Slate Mailer Late Payment Report

Amounts may be rounded to whole dollars

Form 498 Instructions

If This is an Amendment

Part 1 of 3: Slate Mailer Organization Information

Slater Mailer Information

Part 2 of 3: Late Payment(s) Received From:

Late Payment(s)

Part 3 of 3: Name of Late Payment for Candidate or Ballot Measure

First Late Payment

Second Late Payment

Third Late Payment

Fourth Late Payment

Fifth Late Payment

Sixth Late Payment

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End of the Page, Form 498.