SPIRO T. AGNEW, Governor                       925

44.—Signature of candidate

45.—Signature of treasurer..............................................................

(If candidate report, both candidate and treasurer sign)

Business address:

Candidate ............................................................................

Treasurer ............................................................................

Residence address:

Candidate ............................................................................

Treasurer ............................................................................

46.—Subscribed and sworn to (affirmed) before me this..............

day of............................................, 19............

(SEAL)                     ....................................................

Notary Public

47.—Receipt or Disbursements:

(Strike out the incorrect word; DO NOT combine Receipts
and Disbursements on same sheet(s); use separate
sheet(s) of each. DO NOT combine Code Letters on same
sheet. Use separate sheet (s).)

Code

Letter                      Check

Date Name and Address or No. Explanation No. Amount

48.—Total of this Sheet                                $..............................

49.—Coding:

Receipts

Contribution (goods, service(s), money(s), or (C)
equivalent of $10 or greater in value by full
name and address of contributor.)

Sale of Tickets (dinner, testimonials, cocktail (T)
parties, barbecues, crab feasts, and similar
functions). List individual names and ad-
dresses if ticket is sold for $51 or more. List
total only here, if less than $51 a ticket.

Sale of Items (List total sales  only) (I)

Loan or Advance                                                    (L)

Transfer of funds                                                (TR)

Rebate, refund, or discount                                     (R)

Miscellaneous                                                         (M)
To correspond to balance at end of previous re-
porting period)

Disbursements

Personnel                                                                (1)

Field expense                                                         (2)