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CAMPAIGNFINANCIALDISCLOSURESTATEMENT
ForStateandLocalCandidatesForSingle-CandidateCommittees
1.
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2.a.NAM~CANDIDA1E~RCOMMITTEE
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3.ELECTIONDATE4.a.CAMPAIGNADDRESSANDPHONE
StreetorRuralRouteCity
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StateZipCode
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4.b.CANDIDATE'SHOMEADDRESS(ifdifferentthan4.a.)
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StreetorRuralRouteCity
5~
StateZipCodePhone
5.
OFFICESOUGHT(includedistrictnumbernifapplicable)
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kJJ-s~-....
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6.
NAMEOFPOLITICALTREASURER(maybecandidate)
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7.
CATEGORYORREPORT(Checkone)
DD0
FIRSTSECONDTHIRDQUARTERQUARTERQUARTER
o
FOURTHQUARTER
ODD
PRE-
PRE-
MID-YEARPRIMARYGENERALSUPPLEMENTAL
o
YEAR-ENDSUPPLEMENTAL8.a.BEGINNINGDATEOFREPORTINGPERIOD
/0-
0,.
-0~
8.b.ENDINGDATEOFREPORTINGPERIOD
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€)
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9.
(Checkone)a.
0
Thiscampaignisexemptfromdetaileddisclosurebecausecontributions{includingin-kind)receivedtotai$l,OOOorlessANDexpendi-turestotal$1,000orlessforthisreportingperiod.(Completeitems12d.,12e.and12f.)b.
D
Thiscampaignisrequiredtofileadetailedfinancialdisclosurebecausecontributions(includingin-kind)receivedtotalmorethan$1;000
and/orexpenditurestotalmorethan$1,000forthisreportingperiod.
10.I/we
dosolemnlyswearoraffirmthattheinformationcontainedinthiscampaignfinancialdisclosurereportistrueandthatthisreportisanaccurateaccountingofcampaigncontributionsandexpendituresrequiredtobereportedbythecandidatecommitteebytheCampaignFinancialDisclosureAct.Additionally,
I/we
swearoraffirmthatnocampaigncontributionshavebeenexpendedforthepersonalfinancialbenefitofthecandidateorforanyothernonpoliticalpurposeasdefinedbythefederalinternalrevenecode.
~~.
1
(/~/D'1
t
dat~rer
I
/1-1-b9
date
I
O-j-D9
date12.SUMMARY
I
a.BALANCEONHANDLASTREPORT,
$__
---::0==--__
~
367
S
7-
t-L1~~
c.TOTALDISBURSEMENTSTHISPERIOD
$
.!\J;j'}JeJ/.
$
'gDo
BALANCEONHAND(12.a.plus12.b.minu~·'I't.e;i.ti.HH:O:J..
eml.-!-~:!.J.l::;.
.f1i
~J!1r.r.1~.
:""""/-1
:J
b.
TOTALRECEIPTSTHISPERIOD
'1".............•........•........•...•......••..••..••.....•.•.
$
d.
~
.
TOTALLOANSOUTSTANDING;..
r)
$_f.
\500~
TOTALOBLIGATIONSOUTSTANDING:
$
---='--
r;...;;;--_
SS-1109
(Rev.
2106)
Pagelof__
RDA1159
SUMMARYPAGE•CANDIDATE
13.NAMEOFCANDIDATEORCOMMITTEE(InFull)
I
14'.REPORTCOVERINGTHEPERIOD
I
FROM:
I
TO:
RECEIPTS
15.CONTRIBUTIONS(otherthanloansandinterest)
~
1
00
.UnitemizedContributions($100orlessfromeachsourcethisperiod)...................
$
b.ItemizedContributions(over$100fromeachsourcethisperiod).........................~.
$
t2cr.75~
c.TOTALCONTRIBUTIONS(otherthanloansandinterest)(add15.a.and15.b.).......................................$
307S
16.LOANSRECEIVEDTHISREPORTINGPERIOD......................~..................................................................
$
b
17.INTERESTRECEIVEDTHISREPORTINGPERIOD....................................................................................
$
fr
18.TOTALRECEIPTS(add15.c.,16.,and17.)(mustbeshowninitem12.b.).................................................
$
"30,5
DISBURSEMENTS
19.EXPENDITURES(otherthanloanpayments)a.Expenditures($100orlesseachpayeethisperiod)(mustbelistedbycategory-e.g.,printing,postage,gasoline)
$$$
$$
$$
$
$
TotalofExpenditures($100orlesseachpayee)...........................................................
$
-9
~
b.ItemizedExpenditures(Over$100eachpayeethisperiod)...;...................................$
tf2,;2
75
C-
~
TOTALEXPENDITURES(otherthanloanrepayments)(add19.a.and19.b.)................................................
$
f/'2'2..7'5
?-
c.20.LOANREPAYMENTSMADETHISPERIOD...................................................................................................$
~
21.TOTALDISBURSEMENTS(add19.c.and20.)(mustbeshowninitem12.c.)............................................
$
z..'Z7
=:;
22.IN-KINDCONTRIBUTIONS
a.Unitemizedin-kindcontributions($100orlessfromeachsourcethisperiod).............$
-e-
b.Itemizedin-kindcontributions(over$100fromeachsourcethisperiod).....................$
&
c.TOTALIN-KINDCONTRIBUTIONSRECEIVEDTHISPERIOD(add22.a.and22.b.).................................
'$
--e
23.OBLIGATIONS
a.UnitemizedObligationsOutstanding($100orlesseach)............................................
$
~
b.ItemizedObligationsOutstanding(Over$100each)...................................................
$
S()O~
'5
DO
tYfC>
TOTALOBLIGATIONSOUTSTANDING(add23.a.and23.b.)(mustbeshowniitem12.f.).........................$
-
.
r
88-1133(Rev.4/02)
ITEMIZEDSTATEMENT
OFCONTRIBUTIONS-CANDIDATE
1.
NAMEOFCANDIDATEORCOMMITTEE
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lJ\
Vlf-r~
I
.2.REPORTCOVERINGTHEPERIOD
I
FROM/O
-/-0'1
TO:
III-
G.-~
59
3.
iOTALITEMIZEDCAMPAIGNCONTRIBUTIONSFROMPRECEDINGPAGE(ent~r
$0
iftirstitemizedpage)Amount
4.
COMPLETETHEAPPROPRIATEITEMSFOREACHITEMIZEDCONTRIBUTION(contributionstotalingmorethan
$100
fromanycontributor)FirstName
4~
(lfVV
I
iddleNameContributionReceivedFor:AmountofContribution
So
f'yN.[
m
·-d
31'"
rl:
#
LastName/Organiza~nName
o
PrimaryElection
o
GeneralElection
fi2S()
~U~
Address
"2"2..0""2-
tJ~SOr'l
o
Runoff(LocalElectionsOnly)City
N-
~\'V"'f
Iffll
~pCodeDateofContributionAggregateThisElection
'..'.T12.0,
Occupanan
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()Lu
'NAr
I6--
"2...
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5\,
Employer
5<-
t
F~
DP
FlrstName
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s
,.;;"IV
cJ
&
I
iddleNameContributionReceived.For:AmountofContributionlastName/OrganizationName
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N'1h
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PrimaryElection
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GenerplE1ectiori
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Address
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1J
;c_J~~s
in.
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Runoff(LocalElectionsOnly)City
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/l-;5
l-."\
Is~I\7e~7DateofContributionAggregateThisElection
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ccupation
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Employer
(~li)
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FirstNameriddleNameContributionReceivedFor:AmountofContribution
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A
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LastNameJBzatlOnName
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PrtmaryElection
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GeneralElection
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2
5V
Address
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s:"""'--
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Runoff(LocalElectionsOnly)City
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fr<f:,~
1
1VN-
IZJpCode..DateofContributionAggregateThisElection
.•"3----yGb7
"0-
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e-
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Occupation
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W'f\.Q....(/"
tmployer
(SeL+')
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FirstName
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MiddleNameContributionReceivedFor:AmountofContributionLastName/OrganizationName
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GI
o
PrtmaryElection
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GeneralElection
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re.·U-J4
Address
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C
M-A-t-Y\.J
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Runoff(LocalElectionsOnly)City
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ofContributionAggregate
This
ElectionOccupation
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'D~
16/11IfY~
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Employer
(~l.p
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5.
TOTALITEMIZEDCONTRIBUTIONS
#/500
(Carryforwardtoitem
3.
ofnextpageifadditionalpagesofthisformareused.)
(II
thisisthelastpageofcontributions,thisamountmustbeshowninitem15b.ofsummary.)
1*"-.
~i
SS-1131Rev.
2/06)
Pae~ofJRDA1159
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