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REPORT OF RECEIPTS
FEC
FORM 3
AND DISBURSEMENTS
For An Authorized Committee
.
Office Use Only
1. NAME OF USE FEC MAILING LABEL Example:If typing, type
COMMITTEE (in full) OR TYPE OR PRINT over the lines
.
ADDRESS (number and street) PO BOX 9394
Check if different
than previously
reported. (ACC) FARGO ND 58106
January 31 Year-End Report (YE) (c) 30-Day POST-Election Report for the:
in the
Termination Report (TER) Election on State of
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete.
NOTE : Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.C 437g.
M M D D Y Y Y Y M M D D Y Y Y Y
Report Covering the Period: From: 01 01 2011 To: 03 31 2011
COLUMN A COLUMN B
This Period Election Cycle-to-Date
6. Net Contributions (other than loans)
M M D D Y Y Y Y M M D D Y Y Y Y
Report Covering the Period: From: 01 01 2011 To: 03 31 2011
COLUMN A COLUMN B
I. RECEIPTS Total This Period Election Cycle-to-Date
.
453.00 1718.00
(ii) Unitemized.....................................
(iii) TOTAL of contributions
67953.00 76363.00
from individuals......................
0.00 0.00
(b) Political Party Committees...................
(c) Other Political Committees 85384.38 138884.38
(such as PACS).................................
10000.00 10000.00
(d) The Candidate....................................
(e) TOTAL CONTRIBUTIONS
(other than loans)
163337.38 225247.38
(add Lines 11(a)(iii), (b), (c), and (d))
13. LOANS
(a) Made or Guaranteed by the 0.00 0.00
Candidate...........................................
0.00 0.00
(b) All Other Loans....................................
(c) TOTAL LOANS 0.00 0.00
(add Lines 13(a) and (b)).....................
FE5AN018
Image# 11930700756 DETAILED SUMMARY PAGE
of Disbursements
FEC Form 3 (Revised 02/2003) 5 / 62
24. TOTAL RECEIPTS THIS PERIOD (from Line 16, page3)....................................................... 163338.39
FE5AN018
Image# 11930700757
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
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TOTAL This Period (last page this line number only) .......................................................
# PH7 03 30 2011
City State Zip Code Transaction ID: A-MC130
Seattle WA 98102-4393 Amount of Each Receipt this Period
FEC ID number of contributing -2500.00
federal political committee. C
Redesignation
Name of Employer Occupation
Kirlan Venture Capital
Chairman, President, & CEO
Receipt For: 2012 Election Cycle-to-Date [MEMO ITEM]
X Primary General
Other (specify) 5000.00
# PH7 03 30 2011
City State Zip Code Transaction ID: A-MC131
Seattle WA 98102-4393 Amount of Each Receipt this Period
FEC ID number of contributing 2500.00
federal political committee. C
Name of Employer Occupation
Redesignated
Kirlan Venture Capital
Chairman, President, & CEO
Receipt For: 2012 Election Cycle-to-Date [MEMO ITEM]
Primary X General
Other (specify) 5000.00
# PH7 03 30 2011
City State Zip Code Transaction ID: A-C7219
Seattle WA 98102-4393 Amount of Each Receipt this Period
FEC ID number of contributing 5000.00
federal political committee. C
Name of Employer Occupation
Kirlan Venture Capital
Chairman, President, & CEO
Receipt For: 2012 Election Cycle-to-Date
X Primary General
Other (specify) 5000.00
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
67500.00
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
Floor 12 03 21 2011
City State Zip Code Transaction ID: A-C7166
Washington DC 20005-3819 Amount of Each Receipt this Period
FEC ID number of contributing 1000.00
federal political committee. C C00251876
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
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TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
85384.38
TOTAL This Period (last page this line number only) .......................................................
10000.00
TOTAL This Period (last page this line number only) .......................................................
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700792
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700793
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700794
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700795
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700796
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700797
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700800
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700801
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700802
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700803
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700804
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700807
TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
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TOTAL This Period (last page this line number only) .......................................................
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700809
TOTAL This Period (last page this line number only) ....................................................... 60220.28
FE5AN018 FEC Schedule B ( Form 3 ) (Revised 02/2009)
Image# 11930700810
TERMS
Date Incurred Date Due Interest Rate Secured:
M M D D Y Y Y Y
02 11 2010 11/7/2012 0 % (apr) Yes X No
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
TERMS
Date Incurred Date Due Interest Rate Secured:
M M D D Y Y Y Y
02 03 2010 11/7/2012 0 % (apr) Yes X No
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
TOTALS This Period (last page in this line only) ...................................................... . 100000.00
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
A. Full Name (Last, First, Middle Initial) of Debtor or Creditor Nature of Debt (Purpose):
Overland Payroll Inc. Payroll Expenses
B. Full Name (Last, First, Middle Initial) of Debtor or Creditor Nature of Debt (Purpose):
Odney Consulting, Message & Str-
ategy
Mailing Address 1400 W Century Avenue
PO Box 2035
City State ZIP Code
Bismarck ND 58502
Outstanding Balance Beginning This Period Transaction ID: SD10-DEBT7029
10000.00
Amount Incurred This Period Payment This Period Outstanding Balance at Close of This Period
C. Full Name (Last, First, Middle Initial) of Debtor or Creditor Nature of Debt (Purpose):
MAXimum Compliance, LLC FEC Compliance
1250.00
Amount Incurred This Period Payment This Period Outstanding Balance at Close of This Period
. 23000.00
.
....................................................
1) SUBTOTALS This Period This Page (optional)
............................................
.
2) TOTALS This Period (last page this line number only)
.......................
.
3) TOTAL OUTSTANDING LOANS from Schedule C (last page only)
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only)
A. Full Name (Last, First, Middle Initial) of Debtor or Creditor Nature of Debt (Purpose):
Erin Casey Consulting Consulting-Fundraising
. 0.00
.
....................................................
1) SUBTOTALS This Period This Page (optional)
............................................ 23000.00
.
2) TOTALS This Period (last page this line number only)
....................... 100000.00
.
3) TOTAL OUTSTANDING LOANS from Schedule C (last page only)
4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only) 123000.00
FE5AN018 FEC Schedule D ( Form 3 ) (Revised 02/2003)