FOR'ruS7RUCI,OA/S,SEEBACKOFFORM

DISGLOSURESUiIi,IARY PAGE
adirc Januaty1, 201O,all sfffiemenband rcprb fled by newcimmiteris
Me ofr@ mu$ be M effioni@lty ard efuirc January,t, 2012,alt ,:.
and rerorfcfild by all crimmittus tor &b offw nud b frle

tltay 1, 2010,ail &tenanfs and reporfsficrSta,tepAGs and Sbfe

Partiesmu&b fi led e&lrtronicatlly.
flUrcDEC3O
di, B:k7
COUilITTEE ]{AtE (Mu$ tu s€lmeas on s'glernefi at Oeanizdion)

by # type ot @mmitbeyor are DR-2 I orsclosune

(Rev.12l2fi19)I REPoRT

CANDIDATECOf f ITTEESONLY:
Pflitical Party(if applicable)

Distrid (if Senateor House)

I to possible dt il ard oiminal penaltes. P|.rsuantto lma Code sections68B.3ilA(Z) ald 68A,[01(3), the candidde, br a
and the cfiairpelson, br any other type of commithe, is O|elndividualrcsponshlo fir flfrg hely fuid accurate ]eporb.

fA M F f L f N G A
OO.- e,r'.Etr 3l - tl) REPORTFOR(1) ELECflON (2)NOi|-ELECTIONYEAR
(repondab) Indicdeov* D
ECNCCT FAMENDMENTTO REPORT DATED L@l Commitees,enbr Dateot Eection

S Ched( if this b tud (brmindion) reportand attaclrNoticeof DissolutionFom DR-3. Countyln

(Youmusilcontinueto fib repfts until a DR-3is filed.)
ls held

STATETENTOF CASHON HAND

GASHOlrl HANDat the @innhg of the rcportingpsriod. (Iobt of ail tundsheldby the
committee.Thb amountilUST be the sanreas the cashon handat the end
of the lastrepodingpedodor mustbEzeroif this is filst repoilfited.) ...................
$ uL5 , t'i
ADD TOTALiIONEY TAKENIN THIS PERIOD
Sfuule A GashContdbufionstotal fiftaclr Sffiule A) falso see in{<indbetow) o
Sdtdule F: LoansRetued btal (Aftdl ScfiedubD.................... o
SdreduleH: TotalSalesof Gampaagn Property(AitaclrSc*reduleH)....................
(Sch€dule H applies to Candldabs' Commttb€s Onlvl
suB-ToTAL.......-.......
$ 6b5 qq
SUBTRAGTTOTALUONETSPENTTHISPERIOD
total(AttachSc{redute
ScheduleB: Et<ponditures B) (-also seedebtsandloansbelow)............ b65 , tq
total(AtachSctredubD....................
ScheduteF: LoanRepayments
CASHON HANDat the end of tfiis reportingpefiod(it finalrepoftbalancemus(be zero)..........................
g i
-UNPAIDBILLS(FromSdreduleD -AttacfiScHule D)..--................ ...............................$ n
'lN KINDCONTRIBUTIONS (FromScfredule -
E AtrachSchedute E).................... .............
$ o
-OUTSTANDlltlc
LOANS(FromSchedule F-Aftch Schedule R.................... .................$ o
CONSULTANTBREAKDOIflI{(SdreduleG Afiacfred?) YES X HO
CANDIDATEGIUTITTEES ONLY:
VALUEOF GAllPAlclrl PROPERTY(FromScheduleH - AttachScfieduteH) $ o
STATEGOMHITIEES: Submita reconciledcampaignaccountbankstatementin Januaryof eaclryear.
 :=f
tNsTRUCrrOruS,
SE BACKOFFORM I:-J ResetFormI
ftroR scHEDUr"E
I
EXPENDITURES- ITIONETSPENT FROTICOTIIiIITIEE ACGOUNT B I uoNernnv
(Rw.o7/txt) | EGEIIDITURES
srArE PAc GofulrTEEs: NorE: FoR @ttrRtBunoNs MADETo sirATEr/llDEoR r-EctstATIvE
CANDIDATES,USTTI{E CANDTDATEIDENNFICATIONNU,IBERIN fiE orggHnreo coLt,MN ANDTHE
PAc CHECKNTMBERFOREACHEpE!{DrURE A UST OF lD NUMBERStSAvAfLABt€ FROif TttE fOtVA D cnecrms BoxrF
ENTNS & CAMPEIGNDISCLOST'REBOARD.
AMENDINGFORM

COUUfTTEEi|AtE (MusfDesanroasonShbnentotOrganhaton)

\1 s q ev S i rt^- \o' S,.^QocrJi so r

UANUIUAIE NAMEANDADDRESSTOWHOM PURPOSE AMgUNT
DATE IDNUMBER EXPENDITT'RE (DESCRTBETMNSACflON) EXFENDED
E(PENDED Sf apllcable) (Di$urenwrt) $lAS MADE
(MM[ID/YR) ANDPAC
CHECK
NTJMBER
,w 0S-eola. eo.-c't1
Guz e Y l z 1 6 ,bc*r
ll - ll -/tl
cKr '4t,o,!.!,fi AJ uo.{isq d $7f. b o
5 tz-+4 "
tI# 6c-hc\al*- da-n^tY
Pco:s
'ivr4,.-n SF
cl(# 86q a:nl'"tl
,, ,,5 -/D oc-he\oAun,tA
AJ o"--rt;t 5a,5o
{tE,rl
a,.n
RrCr. Si r*.-
It 4l\ 'l a^ c.te ^ 4 .z So-l t'0*rr'-L"rl
a -a-1-10CKF O ohr42_[a,a rn 6t"Fl
5gl ,71
tm
ct(#
tm
cl(#
ItE

ct(#
lw

cK#
rt)#
ct(#

$ 1 .L s . t j
TOTAL(rf tasf ge ot ftls *lulule) $l-t.< xq
THISBOXAPPLIESTO CANDIDATE9'@UTITTEES ONLY:
Purdusesof oertahcarpalgn pmpertyco€finggs{Xlor mo|€mustalsobe lnrentoriedon SdreduleH. (R6br to Sffirds H hsfiucdons.)
ElFntfitre b lE sotlstentt€strovlffig @tlsuft€, advedetng,tmd-rahlng,poffng,managlng,
organkfrqservlceomustalsobe detalltbmtsedon
Sdtdde G byttF ajnqnt, quteoqg,ano_ lgQ^qfga$ typc of er@ndftre madebythe person/endtyon bohalfof fiE canddab'sconrmltGe.(R&r to
S€'EdulsG ln$ucilo'|s ard loua Code68A4@6XI).)

ru€ {61

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