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Amended Campaign Filing 2 - Friends of Racheal Richards Vote March 5th
ASPen C AR ►� EG � Ei , V 1 ! APR 04 2019 CITY OFASPEN CAMPAIGN REPORT FORM REPORT OF CONTRIBUTIONS AND EXPENDITURES (CRA 14S-108 FF CommitteelPerson: As Shown on tegisfildion Address of Committee/Person: City,State&Zip Code: v ! kq CO Committee hype: C� w 44 0 ca f4 Name and Address of Finaueial Institution us GO �J�,�� y a,Q , 1 ' ccl o Type of.Report Regularly Scheduled Filing. _Amended Filing.This amends previous iit mport filed on(date) &* ehang�s r�-new information ONLY Termination Report.(Termination Reports iVlM f ive a monetarysai iancx o m Reporting Period Covered: LI�a//3 aof 'j- jThrough-1oas' ac) 1 Q Me Dam 1 Fonds on Hand at then Totals Detailed Summa Page only) Begin ing of Reporting Period(monetary S r d 2 Total Monetary Contributions $ 3 Total of Monetary Contributions&Beginning Amount s 7 4 Total MonetaryExpenditures a �! 5 Funds on Hand at the End of Reporting period(monetary) - The appropriate officer ssall impose a penalty of W per day for each day that a report is filed late. Art.XXVH1 Sect.10 2) a)] • Anent OR the('aniiutatrl Print Registered Agent's Measures)Name:. , "A Registered Agent's(Treasurer's)Signature: Date:d p 19 Candidate's Signature: Date:. DETA LEDSUNU f Y Full Nese of Cot®®khWPeraon: curte�atlt�,o .re a: A-3 sol� Tom, 6 Fonda-ou mind at the bq*aing of ropordut Period( ►only) 7. It ndud Contribndow S20-or More(c Rs-14s-los(1)(a)l $ (Please llat an 3che�ik"A'� p O . 8 TOW of Non-Itemized Contribadons - $ (Coaffiludm of 519.99.and Lees) 4' 9 Looans Received $ - (Pka9e Baton-Sebodak"C'ry /'� 10 Returned Expenditures(fro®-redpient) $ (Flom list on Scbm ale am 11 Total Mowery-Conulmdow, $ C� 12 Total Now-Monetary CooMbations $ 13 Tofal.Coatribntios. 14 Itetl dud Ezpenditnra320 or More[CRS 145-108(1)(o) $ (Please liston 3cLednie"B'3 -15 Total of Non-Itemized Menai kwo oft19.99 or Lem} =D - Ib .Loan Repeeyotea�-Made (Please Ilan on Sdwok".GG") - t" 17 Return ed Contribution(To-donor) $ (Please list on scLedoic .r Total MonctU7 E:q"dlkwes $ (TOW offim1.4dmu*-l7) 19TOtnl Sponding _ $ (lme 12+1 ►e 18) /�Q 4 .0 3 Schedule B—Itemized Expenditures Statement($20 or more) CRS 1-45-108 1)(a)] ,, + p Full Name of Committee/Person:.�'" S � � t PLEASE PRINT/TYPE 1.Date Expended 3.Name(Last,First): 6PL/t �� 4. Address: 2.Amount 5. City/State/Zip: �Q �� $ o 10 Q 6. Purpose of Expenditure: ` 1.Date Expended 3.Name(Last,First): 5 4. Address: O , ,gnus 2.Amount 5. City/State/Zip: &2ardao� $''� tip 6. Purpose of Expenditure: Prgf=f ZEN V 1.Date Expended 3.Name(Last,First): (� , 4. Address: t)• V. ou Sr 2.Amount 5. City/State/Zip: $ Z5,1<'D 6. Purpose of Expenditure: 1.Date ExpendedQ 3.Name(Last,First): �. 4. Address: 2.Amount 5. City/State/Zip: L► gj i 6. Purpose of Expenditure: Pla 1.Date Expended a 3.Name(Last,First): Cis 4. Address: 2.Amount` 5. City/State/Zip: cod 2!4`, O $ l� 6. Purpose of Expenditure: ao A C P Schedule B—Itemrud Expenditures Statement(M or more) CRs 145-109 1 a Full Name of Committee/Person: f ue�r� �,. Kic�1 S /ricnf�(•� PLMUPR1NMWK 1.Date Expended 3.Name(Last,First): a��ar9' 4.Address: �CS� ST 2.Amount s.city/state/zip: $ < 6.Purpose of Expenditure: fu- i 4 1.Date Expended 3.Name(Last;First): C /9 4.Address: 4/24 A. �s 2.Amount S. City/State/Zip: A5; c'o ���I I 6.Purpose of Expenditure: P 1.Date Expended 3.Name(Lasr,First): 4:Address: . . VI-0 2.Amount s. city/sude/zip: gr $ oC) 6.Purpose of Expenditure: 1.Date Expended 3.Name a ast,.First): HCl 4.Address: �`�'' 2.Amount s. city/State/Zip: , $ I 6.Purpose of Expenditure:. 1 Date Expended 3.Name(Last,Fust): 4.Address: 2.Amount I City/State✓Zip: 6.Purpose of Expenditure- �a_ g - KM 14�409 1 WAZGNCx.-Pbm real tie irNra�fioa�efair 8d ie d,l,etee�e rUasa - 4�Jame(��: • - z C Amt s. = S-4 S. Q A = 's,�..p �= 3.Agee Amt $ v 7.Ovca and Employer; - 1.Dabs Accepted. ODA 'g19 I C AmL 5_Addi+esm bat � V{�►G S�" s �0-•as 6•gip. . Co 3.Agpomi6e Aad. $ oU 7.Oiwnpetiou.and EmPloy+e'r: C ' I.Date Accepted 4..xmn�et��cx � �l, �► r-.flaw ; - S.Addram �/��-/fig -lAggvsieAmt dna : Cep 1.Dale Accepted z Cbm&b9lons.Aa : ,r Civ t. 6. C� , � fQl 3.Ag mwft Amt 7.OCCUPdim *OocWffdoa=d 9 as ea&parsomwlbo liaamsde a ofs1o0 or more 3o a cam/' comnmitt�P ooh leaps commafttw4N~qty.. - Schedale A - Iter h*&Couhtwdow Sbetene nt(S"or eiM)* CRS 1-45408 1 a Feu Name of cemmli�eelPe WARMG:Please read the nstrnction paw fur Sebe&&"A"Were coffiplftl PLZ"Zt PRIIy'rfrM 1.Date Accepted g �9- 4 Name 9.8s,Fust): �? 2.Contribution Amt. S.Address: 36 S , -�Vswti $ �� `��' 6.City/3tatcMp: F,)-.irV.,eJ CO3 . ��. 3.Aggregate Amt. $ 7.Occupation and Employer. 1.Date Accepted t 1 D i� '('� 4-Name a-a-%First): C k 2.Cion A rt. 5.Address: S"a-576 '+6 (i 6.City/State/Zip: 3.Aggmgft Amt. $ _ b�� 7.Occupation and Employer. 1.Date Accepted Q, U o� l l- ,D 1 .1 4Name uast Fiat): �1 �f�� �tj 2.Contribution Amt: S.Address: �C, 6. 3.Agger Amt. t ►City/Statemp: ro�.S�M�I i �1 D. ;; (a 3O �f - . $ C S"-D , � 7.Occupation and Employer ^ 1.Date Accepted 4Name(tam Fust): t)Vcp 2:Cont&uion Amt . 5.Address: a� 6.City/State/Zip: A i k)-J7' �--�— Vr� 3.Agg a Amt V �{ k-.� (973 $ b b 7.Occupation and Employer. [� � o-(kV - a * Oxon and Fmployer Md requimd on each person who has made a contribution of$100 or more to a candidate committee,political committee•,issae committm or political qty. 6+47h1 ScheduieA�ItcaOi�edCea�batioea t�,+��e)� . caas -as-iot Fu![Kane of CommfthwPn=w WARNMG:Piece read the pogo fbir gebeduk"A"bdom enogbaoW . - P PRINTr1YP� - 1.Date Accapted Gru W-Worlk 2.Gowniv mAmk S.A"oss: ' $ 6.CityM p: 5+� L3*Anmg to Amt L �.Occupatia►n snd Employer. Qn�it�ia 1.DiAcoepoed lt� Iq 4Name4A%Fh3ci: 2.Cour,-bation S.Adm: ]DrO `fl Q /J L3.Agg to Amt 6.CrtY/3ftwzip. k5pt� C-0 �t(y I 7.O Wand Employer. ., 1.Date Accepted 4Name gmt mmt): $C.a�rii� AmL- S.Adm: l &A M W 1: ' 3.AWvVft Amt3'�= $ 7.6c6qafim 9nd Einployea: h 1.Date Accepted `. ,fir C� 4Name c icy: PAc4--N ` 12;cauvftAi=AnL. 5.Addmss: CiFj tj } 1 ' - pCC 3.Aggregate A—m�t. 6. ��= $ °� 7.Occupdon amiFaoployei l` !✓ . *Mcupation and MdL=qdnd on e� .to a candi.dwe cow P o hsa a e�of$100 or mage p is=eommkteeorpoIkka party. t PAYS) ��- Schetlale A.=Ihsa�ed Ca�ibalhs$ �er tst�+e�' - - . CRS 14S4 (Dim- Pan Nam of COMMkWPOMM { &�r "t VA Nwg-s� 'W.ARMG:Please n"the IMP lair geb-hde 66A"befen Coin~ " PT$ASE R7tP1Ii - l.Deme Accepted afg)�3ojq sem- 130 i.Con�amAmk s.Addc+ess: $ y� ©� 3. 6.Lly/S lJ r 24 1/ Amt $ �� 7.Occupation.and Employer: VCC4, 1.Deme Accepted QQ _ 1� off] 4Name �)- �� S� tl°`L pL- . 2 Coabr*ution Amt 5.Address: 3.AgRnegame Amt. 6.City/3tc : Co. . r 7-Oc un-an1 Employer: I.name Accepted '> &;)_l Ig -/ 4Name Inc): (. Ij r S6-vi Cows= ahaA•mS.AddesCD 0 - .3. Amt " 6.C><ty/3tatrJZlp; � J. f I v j S �20.- 9&Q $ . Oto• t 7.Oo6�and F,m*yer 1 4-Name q-ae.1 ,r .jV!"ITl� cavtniwmA=. S.Ate: r1V 3.AggrevAe Amt 6.Cit9/S1ateJZip: . , SIP !7� 1, •pZ 7 on and Employer.- ?� 'Ocm4xdion amd nkpq*ed as each -tio a t�mclida�e comms po�lilticstl issue who has made a co�ributian of$100 or moms " e coommrtteeor-political PWtY 6ZA4 fl 'Q"e 4 /t x12 zLiA.6a 1 Schedule A ' Ibw&"C=&awdew 3tateadeat(528 or more)* RS 143408 1 a Full Name of Committ�eeJPeraon: V� t�✓c�{�•�> WARNING:Please read tiro Jushmdiml for Schedule'AA"before oomplgng! PLEASE PRigfffn m 1.Date Accepted 4 Name{1mk First): �jct 2.ComdbutionHart. S.Address: $ 1 C-4 N� (�D Uj 0 a� 6.City/State/Zip: C.C�• 11316113.Aggregate Amt $ �; . 7.Otion and Employer:Ea= �- ,o Pry 1.Date Accepted .!2L/jg/ . [� 4-Name(Lam First): C�1 dv" 2.Conu%Won Amt. S.Address: $ �, 6.City/StawZip: 3.Aggregate Amt v $ 6-C 7.Occupation and Employer: Ca t Sof t 1.Date Accepted (� 0 15 7 4Name Qast;Fn*): %CL 2.Contribution Amt S.Address: \4 S 6.City/State/Zip: 66• -I.AgomsmAtnt . $ ,O a ?.Occupation Find Employer:,P4_a j0,,/" 1.Date Accepted 4-Naw amt Fnst): u *LP 2:Contribution Amt S.Address: �v tc. 3.Aggregate Amt 6.City/Staftop' $ ��`�, 00 7.Occupation and Employer. 44 [a Occupation and Employes goWrequired on each peason who has made a contribution of$100 or more -to a candidate committee,political commium;issue committee or.political ply. P �� Schedule A=Itamdud.Conbtmdm Stiet neut Mg or uiore)+ cats 144 40s D fa Name of Committeemerson: s WARNING:Please read the' a page for Sel edale"A"before eamO tiagi PLEASE PRIlVTTYPE - 1.Date Accepted 4.Name g ak mw): ft*UCg, 2.Cootmaon Amt. S.Address: S DpQ AL $ 6.City/StaWZip: at fs �a• 4 b S� 3.Aggregate Amt $ �b 06 7.Ocmgxdon and Employmi-L A- 1.Date Accepted 4 Qp f q 4Name(u mmY 2.Corrtn'brmion Aart. 5.Address: :3Z I99 6. City/State/Zip: [�c� �(�• �/�o�� 3.Aggoegate Amt. $ o 7.Occupation and Employer. $ , 0 6 1.Date Accepted ONg4.Name amt Fin t): . �i� 2.Coaln'bWm Amt 5.Address: ' 6.City/StakMP: NnJ1ti'�gJ�Z �) -3..Aggmgata Amt $ a©. 7.Oc cq*on and Employer: f 1.Date Accepted 03/1 g�I q 4Nmme(�Fust): 2:Coatnivtim Amt. . 5.Address: (� $ 717- oto / 3.Aggre�aoe Amt. 6.�/StiftMp. $ -0 7.Occupation and Employer. Occupafm and Employer o refired on each person who has made a oontn'bution of$100 or more -to a candidate commiaw, IItic;al issue committm or political party., CA C � f' � a � Sd�IdeA' Ca dos (�e�raioar�e� - FrU Nese atGt�uft�ed!'eiseso 1.Dob Aired I c=aam mAmt s.Adder: 11v$ e --7.Occupatim.SM Fatployar. C OAM 19 v3tj-eq- D&a-s� .7 CGW*M=AuL 6 Y p. - s 3.A e ma $ O a 7.Ooc%.Wimmd&* yw. 1.Dade Awspbd 2 cowAddrew $ 5. ) /l {'i Vp �' i�/s� . _ i .. g� -3.Aggre�eAm� . (a0 3.Ag a A=L �i:l V-2i !w j til /�) ,00 1 OWODWm and *()CCWxvf=ow �a as cwhp=mwho h=made a ooi�dbudon ofs100 or moss awe oo �P"w ao�\yme eminbw . =3143-108 WAxi�llNcr:Pio..e�attre " p�a� a�A",b�te !� - ZOM - 6VAs /o-D q ; -Aue 2.caounwamAint S.Adder - (o SJ ,� p!',ve - 3.Agee AnL CY t7. wd 1.no&AcoepWd 4N=e 0AW.Fly: fl .2.Cadodi6n Ammt S.Addresm 136 3.Awe Amt' 7.Oix-,VWmmd C-974w, %?K$ I.Daft Acoepied 2.cow Amt S.A &a&- 0 vaW`s 4+4 �15� 'od 3.Aggtegift Amt $ DO -7.dc6mofm ma 1.Dale Aooepeed 4Nstae p.,rt Fo: 2:Coon Amt.. S.A &ciw 6.Clgffiftftaap: 3.Aggosa Amt. 7.Oastp dm aad Banploy�er: - *Occupa"sad Employer aluired as cwhper mwho hasmecle a000fnbatim of 5100 or moos .#o a canffdmc cx amfitim amt ooarpoNcalPody. f aZY �,� CT Sd�eddeA= C.a�t tloae st arm"*)* Pl"&LQRlc,�A-mk 4te Awc4-,-�: WA�t3: tread lie ioaat��io��e�•g �cda►�s - . 1.Date Accepted S.AddrawPU ! &6 ,0 6 3. eAmL �. ( �s ed• � 3 s. j o0• 4.o« otlandEmp oyw. - 1.D06 Accepted I� 4Nante DPW-1 S f 2.CoOtafin Amt roc . -sasaa t 3.Awe Ate. - 6.�r�'— r��t�•- �� -���p F � - - - $ , al5760 7.o ,,pd . wM"i -lob Ug -� 1.Date A=q od 4Nsm (Y\ b 2.damo*odm Amt $ fAL).o CLvQ -3�AwvvftA=L 6. 7 do64ofim ana EmpbW. tee . 1.Date Aaoqftd 41+iame > 2:Ce ' atiun Aaat.. S.Addt+ess: S's r $ CDC)* 3.AgpqpftAmL 6. L v. N� . Laqgs * md on sCand&ftCOMU IoM o his tneade a cao�n'b�ion sioo cxmo�+e P --coanpouka pwiy.- - Se6eaieleA=Ifaesioed-Ca�r�tiea= �� � - - 14 409 i WAS:Ple mddo i .Sebe �,e aA �b� eokqpbtbW 1.Dde Aixxpted �- o 1141�Tame��j; .00r�m P•-e�"-g-� �AmL s.Ate- 3.AnmwftAnL 6.CILY/st"Zip. • �t t S �SC�•DO `7.O on and v�4c� 1.Dft Am epW. 4NC40) amepl�sy; c Q • 70 AA. 5•�: ob 3.Ag Oe AM s.cmy�s p. n L°Q • sz. 7.06cqe�and Empbyw. FID:a:,e A/�,cept�eyd, - s3� ,00 Amt cz S3'$ •v� 7 I. kftA,00"d - aaf� s 3.Aamvft Amt. - LQ s (00• 7•Occupdon and*00 amd umu am Batch D a e P ��made a Of X100 armoire - O0Q° � SdOA— ai0ae),., Fam Nam oiCoadaadtbadie+easam WAWMG.'Pbm read the kw&oiedpadelair 8eied�e aA"belia+e aaieeieti - 2.DdeMcepted j LtAgs Y S'RW �a a CoaAmR. s.Aaaress: _ 46 C°� s(a.Q rid 6. $ a a :7.o« ud . 1.Deee Acoepfed 2. Amt 5.Ad&vm • del wzip- 3.Awe Amt ��.Ci� � b�� 1.Dft AmepW- L 6�- ,- 4xame , -7 0 l�jtkri 2. Ami. S.Adder aO AspvWftAmiiL .C) s 7 doiapdion �-ST%-k�A 1.DdeA ed lcomimonme.. s. . 3.Aggmq1e Amt 6. • O Zvv,C) C7 7. soda C6 OcotpdiM andlRo3plooW +agng+ed oa each -tDacrjWi&ftoammfdmkpayiticalimm coosiftal acoetn'butjoaof�100 armor /��C)r- e,* p � FM 1-6-IOt 1 ISH Nn®e of G t�ea,P'elso� y CJA rd.S V,�a:� wow O,- WA M(G-.Pion lana iia is PR;, . PLU �.> - 2 Caotribelim Amt. 5.Adda m h 66 Opel 3.Agg<gpftAML s � .CO. 7.Occulafm saw: .- 1.Data Accepted - /,3b �Wj cc - - _ �. 2.C.a Amp S.A(klra : V at 3.Aggeveb Amt . -1 $ - p 7.Oocpeiimmd Empl"w. ' I.Dela Accepted. /,off $ 4 ani S.Ad&nw ID D �V � 0 4 -3.Aggmg� �A - 6- $ l � ,a� 7.Oo64m&wgnd Eopbyw. 1.Dale Accepted D n 4Name p."t raw 2: A=L, i Addreim Ad&6.Cuy1smftr4P.- h1 3.Aggiawm Amt. s �pct 7•OOMPam and * trod FAWloy+etjlmm,regwu an eachPmm wbo hu mads:a�a�fs100 ati mope a a � P ,tee • >e� Cr �Y. P4 <.30 �- Sd�eA= Cesdri6 ���� - - " ISH Nie otC��n�nMA s�semw*4 WARNING:Pose t+ead tip fie•Scbwob uA" +e . Z. Amt S.Addreml ! S—D• 0 6.CkyJSWdZlp !�0• D7.Occtipatim.md Employm 1.D& .A,oj=pbd 4-Wmw O&A FbW JR 6 LAX-,j 2.Coub7oulkn Amt S.Addrow 3.Age Ant 6-cYft�p. 1JZ�?•��d 5 S e g�(OJ 7 d 7 n = $ wow qo 1.DMA«opled 2.C Anti S.Ate: 014 1 n L.e 3 Amt Co • �l1�I . (�. 6P -7.4cc i oa goat Employw. 1.DmbAooepfed 4Name ga* LLO,a 2:ao.ammdoaA=L. S.Avdrei:6.CRY/smazip.- B� t 3 Anmwoe AmL loo•°`� 7.Occuption ane * mm%WQ%IUUWI as eaehpersmvft lies made a dean 00 cmr ' ID a omnmmpolmxl comown bm C � � I+�lYaaee a[Ce�,O Priem ,- S �)r Wi Sy WARNING:Pie�dtbeieoal .8de�A"Le�ae�e oeirpietie�gi 1-Dae - - / �9 h r z C, Arc. 5.A,d 3.AggeAm� 6�`?'� $ BOO• :�.()Cctqm CMand . 1.DOMAwspoea (L,^pby: 3 6++Y ' z CadftbatioaAmt: s.Aad Na rh-\ ' • - A5Pe'v--- Ca11 s 0.1Oa • 7.Occgmfimand8� _ 1.nate Adapted T_/� yQ.,�. 4.1�1..x.1 a kw 2.c Amc .5. $ o0 �� ar K -3.AWmsi cAmt . ` '� Cd• I-f $ �P 7 1.DdeAnmeed _ 0 2:GowrbonAmk. s. 9 -- $ 40 , 3 6.awsboarip. 3� •Agile Amt. _ $ 7. and *Occupstion and almalwlInfu aed as eachpeemql"bas made a Of$100 ormoas ID a candle caamnit m post cow ime©omnitim �. SdwAWIe A-Itewhed-Cesu budow Sb t(S29 or eiore)* ceS 14s408 Q - Fult Name of Commttteel!'ermw WARNING:Please read the ptge fe Sebedale KA"besene eokkpbdng1 - rr.�sEr�n�rrrrrr� . 1.Date Atd 4Nama"UAki,F: 2 Co*RMdon Amt. S.Address: - V J T, 6.Ciw/Stftzip: 3.Agpigo Amt. �. .Occupation and Employer: Mt fIJ-4`. 1.Date Accepted �a , �q` 4Name(i t Ihat). C� aj` �i a 2.C Amt. S.Address: $ /CO 3.Agpevft Amt, 6.Ci!A fatdTap: 7.06cgedmapd Employer. 1.Dabs Accepted / 4.Nme 2.Cc�n WOU Amt: S.Address: �d v A4, $ J0;.00 IAgg�ttAmt 6.cm►�: •°`� 7• and ire: —Gw AIX 1� 1.Debt Accepted 4Name O wk�= , Yv 2:Conmribtrtiott And. i Address: U AA $ l od F0 �V 3.Aggregate Amt; 6. 1 $ Cf) 7.Occupation and *Occupafiort and an required an eah person who has Muk. of$100 or moms -to a candidate commhbe,Pon&d commhhw,,u, sw Comm ai tee or SeLe�leA= ■ 1 C«Melis� Memrd 2-X13-IOt - - FO Nuw a[C etit�eeR'e`sos; wMawr:rheas n"ft Pw J*$tiedlde aA� B 1. Dab AboepMd 2.cmftmwm Ai.t s. ro,oa 6'` 3.AnmgmAmt �� - C © •°� `7-Occuvdion.md Igamployw. �Wr /d - r See Www.- 1.DM AcoVW- - 2 Amt S.Adch+ees; I V/., $ cP�d1� 3.Aggc+sm AmR. 6' !-t> .Eti` "�,C�, QlW 1 L ISO 1.DaraAmepwd �vZD l9 41�mue tt iay; AM to 2.Coy Amt- S..A s -C),g6• -3.Ann smAmt . and Eiqioyer. : 1.DW Aoxpbd Y _ C oaAuL s.A,�dre a us 5T 6-MYMWJ2*- . 3rd•°� --r— - - . 3.Aggmp"Amt 0 7.Oompfm m®dBat�loyLa oari Ooaupfim sad ,i�d on ewhpmmwho�msctoa -to aau idit ca se, 000�ri"b o�oft100 armoae c - Sclie�deA= dCadrl6�Ueani$�ere■�t{�Amraiecne� - .. _ . FOR Name a[ -�' • P,--A - T- w, 'OPARMG:rune Head the a 1MV i+w SdkftWe KA"hese eakoedw L Deft Mxptod z.Dante Ami. s.Andress: 1 1 3.AspermAmt 6.ChylftftrAp: $ $ ;;�06 1'7.OcavationaoaR04AOYw. Cdr 1.DW AmepW s.Aaafem6. � 1 3.Agg� sue Amr. 9�" V 8 7.O�cacpWmmrdEmploy= "gip, 1.Debs Acoepiea. 4.Nanee%- Ak play. aCOMPSudw Ami S.Addms;. -3.AsvewmeAmwL - j '� •�l W 7 dFA 1.De1e Aroepfed 4Name gAa;FbW 2: Amk. 5.Andre 6. 3.Agwgv a Amok 7 Occapedw and Occupafim and Eho O eatiequu�ad cneach : peaao�n.who lies mode a og6100 ormore .D a came amnift oe,P � 7p - Sd�ieA= �IiMrt{�acai�ej� � - - - l'aH Name adkieaMftrso� � S P A1F�1� WAMOPIG:Pbm mid tie fiw&adlU pule Jbr 8dadde"A"bdw.eeompkdiW. 1.Deo A6cq*d - 14 �u k4e 2.1 onAiea. S.A�aa au►�C°:�i� $ - � l fib•°� - . 3 Ate. 6.ala►/ P� S 7. . Imo • � . AA _ 1.DW Accgftd � � - 4�meu.•��: - -�I1i-� - �v1d 2-c S.Adder n. �� Innac 0'�ST oCr 3.Aumvft Amt: JCS•as . 7.Occupdmand%Vioyw a r 1.Dwme Anepbed- sAmt. 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