I

FOR INSTRUCTIONS, SEE a4CK OF FORM FORM

Resr;tForm
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Mustbe same as on Statement of Organization) (Rev . 0712004) REPORT

firmctn for Oouse

IMPORTANT: kndicate by *type of cortrniltee you are reporting for
-
(1)Statewide/Legislativel Judge Sfandirg for Retention Cerrrbdate (2)Stata PAC (3)31ate Party
(4 )County Central Comnlife (5 )County Candidate (6 )City Candidate (7 )School Board or Other
Political SdAk- ion Candidate (6 IM,MQ ,(,1 J%hWI Board or Other Political
Subrrnrsion PAC ( 1"Local Ballot

Ca Name I Party (ifapplicable)

Late reports are subject to
possible civil and criminal
Office Sought (if Senate or House) penalties.

r//,F/o5
C/" Difl4lie-C, 31 - .268,-Id-N
SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

January 19, 2005

I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .

(report date) Indicate by #

Local Committees, enter Date of Election

OCHECK IF AMENDMENT TO REPORT DATED

0 Check if this is final (termination) report and attach Notice of Dissolution Form DR3. County & Local Commtitaes . enterCounty in
which Election is held
(You must continue to file reports until a DR-3 is god.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the
committee. This amount MUST be the same as the cash on hand at the end
2855.45
of the last reporting period or must be zero if this is first report filed.) . .. . . . .. . .. . . . .. . .. . . . .. . .. .. . ... . $

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) . .. . . . .. . . 2855 .45
Schedule F: Loans Received total (Attach Schedule F) . .. ... .. . . . . . . .. . .. . .. .. . . . . . . .. . . . . . . .. . . . ... .. . . . .. . .

Schedule H: Total Sales of Campaign Property (Attach Schedule H) . .. . . . . . . .. .. . .. . . . .. . .. . .. .. . .. . .

had H

SUB-TOTAL .....$ 2855 .45

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B: Expenditures total (Attach Schedule B) ('"'also see debts and loans below) .. ..

Schedule F: Loan Repayments total (Attach Schedule F) .. . . . . .. . . . .. . .. . . . .. . . . . . . .. .. . . . . .. .. . .. . .. .. . . . . .

CASH ON HAND at the end of this reporting period (iffinal report balance must
2855 .45
be zero) (Attach DR3) . . . . . .. ... .. . .. ... . . . .. .. . . .. .. ... ... ._ ._ . . . . ... .. . .. . . . . . . .. .. . .. . . . ... .... . .. .. . . .. . . . . . . .. .. . .. ... .. . .. $

"`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) . . . .. . .. . .. .. . .. . . . .. . . . . .. . . . .. . .. . . . .. . .. . . . .. . .. $

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?) YES ONO

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $