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REPORT OF RECEIPTS
FEC
FORM 3
AND DISBURSEMENTS
For An Authorized Committee Office Use Only
125 N 7th St
ADDRESS (number and street)
Check if different
than previously Spearfish SD 57783
reported. (ACC)
CITY STATE ZIP CODE
January 31 Year-End Report (YE) (c) 30-Day POST-Election Report for the:
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
5. Covering Period 05 01 2021 through 09 30 2021
I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete.
Mowry, Mark, , ,
Type or Print Name of Treasurer
M M / D D / Y Y Y Y
Mowry, Mark, , ,
10 01 2021
Signature of Treasurer [Electronically Filed] Date
NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 52 U.S.C. §30109.
Office
Use FEC FORM 3
Only (Revised 05/2016)
Image# 202110019467154811
SUMMARY PAGE
FEC Form 3 (Revised 05/2016)
of Receipts and Disbursements 2 2 / 25
PAGE
Page
M M / D D / Y Y Y Y M M / D D / Y Y Y Y
Report Covering the Period: From: 05 01 2021 To: 09 30 2021
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
COLUMN A COLUMN B
I. RECEIPTS Total This Period Election Cycle-to-Date
06 23 2021
City State Zip Code
Transaction ID : SA11AI.4118
Hermosa SD 57744
06 02 2021
City State Zip Code
Transaction ID : SA11AI.4112
Spearfish SD 57783
07 25 2021
City State Zip Code
Transaction ID : SA11AI.4126
Rolling Hills Estates CA 90274
05 11 2021
City State Zip Code
Transaction ID : SA11D.4128
Spearfish SD 57783
05 15 2021
City State Zip Code
Transaction ID : SA11D.4131
Spearfish SD 57783
05 03 2021
City State Zip Code
Transaction ID : SA13A.4146
Spearfish SD 57783
355.00
TOTAL This Period (last page this line number only).....................................................................
, , .
414.00
TOTAL This Period (last page this line number only).....................................................................
, , .
209.43
TOTAL This Period (last page this line number only).....................................................................
, , .
99.41
TOTAL This Period (last page this line number only).....................................................................
, , .
96.48
TOTAL This Period (last page this line number only).....................................................................
, , .
312.57
TOTAL This Period (last page this line number only).....................................................................
, , .
100.06
TOTAL This Period (last page this line number only).....................................................................
, , .
3373.29
TOTAL This Period (last page this line number only).....................................................................
, , .
52.47
TOTAL This Period (last page this line number only).....................................................................
, , .
52.72
TOTAL This Period (last page this line number only).....................................................................
, , .
623.94
TOTAL This Period (last page this line number only).....................................................................
, , .
805.16
TOTAL This Period (last page this line number only).....................................................................
, , .
Purpose of Disbursement
C
Candidate Name Category/ Amount of Each Disbursement this Period
Type
Office Sought: House Disbursement For:
, , .
▲ ▲ ▲
Senate Primary General
President Other (specify)
Memo Item
State: District:
Full Name (Last, First, Middle Initial)
Date of Disbursement
C.
M M / D D / Y Y Y Y
Mailing Address
Purpose of Disbursement
C
Candidate Name Category/ Amount of Each Disbursement this Period
Type
Office Sought: House Disbursement For:
, , .
▲ ▲ ▲
Senate Primary General
President Other (specify)
Memo Item
State: District:
402.40
TOTAL This Period (last page this line number only).....................................................................
, , .
6896.93
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
,
,
.
1000.00
,
,
.
0.00
,
,
.
1000.00
TERMS Date Incurred Date Due Interest Rate Secured:
(If none, enter 0)
.
M M M / D D / Y Y Y Y
05M / D
03 D / Y Y Y
2021 Y
none 0.00
% (apr) Yes ✘ No
List All Endorsers or Guarantors (if any) to Loan Source
1. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding: ,
,
.
2. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding: ,
,
.
3. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
,
,
.
4. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
,
,
.
1000.00
TOTALS This Period (last page in this line only).................................................................
, , .
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.
Original Amount of Loan Cumulative Payment To Date Balance Outstanding at Close of This Period
,
,
.
3000.00
,
,
.
0.00
,
,
.
3000.00
TERMS Date Incurred Date Due Interest Rate Secured:
(If none, enter 0)
.
M M / D D / Y Y
M
09M / D
16 D / Y Y Y
2021 Y
NA Y Y 0.00
% (apr) Yes ✘ No
List All Endorsers or Guarantors (if any) to Loan Source
1. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding: ,
,
.
2. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding: ,
,
.
3. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
,
,
.
4. Full Name (Last, First, Middle Initial) Name of Employer
Amount
City State ZIP Code Guaranteed
Outstanding:
,
,
.
3000.00
TOTALS This Period (last page in this line only).................................................................
, , .
4000.00
Carry outstanding balance only to LINE 3, Schedule D, for this line. If no Schedule D, carry forward to appropriate line of Summary.