Shohreh 5 2022/12/13

2022/12/08 Date (yyyy/mm/dd) Date Filed (yyyy/mm/dd) Time Filed 2022/12/13 12:10 Page 1 of 7 Box C: Statement of Campaign Income and Expenses LOAN Name of bank or recognized lending institution Amount borrowed N/A Income Total amount of all contributions (from lin 1A in Schedule 1) $9140 Revenue from items $25 or less Sign deposit refund $280.04 Revenue from fundraising events not deemed a contrib. [...] Page 3 of 7 Schedule 1 - Contributions Part 1 - Summary of Contributions Contributions in money from candidate and spouse $8720.00 Contributions in goods and services from candidate and spouse (include value liste d in Table 1 and Table 2) Total value of contributions not exceeding $100 per contributor + Include ticket reve$n1u2e0,. [...] 00 contributions in money, goods and services where the total contribution from a contributor is $100 or less (do not include contributions from candidate or spouse). [...] Less: Ineligible contributions paid or payable to the contributor $0.00 Less Contributions paid or payable to the clerk, including contributions from anonym$0o.u0s0 sources exceeding $25 Total Amount of Contributions (record under Income in Box C) $9140.00 (1A) Part Il Contributions from candidate or spouse N/A Table 1: Contributions in goods or services Description of Goods or Services Date Rece. [...] spouse /J Table 4: Contributions in goods or services from individuals other than candidate or spouse (Note: Must also be Treoctaolrded as Expenses in Box C.) N/A Name Full Address Description of Goods or SerDviactes Received (yyyyVya/mluem (/d$d) ) Total Total for Part lll Contributions exceeding $100 per contributor (Add totals from Table 3 and Table 4 and record the total in Part 1 Summary o.