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1st Quarter for DELTA DENTAL PLAN OF TENN COMMITTEE FOR GOOD GOVERNMENT submitted on 04/08/2004

Beginning Balance

$12,760.59

Receipts

Monetary Contributions, Unitemized
$0.00
Monetary Contributions, Itemized
Contributor C/P Date Amount
JOHNSON, DDS , WAYNE
401 WEST MAIN STREET, SUITE 101
LEBANON , TN 37087
DENTIST
SELF
02/18/2004 $250.00
TOTAL CONTRIBUTIONS
(other than adjustments, loans, and interest)
$250.00

Contribution Adjustments
$0.00
Loans Received
$0.00
Interest Received This Reporting Period
$7.64
TOTAL RECEIPTS
$257.64

Disbursements

Expenditures, Unitemized
Purpose Amount
BANK FEES $37.55
Expenditures, Itemized
Vendor C/P Purpose In-Kind Independent S/O Date Amount
KURITA , ROSALIND
211 DEERWOOD
CLARKSVILLE , TN 37043
C CONTRIBUTION 01/05/2004 $500.00
Loan Payments
$0.00
Obligation Payments
$0.00
TOTAL EXPENDITURES
(other than adjustments)
$537.55

Expenditures, Adjustments
$0.00
TOTAL DISBURSEMENTS
$537.55

Ending Balance

ENDING BALANCE
$12,480.68


Outstanding Loans


TOTAL OUTSTANDING LOAN BALANCE
$0.00

In-Kind Contributions

In-Kind Contributions are not included in the report ending balance.

Unitemized
$0.00
Itemized
$0.00
TOTAL IN-KIND CONTRIBUTIONS
$0.00

Obligations

Obligations are not included in the report ending balance.

Unitemized
$0.00
Itemized
$0.00
Obligations, Outstanding from Previous Reports
$0.00
TOTAL OBLIGATIONS OUTSTANDING
$0.00

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