for.
'-- '(IMPORTANT: Indicate type of Wrnmittee Indexed
)State Party (4 )CauntY/LocaJ Candidate Audited
(1 )Stale+ddeft.egisiative CancrKate (2 )Statewide PAC (3
Committee (7 )Caunty/City Central Committee
(S )County PAC (6 )ballot IssuefFranchise Computer
(8 )Support Slate of Candidates
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Candidate Name Political Party
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:
1 AM FILING A ntl ±6 bE' _ I l 2CX) i~a f
REPORT FOR ANIA (Y) ELECTION l(2)NOWELECFION YEAR .
(report date) Indicate one
`I Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a Notice of Dissolution is filed.) which Election is held :,
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