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January 2012 Finance Report -- Roman Larson for School Board

January 2012 Finance Report -- Roman Larson for School Board

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Roman Larson's Jan 2012 Continuing Report
Roman Larson's Jan 2012 Continuing Report

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Published by: Roman Michael Gregory Larson on Feb 16, 2012
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02/16/2012

 
 
Roman Larson for School Board
Finance Report  January 2012 Continuing Report 
 
 
CAMPAIGN FINANCE REPORTLOCAL COMMITTEES OF WISCONSIN
Is This Report an Amendment: Yes NoInstructions for completing schedules are on the back of each schedule.
 
COMMITTEE IDENTIFICATION 
 
Name of Committee
 
Street Address
 
OFFICE USE ONLY
 
City, State and Zip Code
 
Please check if address is different than previously reported, and complete the Campaign Registration Statement in the back of this form.
 NAME OF REPORT 
January Continuing _____ Pre-Primary _____ Spring Fall Special
 
Termination
 
Report
 
July Continuing _____ Pre-Election _____ Spring Fall Special
also complete Schedule 4
 
SUMMARY OF RECEIPTS AND DISBURSEMENTS
Column AThis Period
 
Column BCalendar
1. RECEIPTS
 
Year-To-Date
 
1A. Contributions (Including Loans) from Individuals
 $ $
1B. Contributions from Committees (Transfers-In)
 $ $
1C. Other Income and Commercial Loans
 $ $
TOTAL RECEIPTS
 
(Add totals from 1A, 1B and 1C)
 $ $
2. DISBURSEMENTS
 
2A. Gross Expenditures
 $ $
2B. Contributions to Committees (Transfers-Out)
 $ $
TOTAL DISBURSEMENTS
 
(Add totals from 2A and 2B)
 $ $
CASH SUMMARY 
Cash Balance Beginning of Report
 $
Total Receipts
 $
Subtotal
 $
Total Disbursements
 $
CASH BALANCE END OF REPORT
 $
INCURRED OBLIGATIONS
(Balance at the Close of This Period-3A)
 $
LOANS
(Balance at the Close of This Period-3B)
 $
 I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.
Type or Print Name of Candidate or Treasurer Signature of Candidate or Treasurer Date:Daytime Phone:
NOTE:
The information on this form is required by ss.11.06, 11.20, Wis. Stats. Failure to provide the information may subject you to the penalties of ss.11.60, 11.61, Wis. Stats.
GAB-2L (Rev. 12/09)
This form is prescribed by the Government Accountability Board. Completed forms must be filed with your local clerk.
s
Roman Larson for School Board
9119 West Bonniwell Road
2012
400.00 400.000.00 0.000.00 0.00
400.00 400.00
7.37 7.37
0.00 0.00
7.37 7.37
0.00400.00400.007.37
392.63
0.00
0.00
Roman Larson
Mequon, WI 53097
January 30, 2012262-993-0888
 
SCHEDULE 1-A
Page ____ of ____ 
RECEIPTS
Contributions (Including Loans) From Individuals
Complete Committee Name
Instructions for completing schedules are on the back of each schedule
.Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ Date / Full Name, Mailing Address and Zip Code Occupation, Name and Address of Principal PlaceOf Employment (if year-to-date total exceeds $100)Amount CalendarYear-to-Date TotalCheck if:
In-Kind
Loan
ConduitConduit Name:_______________________________ 
SUBTOTAL ITEMIZED CONTRIBUTIONS THIS PAGE
$
TOTAL ITEMIZED CONTRIBUTIONS
$
TOTAL UNITEMIZED CONTRIBUTIONS $20 OR LESS
$
TOTAL CONTRIBUTIONS RECEIVED FROM INDIVIDUALS
$
11
Roman Larson for School Board400.00400.00
0.00400.00
1221
11
Roman Larson9119 W Bonniwell RdMequon, WI 53097
Student at Stanford UniversityPO Box 17559Stanford, CA 94309400.00400.00

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