Meriden Mayor Michael Rohde's Finance Disclosure Statements

i)

SEEC FORM 20

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Itemized Campaign Finance Disclosure Statement

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CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION Rev. 1/08

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First

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Last

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. 4. ELECTl<fNIREFERENDUM DATE

(mm/dd/7Io J / W

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Suffix

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3. TREASURER ADDRESS

560 Yqk

Page 1 of]7

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2 TREASURER NA ~

Street Address

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1. NAME OF COMMITTEE

ITi!le

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se~

SUMMARY PAGE

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Do Not Mark in This Sgace EQT

Officla

ICi/1er~~

State

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ZIP Code

06 '-lTe)

6. DISTRICT NUMBER

5. OFFICE SOUGHT (Complete only ifCandidaie Committee)

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7. CAND~ATE NAME (Complete only if Candidate or ExplorPtr/ry Committee) ITitie

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First

IMI~

1'1)~el

!LaSI

1Lo~

ISUffiX

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Is. TYPK OF KEl'UK '(Check One Boxl

o January 10 filing o April 10 Iiling o July 10 filing o October 10 filing o Independent Expenditure o Primary

o 7th day preceding referendum o 45 days following referendum o Deficit o Termination

}{;th day preceding primary 030 days following primary

o 7th day preceding election o 12th day preceding election

o Initial Contribution or Disbursement (PACsONLy)

o Amendment to Type of Report:

(State Central CommiJtees Only)

0 Election

045 days following election not held in November

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L

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Beginning Date

Ending Date

dl{alt.~t- t tJ l LoV~

thru

Sft2leM-(,( ,.. Il

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10. CERTIFICATION

I hereby certifY and state, under penalties of false statement, that all of the information set forth on this Itemized Campaign Finance Disclosure Statement for the period covered is true, accurate and complete,

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-' SIGNATURE)

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J'PrcK S'lfc9 IL/L

PRINT NAME OF SIGNER

1/ V PENALTY FOR FALSE STATEMENT IS PUNISHABLE BY FINE NOT TO EXCEED $1,000, OR IMPR1S0NMENT FOR NOT MORE THAN ONE YEAR, OR BOTH.

i

09/0;-J20fL DiTE (m~dd/yyyy5

SEECFORM20 Itemized Campaign Finance Disclosure Statement CONNECTICUT STATE ELECTIONS ENFORCEMENT COMMISSION Rev. 11m

Page 2 ofl7

SUMMARY PAGE TOTALS NAME OF COMMITTEE

~r;'e>1.d5

FILING DUE DATE

of--

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t?-u hd...cL­

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COLUMN A

COLUMNB

This Period

Aggregate

Il. Balance on hand January I of current year for Ongoing and Party Committees OR

0

Balance on hand from day Committee was formed for all other committees

D

12. Balance on hand at the beginning of Reporting Period

6/00 /00

13. Contributions received from Individuals (Sections A and B) 14. Receipts from Other Committees (Sections CI and C2)

6/00 t' () ()

0

15. Other Monetary Receipts (Sections D-K)

()

16a. Total Small Food and Beverage Receipts at Fair (Section Ll) Town Committees ONLY

0

16b. Total Proceeds from Small Purchases at Tag Sales, Auctions or Other Sales (Section L2)

t)

Municipal and Town

16c. Total Purchases of Advertising in a Program Book (Section L3) Committees ONLY

0

5"~~O

6 SS-O

17. Total Monetary Receipts (add totals for lines 13-16c)

:€ ;

7!:>u

67ro

18. Subtotals (add totals in line 12 + line 17 in Column A; and in line 11 + 17 in Column B)

67S-0

67':J---U

19. Expenses Paid by Committee (Section P) 20. Balance on hand at close of Reporting Period (Subtract line 19 from line 18 in both Columns) 21. In-Kind Donations not Considered Contributions Received (Section L4) 22. In-Kind Contributions Received (Section M)

$0

S .2.:> Y

t; Lf ~/ I~ 6{,

0

3Qg .

6 l[if1.6,6

0

'-I L/f,. is­ 'f '£(..1:;-­

0

23. Refundable Deposit to Telephone Company (Section N)

()

24. Receipts of Organization Expenditures (Section 0)

a

25. Beginning Loan Balance

()

U

fJ

()

0

()

D

0

()

OJ

25a.

25b.

25c.

+ +

-

Loans Received (Section

D)

Interest and Penalties on Loan Payments on Loan

25d. Total Outstanding Loan Amount 26. Campaign Expenses Paid by Candidate (Section Q) 27. Expenses Incurred on Committee Credit Card (Section R)

.s V

()

)22 ..

7)­

V

28. Expenses Incurred by Committee During this Period but Not Paid (Section S)

'3 I l-[ f" ~--7

28a. Total Outstanding Expenses Incurred by Committee still Unpaid (Section S)

"3 ~ Ycr')'7

22- 2, 7 J i)

I. MONETARY RECEIPTS (Sections A-I{) NAME OF COMMITTEE

Page 3 ofl7 FILING DUE DA TE

ot-­ JVlv..t JV'l.

Fdl'A--iS

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A. TotalContributions from Small c..'Ontributors-Received this Period ONLY Subtotal Section A

(See instructions for definition ofSmall Contributor)

9b/zO() 'J

$/f/7&

B. Itemized Contributions from Individuals Last Name

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J)

first

r- ,.

6toaIS~t;dM

(M·'{-i

Is contr\t~r a lobbyist, spouse, or de pen ent child of a lobbyist?

D

,iJ

Is this contribution associated with a fundraising event listed in Section L I? Ifyes, list Event #

e

~ CityA-e~\

Yes No

J

tr- ~C050

Last Name

DYes No

Lt. -z.-O Res;;~eett1d:;A~ J:.

First

o (

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

D

~

Is this contribution associated with a fundraising event listed in sect; L I? Ifyes, list Event # Method of contribution: D Cash I8"Personal Check

~ Yes D No

o CreditJDebit Card

iJr'v-e­

ity

~

o

4-fD6°tJD

'-1

.aa.-l

~f

Residential Street Address

3&

f:''-I..''-f'' ,!<;e..

Yes No

lis contributor a lobbyist, spouse, or dependent child of a lobbyist?

D

M

Is this contribution associated with a fundraising event listed in Section L j?

Ifyes, list Event #

Arnount of Contribution

bre.J~ ,/J

~

2--/() i

DYes ~ No

IAggre;:;O~ributions

/iJO

Principal Occupation

IZiP8b~rV

Arnountof Contribution

Name of Employer

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: D Executtve D Legislative

CA~

H·AL

Voo

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business helshe is associated with have a contract with said municipality valued at more than $5,000') DYes D No

Yes No DYes

I2f> No

Dare Re;r;

I~%-

First~ Or((:i ;?-f..

('Lit,\ V'\o W

e.s\d:;5

Name of Employer

Date R?17

I MI

:/

Method of~tribution: D Cash Personal Check D Credit/Debit Card 0 Payroll Deduction 0 Money Order Last Nan~

r~1

S

D Payroll Deduction D Money Order

JV'G:,."

D Yes ~ No

Is this contribution associated with a fundraising event listed in SCion L1?

Ifyes, list Event #

Principal Occupation

IMl

IAggr;; ~tribUriOnS

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: D Executive D Legislative

Firs~~

Is contributor a lobbyist, spouse, or dependent child of a lobbyist')

j u9

Date Re;7;{)

DYes ~ No

J"1::i ~ '4"" / I If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or buslOess helshe is associated with have a contract with said municipality valued at more than $5,000?

D Yes ~ No

Yes No

Last ~c:.p/f\ef!.fJ-L

Res~7,:/tree~;; tJ

e./

~ {:e.

City~

~

N;WE~~t<J'1 Ud

Is contributor a principal of a state contractor or prospective state contractor') Ifyes, indicate which branch or branches of government the contract is with: D Executive D Legislative

'Iia'

c::;

Arnountof Contribution

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said DYes!ii:t No municipality valued at more than $5,000?

Method of contribution: DCasiJ ~ 'Personal Check D Credit/Debit Card D Payroll Deduction D Money Order

i

PrinCiPal~f~t;r~

Ml

I~tate

0­

de IZ1m

yI c) ?

DYes D No

IAggre~r:;::trions

Principal Occupation

Arnauntof Contribution

~

b1Jv)

Name of Employer

-

i

K:

If contribution is in excess of $400 to a candidate committee for a chief executive officer ofa municipality does contributor or business helshe is aSSociat have a contract with said municipality valued at more than $5.0000 D Yes No Is contributor a principal of a state contractor or prosPective state contractor?

Ifyes, indicate which branch or branches of government the contract IS wtth: D Executive D Legislative

Method of contribution: D Cash~Personal Check D Credit/Debit Card D Payroll Deduction D Money Order

/00

Dat:;7t~!J '1

I

DYes No

lit

IAgg?{)#,tri~ons

SUBTOTAL Section B-This Page TOTAL of additional Section B Pages TOTAL OF ALL CONTRIBUTIONS FROM Th'DIVIDUALS (Sections A & B) (Enter total on Line 13 o/Summary Page)

I

i

loa J('oO 3b"2-J­ 6100

I

I. MONETARY RECEIPTS Section B. Additional Page IFlI.TNn OJ iF nA TF

INAMF OEr01\;

... B. Itemized Contributions from Individuals LastN.me

fJ Ii sit Ie q

I IV, Ml

Principal Occupation

Amount of Contribution

l I Is contributor a lobbyist, spouse, or dependent child ofa lobbyist?

9'

Is this contrtbution associated with a fundraising event listed in Section L I? Ifyes, list Event # Method of c£0I'lbution: Cash ~ Personal Check

o

0 Yes ~

Is this contribution associated with a fundraising event listed in SectIOn Ll? Ifyes, I ist Event #

o

9'

0

Is contributor a principal of a stale contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: 0 Executive 0 Legislative

~

Is this contribution associated with a fundralsmg event listed in Section LJ? If yes, list Event # Method of c~tribution: Cash V:lI Personal Check

o

~ Yes

0

Date

Payroll Deduction

0

Money Order

I

Received l

DYes No

o

IAggr;:t~oOntributjOnS

£/ P1 t.J7

' (../

If contribution is in excess of$400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,0001 0 Yes 0 No

No

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: 0 Executive 0 Legislative

No

Credit/Debit Card

0

Is contribu tor a lobbyist, srk/use, or dependent child of a lobbyist?

I

DYes $;I"No

o Credit/Debit Card 0

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

Method of c~tribution: Cash Personal Check

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,000?

0 Yes 0 No

DYes No

0

Payroll Deduction

0

Money Order

IDate Received ~ I I 9/ c.) ,

DYes No

o

IAgg/reg:~ coontributions

v

If contribution is in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business he/she IS associated with have a contract with said 0 Yes 0 No municipality valued at more than $5,000?

Yes No DYes ~o

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: 0 Executive 0 Legislative

o CreditlDebit Card 0

J

Dale Received~.

Payroll Deduction

0

)

Money Order

I

I

DYes

o No

I

Aggregate contributions

<5 17'/1/1 ' J-tJ 0

Name Ct-...··~ k> r FirSfJ e­ ~ ~ Principal occup~~ >~l ~ "R;:-e-,c;:i" d-eL/n-, ~a"'lS"'rtr-:m-e"-t::"Att""'ddrt;"-es-s­ (I-EXi---.rl-----.....,f;,c"'ity---\J--.fj-l .......---Ir,:~s.,-tt.~t~n--r;J.llPI9-;c",~tr-ef-v--+-;:-N"'a-m.,-e-O"'fEr:l=np:;I":'OY":'e":'r-'--I\--/L--''-=:;...:::...c...;......;=...::;......~--+ Last

I

~ No

,5 thIS contnbunon associated with a idndraismg event listed in Section LJ? Ifyes, list Event #

0 Yes

¥l

Is contributor a principal of a state contractor or prospective Slate contractor?

Ifyes, indicate which branch or branches of government the contract is with.

0 Executive 0 LegIslative

'No

I \lethod of contribution: Cash ~ Personal Check 0 Credit/Debit Card 0 Payroll Deduction 0 Money Order

: 0 '!

Last Name

Firsl

/J

IL-V~~~

17,;)-0

(leI

)J~M-')"" L.ir~ 0 V

contributor a lobbyist, spouse, i or dependent child of a lobbyist? t Is

i

Is thiS contribution assOCIated wlth a fundraising event listed in Section L1?

Ifyes, list Event #

I Method of contribution: I

0

Cash

ISf'Personal Check

0

Contribution

M"

, ....

"AA

JDale

IMh... rr

"J

(J<",,,,

Recejve~ / {

. J dY (5 f 1---, f (J'7

DYes No

o

JAggregate;;:'~ution'

/1/(/

Principal Occopalion

~R7c-~.dlccnm'~ial~S~tr~~~S-~----/~~----~C~i~~~~~J,~-,~-.--,~-1--~--~1ISSt~;~;;-1~fi7£P~ccotcJdle;-L--~N~a,mne~O~f~Emm~PIQ,Oy~efr----------------------1

i

Amount of

If contnbution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she IS associated with have a contract with said municipality valued at more than $5,000?

0 Yes 0 No

DYes

Is contributor a 101Jbyist, spouse, or dependent chIld of a lobbyist?

/00

_v~

Yes No

'/lJo Amount of Contribution

1>",1

(. c) ....

II"I., If contributlOn is in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business heishe is assOCIated with have a contract with said municipality valued at more than $5,000?

0 Yes 0 No

DYes

~No

CreditIDebit Card

ls contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: 0 Executive 0 Legislative

o Payroll Deduction

Date Received

0

Money Order

I

.

(

l

q

~'y(, . cJ1_

DYes No

o

lAggreg;e~on~ibuti~~s

£.

u tJ

v-

SUBTOTAL Section B-This P~e Page

J.r::

of

-L­

I. MONETARY RECEIPTS Section B. Additional Page ~~.> lasr Name

IFlI.lNn m n:: nA TF

~.-~

INAMF0Fcm"

1.91'-­

f1.&'"1 A

-

5"fJ iY\. -e-l \ .

Firsl

~

L

"

I

f/~{Ja.f)

ls contributor a principal of a state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract is with: Executive Legislative

o

!Lasl Name

D

, fundraising event listed in Section LJ? Ilyes, list Event # Method of ~ibution: D Cash Personal Check I

Last Name

(

~rr,t

D Yes

City

Is this contribution associated with a fundraising event lIsted in sectr L J? Ilyes, list Event #

DYes No

.ResidentiaJ Street

t: Iii···,,. J

e-(-(...__

Is contributor a lobbyist, spouse, or dependent Chlld of a lobbyist?

City

Is this contribution associated with a fundraising event listed in sec,on L J? Ilyes, Itst Event #

~Yes

I

Asgr,&tr~7ns

~rinCjp~Upal$~)~

MI (

Payroll Deduction D Money Order

/t:/O Amount of Contribution

Name ofEmpJoyr

o

FIti <7

Dare Recei~/l

1

Agg/Dnuions

PrineiiaJ OC~Ufaliori

\w

DYes D No

tJf-[;~

fI~)f-r..>

;(){} Amount of Coutribution

;1.{-lj/~ !r-Jb6dt~ ~e::;;;oy~ C.~1 fky (cL,';f

o

o Payroll Deduction o Money Order Dat?t~ei;;U 1

City

Yes No Yes D No

I

Ml

~: J;==riO~JJ~

PrineiVai o~:a~fr.

I

Name of Efnployer

,

....

DYes No

o

IAgs~cvtions -'-'H'I::!3-2

[;lio Amount of Contribution

;>

If contribution is in excess of $400 to a candidate comminee for a chief executive officer of a municlpaltty does contnbutor or business he/she is associated with have a contract with said DYes D No municipality valued at more than $5,00Q? ls contributor a principal of a stale comractor or prospective state contractor?

Ilyes, indlcate which branch or branches of government the contract is with· Legislative D Executive

Method of tl\lntribution: ~ Cash ~ Personal Check D CreditiDebit Card D Payroll Deduction

I o I

I

Is contributor a principal of a state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract is with: Legislative D Executive

No

G

DYes D No

If contribunon is in excess of $400 to a candidate committee for a chief executive offiq[r of a municipahty does contnbutor or business he/she is associated with have a contract with said DYes D No municipality valued at more than $S,OOO?

Yes No

0r .tt::.~

I

o

First !~I

ess

G)

e

o Money Order

o

Is contributor a principal of a state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract is with· Executive Legislative

lid-

o

I t~'1

Name of Employer

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said DYes municipality valued at more than $5,000?

No

Method of~bution: Cash Personal Check D Credit/Debit Card

[)w...;-ei .>

Amonntof Contribution

o

Re~eceettrn CI( sf- 1ei'1(J.{f

Last Name

Payroll Deduction

Flrsk.ct~ V Ih,

iii

/00

I

Yes

f D

Principal Occupation

o Dal?l~~/tJJ'

J.Jt tit f' ~,aL) ~~f7

o CreditJDebit Card 0

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

rgg72Jztlions

Is contributor a principal of a state contractor or prospective state contractor?

IIYes, indicate which branch or branches of government the contract is with: Executive Legislative

~ No

\2l No

115 this contribution associated with a

DYes No

o

If contribution is in excess of $400 to a can9fclate committee for a chief executive officer of a municipality does contnbutor or business he/she is associated with have a contract with said municipality valued at more than $S,OOO? DYes D No

sr--

Is contributor a Jobbyist, spouse, or dependent child of a lobbyist?

7

j'/~p/cJ

od

firSILJ -t [ { "

fie Vi

o

Date Received

!~ fl&~itv/~Jcl---IZ36yy;>

o CreditJDebit Card 0

(yc:? u:. "\~

Res~;al StTlY~et--

o Payroll Deduction o Money Order

e;

D Yes \,(l' No

Is thlS contribution associated with a fundraising event listed in Section LJ? IIYes, list Event # Method of V~butiOn: D Cash Personal Check

Name of Employer

F~

Is contnbutor a lobbyist, spouse, or dependent child of a lobbyist?

I

iP

Amount of Contribution

o

.~ Yes No

c.o ~

Re~ni( Streel 0~~ 0

I

r'2-r--f (91;JU

PrincipaJ Occupalion

MI

If contribution is in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $S,OOO? DYes No

Yes No

Method of c~tion: D Cash Personal Check D Credit/Debit Card

S

t11~

J)1'r<:-­

Is this contribution associated with a fundraising event listed in Section Ll? Ilyes, 1ist Event #

laS! Nam~ I{

I

L

Is contributor a lobbyist, spouse, or depend ent child of a lobbyist?

i

r::r((; If...C. • .s

City

J t.<. \:/i

3t'1

~<fl '2AJ() 9

B. Itemized Contributions from Individuals

,

Residential Streer Address

J

t1.-~~_

o

0 Money Order

DYes No

o

J?/tJf !

Date Recei~8l

II

Aggrega7;,utr

1uBTOTAL Section B-This Page Pa e

/{)O ~b5£. of

-t

I. MONETARY RECEIPTS Section B. Additional Page 'NAME nF roll.

Lasl NamDQI\ ~l Residential

-4 B. Itemized Contributions from Individuals

JMro

Firsl~

.>

/'rddr~l JI/'C"'­

C~

Is contributor a lobbyisl, spouse, or dependent cnild ofa lobbyist?

D

~

Is this contribution associated with a fundraising event listed in serion L I? Ifyes, I ist Event #

~ £Lj

City

CC

l2ii.J-o

J...c/ /

tf.If

g

Is contributor ,t lobbyist, spouse, or dependent chJld of a lobbyist?

Is this contribution associated with a fundraising event listed in Section L1?

Ifyes, list Event # Method of C'F!!!~bution: D Cash Personal Check Last Na"lL-o

"11

City

rJ ,Il C.vt

DYes tiiYNo

I of,;!6cf D

Ilt

Is this contribution associated with a fundraising event listed in Section L1?

Ifyes, list Event #

City

CgeJ':i/'

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

tL.lt;..

D

ls this contribution associated with a fundraising evemlisted in Section L1? lfyes, list Event #

ot

P IZi

I

IMlD.

D

Is this contribution associated with a fundraising event listed in Section L J? Ifyes, list Event # Method of c~tribution: D Cash Personal Check

Name OfEmplo;~L

Amount of Contribution

t-

o Payroll Deduction D

WA-... to ~ 4-

IDate Rec<wed

Money Order

IlL

IStaCrlZot~/9f

8'[ v>/J1

DYes D No

I

Aggregater;joS

::200

PrindpaJ Occupalion

AmouDtof Contribution

Name ofEmpJoyer

If contribution is in excess of $400 to a candtdate committee for a chief executive officer of a municipality does contributor or business helshe is associated with have a contract with said municipality valued at more than $S,OOO? DYes No

Yes No

o

DYes ~ No

r

IJJcr..hf~~ !

a

00

1

PrinCiP~~tt:'~

~ ISct-rl~~

Ci:S;::J4.A..

ILa'At J'f'gJl .'

//.-1.2

DYes No

o

IAggreg./::;~tiJJ

f:ll--?/m

o

Is contributor a principal of a state contractor or prospective Slate contractor?

Ifyes, indicate which branch or branches of government the contract is with: Executive Legislative

First

\IS contributor a lobbyist, spouse, or dependent child of a lobbyist?

,,-/11­

Date Received

o

I

I(}O Amount of Contribution

(C

Name ofEmployer

y{ V

Money Order

Method of C~bution: Cash Personal Check D Credit/Debit Card D Payroll Deduction D Money Order

!Residential Street Address

Occnpt-IJ 'y c!.

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: Executive D Legislative

First

'P

Auc

D Yes D No

!, -", . Jer'-.

d-- :3 <.!)

IS~T

DYes D No

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business helshe is associated with have a contract with said DYes D No municipality valued at more than $5,0001

Yes No

Method of ~tribution: D Cash Personal Check D CreditIDebit Card

F Residential Street Address

...

JAg/j?;:~rtions

vi

D.tedV;j/

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate whIch branch or branches of govemment the contract IS with: D Executive D Legislative

First

Is contributor a lobbyist. spouse, or dependent child ofa lobbyist?

Last Name

A.-0---r.~ .J:;;-.

I

I M l f L I Principal

o Credit/Debit Card o Payroll Deduction D

\/;~

Amount of Contribution

If contnbution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business helshe is associated with have a contract with said municipality valued at more than $5.000?

DYes D No

Yes No

be/'\

Residential Street Address

.

sit.

81

Is contributor a principal of a state contractor or pro~pective state contractor?

Ifyes, indicate which branch or branches of govemment the contract is with: D Executive D Legislative

¥Yes D No

FiTSIf ,.....

Re'id73r~ AddTfJO CCl),j(

~

Name ofEmpJoyer tnt>.(;-...

If~ 1.v&1/~ If contribution is in excess of $400 to a candidate committee for a chief executive officer' of a municipality does contributor or business helshe is associate~ith nave a contract with said D Yes No municipality valued at more than $S,OO()?

Yes No

Q/ r •~

[ ~ f., 1.-r.9vj

Principal Occupation

ZJ

Method of crI/ribution: Personal Check D Credit/Debit Card D Payroll Deduction D Money Order D Cash LaSt7'lc,

IFn .IN<l m lP nA TP

/'1~ ~

r1.e~s

Ac

~.

Yes No

v1J:.

o o I 'iiI 2..v OZ I Date Received

DYes No

o

lit?o

AGG/;)O;;butions

Principai Occupation

I Ml

~. d Jf R/,o<) IS~1-n~otiu

Amount of Contribution

Name of Employer

If contribution IS in excess of$400 to a candidate committee for a chief executive officer of a municipailty does contributor or business he/she is associated with have a contract with said DYes municlpality valued at more than $S,OOO? No

o

~Yes No

o CreditlDebit Card o

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: Executive D Legislative g Date Received Aggre Payroll Deduction 0 Money Order

o

I Rfu 'IIu9 I

DYes No

o

I a'72t)

SUBTOTAL Section B-This Page Page

~

Idv ~ OJ

of·2_

I. MONETARY RECEIPTS Section B. Additional Page ,N A MF

nF rOMMITfFF

~/"/9~) Last N~t?tf\.t'

IFll INn DJ IF nA.TE

~f1 I~ p. ~. Itemized Contributions from Individuals ILo~

-.:;)(f-­

~L~

Re(;sttree~r&~

FirS/g

i

Yes No

bh

AddQ{J

Last Nami2.

D5cJo

0

It contnbuc.un lS

DYes ]>DIo

c

Firstl<'e ;K City /f/La.t

I

Method ~~~ibution: Cash Personal Check

o

J_ , / : ; ,

0 Yes

Is conlribulor a lobbyist, spouse, or dependent chIld of a lobbytst?

First

City

DYes No

gr

Is this contribution associated with a fundraising event listed in Section L I? If yes, list Event#

D Yes No

¥

n2trJ'Z.

0

Money Order

I

!vi]

I~~

Name OfEmPJOye~

I piU itch I

It.

Prin~ip'"

DYes No

o

IAggres; ~:ar

Date Re

!06rrl

J

Oc61ipation

Amount of Contribution

IslJ Amount of Contribution

Name c, EmpI0,"f

o

Date Received

0

Payroll Deduction

0

C;C? r.:;r«­ ~~

Money Order

I

;;1].)," /r.9 ~

D Yes No

0

JAggregate7;;Z;

Principal Occupation

MJ

i:r--rctYJ7

Amount of Contribution

.p1'\.S'/~

Name of Employer

/u{)

fS/? Lb--­

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a muniCipality does contributor or business he/she is associated with have a contract With said DYes municipality valued at more than $S,OOO? No

o

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: Executive Legislative

Method OfC~bution; D Cash Personal Check D Credit/Debit Card D Payroll Deduction D Money Order

"­

CO"'1I~ 3f121(J'0J2.

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: D Executive Legislative

o Credit/Debit Card

C

2SO

Pri~cjpaJ Oc!upation

Ml

o

P No

~ol d r :-J( Res9~al 7X:/;;~, cI >1vt-t~

!LastNan;1{

I

~~~

AgU.vtTibutiOI1S

If contribution is in excess of $400 to a candiMte comminee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,000?

DYes No

DYes

~No

Is this contribution associated with a fundraising event listed in Section L j?

Ifyes, list Event #

I

(1/ ~ viOl

Money Order

DYes

LegiSlative~

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: D Executive D Legislative

Method of ~7ution: Cash Personal Check D Credit/Debit Card D Payroll Deduction

l?

P_ C.

Amount of Contribution

If contribution is in excess of$400 to a candidate committee for a chief executive ofJicer of a municipality does contributor or business he/she is associated with have a contract with said DYes D No municipality valued at more than $5,000?

Yes D No

6'" r r:! r-, et Resi/ 1 A}3;j ~ ~ &,v 6

0

t;, r

IV\. ~-

'K1

\

l

/IJD

In

D Payroll Deduction

I0

Is contributor a lohbyist, spouse, or deoendent child of a lobbyist?

CL rtzP/'~

o

City

~

Is this contrIbution associated with a fundraislOg event listed in Sec/on L1?

Ifyes, list Event #

ILast Name

IPrincipal Occupafion

JDate Received

Fi'l>c;.

C'1 ~e..Yes Is contributor a lobbyist, spouse, No or dependent child ofa lobbyist?

i

Aggrega7IJ{)

Date

Is contrlbutor a principal of a state contractor or prospectlve state contractor? /fyes, indicate which branch or branches of government the contract is with: Executive D

o Credit/Debit Card

I\1C A

DYes D No

excess of $400 to a candIdate commJnee fol a chtef executIve officer of a municipality does contributor or business he/she is associated with have a contract wtlh said municipality valued at more than $5,OOO? DYes D No

Yes ~ No

Residentia1 Str·eet Address

.:+!

Fi'C L .

f 6?r- iLs?;.d ~:\'CJb{lJ d<.IScrred~rl(fll"meL::tyer. ()ff. .h

Is this contribution associated with a fundraising event listed in Section L1?

If yes. list Event #

o

p'-/

Name of Employer

I L/"~lvedL.--"7i£vC; I

I~

FirstrM~

Is contributor a lobbYlst, spouse, or dependent child ofa lobbyist?

Method or c~~ution: Cash ersonal Check

~.?_W'dtjO

o Payroll Deduction o Money Order

o

,ReSidenti

Amount of Contribution

~rnr~

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: D Executive D Legislative

Method OfA~bution: Cash Personal Check D Credit/Debit Card

Lo..-(.0 '"1

Principal Occupation

114­

If contribution lS in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,OOO? DYes D No

DYes !iJ- No

Is this contribution associated with a fundraising event listed in Section L]?

Ifyes, I ist Event ~

Lasr Name

e

City~

$r

Is contributor a lobbyist, spouse, or depend ent child of a lobbyist?

I.(I

f

?-UV 7

o

IDate Rec~:f/uf JJf /

o

DYes D No

\ Asgr":?a "?)ions

SUBTOTAL Section B-This Page

/CfYJ 1ffD ~

I. MONETARY RECEIPTS

I

Section B. Additional Page

h'll IN(; nIH:: DA TF.

"".,.~,

!NAMF.nE

f i ;e.-LAs.

;11.c~'1 ,/\

Lr-:r--:

'"

/;qaIS~~

First

~ Yes No

rr

lii3

Is this contribution associated with a fundraisi ng event listed in Section L I? Ilyes, I ist Event #

0

l

Method of ~ibution: .r -'lash Personal Check

Resitti 2:'ee, S;;;~

b

o

\

Last Name

I Last Namef2-."

IReside~.aOeet

~ Yes No

Last

7r

j

l'r

/h :{ ~

IReSidenrral,SIG Add?,S

'

J

")prCf

Yes

Yes §Y'No

I or

dependent chIld of a lobbyist?

'/"Ile '-~ 0

11

City

!

I I I

I

Method of ~ibution: 0 Cash Personal Check

~'!!J.~hr.

PrilkipalOccupation

MI

e:dA.C r. .J;;­

'/\I

r::;;;J..fJ

/So Amount of Contribution

Name of Employer /

';

Payroll Deduction

0

I lMt:r

Money Order

!L J- c..Atv'd..­

~r

o

o

Da,e R~7te0

Or

f U

DYes No

o

J

Aggre/;pz:;ns

1PrincIjaJ Occupation

/t7D/ I

Amount of Contribution

rDbd~ Name of Employer

0

S,~ ,"2: ~ f)!i!

Money Order

I

o

o

Date Receivel~

~ l-

ifLU)1

PnnclpaJ ~d

M 1 ]

~ Is~erlZiP~~drj-V

I

Aggregate;j)D

{ Cc;,./

Name of!-n

lre-.Va~

DYes No

o

~ 1l1iJ.,r-5t

loU Amount of Contribution

Ad(ll,t~"J

If contribution is in excess of $400 to a candidate comminee for a ~"ic, ~"CCUtl.~ officer of a municipality does contributor or business he/she IS associated with have a contract with said municipality valued at more than $5,000'1 DYes No

Yes No

o

I

I

0

o Credit/Debit Card o Payroll Deduction

Is thIS contribution associated with a fundraislOg event listed in Section L1? llyes, Itst Event #

!

-' Aggr,~~ons

~ ':J... ,'y'

Is contributor a principal of a state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract IS wllh: Executive Legislative

First

liS contributor;:: lobbyist, spouse,

Money Order

o

to

L

o

~

If contribution is in excess of $400 to a candidate committee for a chIef executive officer of a municipality does contributor or business he/she IS associated with have a contract with said munictpality valued at more than $5,OOQ? DYes No

~ No

t/b"

o

Date Rece;/;d

Is contributor a principal of a state contractor or prospectIve state contractor? llyes, indicate which branch or branches of government the contract is with' Executive Legislative

City~

Is this contribution associated with a fundraising event listed in Section Ll? llyes, Itst Event #

I

DYes No

o

o

{tYes No

0

lobbyist, spouse, or dependent child of a lobbyist?

¥rl

Amount of Contribution

municipality does contributor or business he/she is associated with have a contract with said DYes municipality valued at more than $5,OOO? No

o CreditlDebit Card

liS contributor a

0;::;t.'l-- ed Name ofEmploy~ I ~

rfv!~ ,~ r~~fZJ J"C2.1Vr'\..

If contribution is in excess of $400 to a candidate comminee for a chler exeeutive officer of a

~

o

t i'-IZi'66

;vt.vr,~

First

Method of ~~ution: Cash ersonal Check

lc

IY-

Is contributor a principal of a state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract is with: Executive Legislative

City

. tl

AM

IAggregat/:9m;:JO~O JOZJ

fl1~iJ~

Principal

First~

eO 't'_

I

Money Order

o

o

DYes 1':i4"No

Is this contribution associated with a fundraising event listed in Seetion L1?

Ilyes, list Event #

o

0

JDate Received

DYes No

o

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or bUSiness he/she is associated with have a contract with said municipality valued at more than $5,0001 DYes No

Residential Street Address

or dependent child of a lobbYIst?

Name of Employer

o

o CreditlDebit Card o Payroll Deduction 0

Il~] ILcgj ,n ( Lu' 4- '-'1 .rs contributor a lobbyist. spouse" j

Zi

Amount of Contribution

Is contributor a principal of a state contractor or prospective state contractor? llyes, indicate which branch or branches of government the contract is with: Executive Legislative

1..

fl£"", 'e~1

Method of jOtribution: Cash Personal Check

t

Dr,;'-C- City~.

Is this contribution associated with a fundraisin g event listed in Section L1?

Ilyes, list Event # Method of ~tribution: Cash Personal Check

Jri &67"rz

Fi~f<J..--

0 Yes ~ No

Is contributor a lobbyi((, spouse, or dependent chlld of a lobbyist?

Principal Occupation

o

Yes No

o Credit/Debit Card o Payroll Deduction

([(0'1

JM~

If contribution is in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $S,OOO? DYes No

Cq-r/~.~-~'

Last Name

fl1cvJ-c

City~

0

Is contrib'-ltor a lobbyist, spouse, or depend ent child of a lobbyist?

c;,.~h ~uvj

B. Itemized Contributions from IDdividuals

II- \9,l.S$ e ~

Last Nam,,­

I

1l .. 4.~

~es No

Is contributor a pnncipal ofa state contractor or prospective state contractor?

Ilyes, indicate which branch or branches of government the contract is with Executive Legislative

o CreditlDebit Card o Payroll Deduction o Money Order

o

I

o

7 .

Da'g7l:P/()

DYes No

o

IAggreg_so23~ts

)tD

frfv Page _b_ of 7

SUBTOTAL Section B-This Page

I. MONETARY RECEIPTS Section B. Additional Pa~e 1FT! .lNG m IF DA TF

!NAMF

_I-rl el\..A s

C)f­

/"t iLl~ Resi~~SteJifljri~

k0

City

Yes ~ No

Is conui&-utor a lobbyist, spouse, or depenci en child of a lobbyist?

Is this contribution associated with a fundraisi ngevent listed in Section L1?

Ifyes, J islEvent # Method =fl~ution: Casl'" ersonal Check

o

Res'55

0

~

0

Method of contribution: ~ Personal Check Cash

o

I

_

0

WJ

Is this contd bUlion associated with a fundrmmg event listed in S/iOO Ll? Ifyes, IrSt Eve?t # Method Of~;jbution: Cash Personal Check

o

LaS!

I

Name

/-...

"K1 0

liS contributor a

lobbyist, spouse, or dependent child ofa lobbyist?

0

ijl

Is thiS contribullDIl associated With a fundraising e~ent listed in Section LJ7 Ifyes, list E~ent # Method of ~~ribution: Cash Personal Check

o

!

Money Order

Amount of Contribution

I

Aggreg~~~lltions

Principal Occupation

2r-t':J Amount of Contribution

c~

1h..5.~

0S

DYes No

o

I

Istate

IlIP Code

Is contributor a prinCIpal of a state contractor or prospective state contractor?

Ifyl!S, indicate which branch or branches of government the contract is with: Executive Legislative

City

8c e(

/""'~

I

Da;,

tJ1 t/JL;

it

R~~ t.9 1 Princip~

I Ml

IS~:djp

o

DYes No

o

J

Aggre;te;n:;utions

r;;,;rn

b6~

Name of Employer

~ ~

/00 Amount of Contribution

n('~

i>hl­

If contribution is in excess of $400 to a candIdate comminee for a chief executive officer of a mUDlcipality does contributor or business he/she is associated with have a contract with satd mUDlctpality valued at more than $5,00Q? DYes No

o

Yes No

Is contributor a principal of a state contractor or prospective state contractor?

Ifyl!S, indicate which branch or branches of government the contract !s with Executive Legislative

First

OeM,y

Cityr"-~

ro....o( DI"'f'<-

ou/~

e vV)'IW '9-!

o

I r( ~!u ,

M1

o CredlllDebit Card o Payroll Deduction 0

h.

f1{.o"\.

0

.fi ~ .>

(Lc.

Yes No

£.e,C cv\ !Residential $treel Address

I d- I

Payroll Deduction

First

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

I

0

o CreditlDebIl Card o Payroll Deduction o Money Order

C",lc. G.-Q !Residen!ial Street Address . (7 £' M~('cL J1 /(yc i

t p m ' { j v Name ()fES;J~

'.:JJ

1'00

Name of Employer J jVL~ (../' ()6tfV S'-I. c,N:> ""'"f.?1-!2 If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said 0 Yes ~ No municipality valued at more than $5,00Q?

DYes B.,No

t

!Last Name

Pri~~~ ~'vt..

o

Cily

Yes No

Is this contribution associated with a fundra!sing event ilsted in Section L I? Ifyes, IJst Event #

I

Aggrega~C:;b~ons

.-f/ t!{

~/1

o

First

Ja

DYes No

o

Is contributor a principal of a state contractor or prospective state contractor?

Ifyes, indicate which branch or branches of government the contract is with: Executive Legislative

CreditlDebit Card

,,~l.vz.! "" () .;v..r----

Is contributor a lobbyist, spouse, or dependen'l child ofa lobbyist?

JMS.

o

o

Date Received

0

r:;;C/

If contribution is In e~_ess of $40010 a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5.000?

DYes No

~No

rre.~

'i

Money Order

tar

f\/~wfo~(l

I

Da!e Received

TJ..~d.Dle-

DYes

Residential Stteet,,~ddreSS

J

o Payroll Deduction 0

City

Yes ~ No

tr'Personal Check

Last Name

Na~~10Y~C-t.U.t, <t 1:!keJr',t-.

o

0

I Method of" contribution:

Amount of Contribution

Is contributor a principal of a state contractor or prospective state contractor?

Ifyl!S, indIcate which branch or branches of government the contract is with: Executive Legislative

fI

Is this con tribution associated with a fundraislo g event listed in Section Ll? Ifyl!S, list Event # Cash

P 2..v09

If contribution is III excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,0001 DYes No

Credit/Debit Card

LQke

or depende]l'lt child of a lobbyist?

0

v.,kiJ 1'N;f.., Ij IState IliP Code I _. .c.r- 1)6 r(/2­

First

~O,..rlbut::ora IObuYISt, sp,_"",­

i

r

DYes No

Za f";;5 ~'''!-~~ 10'1

8cj?/e~

B. '""Itemized Contributions from Individuals First Principal OCf!;.,3tion IMJ fLol:>~ -Cf'~

LastN.me

Last Name

I

tLohd...­

~~

Yes No

0 Yes ~ No

It-

Money Order I Ml

I

o

S l..·n vl1

o

DYes No

o

I

Aggreje;Otions

Date Received "'

S-b

Principal occuPa;~1-lr~

J-1

~a(-' Ili~~dt j 7J

Name of Employer

Amount of Contribution

/\/11

If contribution is in excess of $400 to a candidate comminee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with saId mumcipality valued at more than $5,OOQ? DYes No

o

Is contributor a principal of a state contractor or prospective state contractor?

Ifyl!S, indicate whtch branch or branches of government the contract is with· Executive Legislative

o CreditlDebit Card o Payroll Deduction 0

Money Order

l

o

o

8 y\1/ (JOJ

Date Rece; ved;)

DYes No

o

I

Aggregate JO~u;:s

I

SUBTOTAL Section B-This Page Page

l

b-)

6 d-f> of

-l-­

!

I. MONETARY RECEIPTS (Sections A-K) NAME. ()F COMMITTEE

E{':e~;.

00­

I

iFILING DUE DATE ). ,/::::7::­

I

~

M~

Page 4 oft? I

~

cS't

2A20 )'

I

Ct. Contributions from Other Committees Name of' Committee ~ ( t5~ Address City

'-{:3

W ".o.J

(-efl'cre

!(,lV'v'\

fI\...-er. ~

IName of Treasurer

~~,'-r~

(1·/ f~

L,

~ ..Jo;" erto

jIsfundraising this contribution associated with a event listed in Section

IZi

Q~ V]"V [Dat~?~;! () 7

IAggregate /;~~

/00,

\15 this contflbution associated with a

Jt.!e

City

Amount of Contribution

DYes Ifyes, list fundraising event I isted in Section L I? D No Event #

riP Code

IAggregate Contributions

IDate Received

Name or Comn..j ttee

rame of Treasurer

Address

1:5 this contnbution associated with a

Amount of Contribution

0 Yes Ifyes, list fundraising event listed in Section L I? 0 No Event #

I

City

State

riP Code

IAggregate Contributions

IDate Received

I

Name of Committee

Name ofTre.surer

JIsfundraising this contribution associated with a 0 event listed in Section L]? 0

Address City

rate

IZi P Code

Amount of Contribution

Yes Ifyes, list No Event #

rggregate Contributions

rate ReceIved

Name of Committee

rame ofTre.surer

!~s this contribution assoctated with a

Address

Amount of Contribution

0 Yes Ifyes, list fundraismg event listed in Section Ll ry D No Event #

City

IState

IZi P Code

IAggregate Contributions

rate Received

rame of Treasurer

Name of Committee

Address

Amount of Contribution

I;s this contnbution associated with a 0 Yes Ifyes, list fundralsmg event listed in Section LP D No Event#

City

Istate

riP Code

rggregate Contributions

IDate Received

..

ents. Pavments, or Surnlus r'

C2. Reimf Name of Committee

Name ofTreasurer

Address

Date Received

I

ity

()0:7

Name of Treasurer

Address

i

Amount of Contribution

I

Name of' Committee

State

\Zi P Code

Address

Date Received

State

IZi P Code

from other C

.

o Reimbursement for shared expense o Surplus o Payment for goods and services Distribution Name ofTreasurer

I

.

Amount of Receipt

Name of Committee

City

GoO<!e

DYes Ifyes, list L1? ~ No Event #

P

IState

ft.

() Amount of Receipt

o Reimbursement for shared expense o Surplus o Payment for goods and services Distribution SUBTOTAL Section C·This Page TOTAL of additional Section C Pages

TOTAL OF ALL COMMITfEE CONTRIBUTIONS AND RECEIPTS (Enter total on Line 14 ofSumma11l Po£'e)

0 0

IvO

I. MONETARY RECEIPTS (Sections A-K) NAME

a

Page 5 of17

IFfLING DUE DATE

COMMITTEE

I D. Loans Received this Period Name of L<nder ~treet

! Source of Loan: City

Addr!ss

State

I

Name of C <signer/Guarantor

o Bank

IZiP Code

o

DYes rlfyes list

o

0

Individual

I

Street Addr<ss

Candidate

State

jCity

Other Committee

Source of Loan:

r tty ity

Name ofCosignerfGuarantor

Street Addnss

State

o Bank

IZiP Code

o

o Individual 0 State

name and address of Cosigner-Guarantor)

o

No

Date of Receipt

[ZiP Code

Name of Lender

Street Addnss

Is there a Cosigner Amount Received or Guarantor of this loan?

Candidate

Is there a Cosigner or Guarantor of this loan?

Amount Received

DYes rlfyes list name and address of Other Committee

('osigner Guarantor)

o

No

Date of Receipt

riP Code

Total Section D

0

$

E. Receipts from Entities other than Individuals or Other Committees (Referendum Committees ONLy) i Name

orEn,ty

Street Address

Date Received

Aggregate ContnbutlOns

Zip Code

State

City

Amount Rec:eived

Name of Entity

Street Address

Date Received

State

City

Amount Received

Aggregate Contnbutlons

Zip Code

Name of Enfity I

IStreet Address

Date Received

State

City

Amount Received

Aggregate Contnbuttons

fiPCOde

Total Section E $

0

F. Amount Transferred from Affiliated Business Treasurv (Business Entity Committees ONLY) Date of Receipt

Amount

Date of Receipt

Is this transaction associated with a fundraising event listed in Section L I?

DYes No

o

/fyes, list Event #

--足

Amount

ls this transaction associated with a fundraising event listed in Section

DYes No

LJ?o

Total Transfers

0

Ijyes, list

Event# _ _ _

$

G. Amount Transferred from Atliliated Labor Union or Other Onlanization Treasurv (Oreanization Committees ONLJ') Date of Receipt

Date of Receipt

Amollnt

Amount

Total Transfers

$0

H. Personal Funds of the Candidate Received this Period (Candidate Committees ONLY) Date of ReceIpt

I

Amount

Method of payment:

o o o

Cash Personal Check Credit/Debit Card

Method of payment: Date of Receipt

Amount

o Cash o Personal Check o Credit/Debit Card

Total Amount Received

$

V

I. MONETARY RECEIPTS (Sections A-K) NAME OF COMMIITEE

Page 6 ofl7 r IFILING DUE DAIE

I I. Anonymous Contributions (Specify dollar amount ofthe bills received) Date Received

I

Date Received

[Amount

Total Amount Received

Amount

$1 bills

$5 bills

$1 bills

$5 bills

coins

$10 bill

coins

$10 bill

S

Date Received

I

J. Interest from Deoosits in Authorized Accounts

Date Received

Amount

Name of Institution

Name of Institution

Street Address

Street Address

City

0

I State

I

. !Amount

City

Zip Code

Total Amount Received

IZi P Code

I Slate

$

I

0

K. Miscellaneous Monetary Receipts not Considered Contributions Date of Transaction

Name

I

Sireet Address

City

Amount Received

I

I

Zip Code

State

Description

I

$

Date ofTransaction

Name

I

Street Address

City

!

Amount Received

riP Code

State

Description

I

I

$

Date of Transaction

Name

I

Street Address

City

0

I

State

b

Amount Received

I

Zip Code

sV

, Description I

Total Section K

Summary of Other Monetary Receipts (Sections D-K)

0

Total Loans Received tbis Period (Section D) Total Receipts from Entities other tban Individuals or Other Committees (Section E)

+

Total Amount Transferred from Affiliated Business Treasury (Section F)

+

Total Amount Transferred from Affiliated Labor Union or Other Organization Treasury (Section G)

+

: Total Amount of Personal Funds oftbe Candidate Received tbis Period (Section H)

+

Total Amount ofAnonymous Contributions (Section I)

+

Total Amount ofInterest from Deposits in Authorized Accounts (Section J)

+

Total Miscellaneous Monetary Receipts not Considered Contributions (Section K)

+

Total of Other Monetary Receipts (Add Sections D-K) (Enter total on Line 15 ofSummary Page)

0

$

(/

ll. FUNDRAISING EVENT ACTIVITY

('r:~MJ

f11~ !Lo~

of-­

V Fundraisiog Event II / Dale of FundTaiser

~).(wd!

Page 7of17 IFILING DUE DATE

NAME OF COMMITTEE

L,~ -<.JIiITV<-...,

I

d­

Z-OO

7'

Ll. Fundraiser Event Information Letter

ct..­

Location:

Description

P4

Street Address

City

~rcJoJ<. .4, (Y

67q

.11 T'

~

State

Zip Code

Cr

06f6lD

/

.Subpart 1: (All Committees)

~Yes (l/yes, go to'Section L4 In-kind Donations not Considered Contributions

Was this fundraising event hosted at a personal residence?

and complete required information for purchases made by host(s) for food, beverage and mvitations.)

ONo DYes (I/yes, go to Section L4 In-kind Donations not Considered Contributions and complete required information)

Did this fund raiser include items donated by a business entity of up to $100 or items donated by an individual of up to S50?

1SJ..No E::JYes (lfyes, go to Section L2 Proceeds from Tag Sale, Auction, or Otber Sale of Donated Items.) htNo

Was this fundraiser a tag sale, auction, or other sale of donated items i with purchases from an individual of up to S50?

\SUbPart 1: (TUI'm Committees and Municipal Candidate Committees ONLy) Were there purchases of advertising space in a program book associated with this fundraiser?

I

I Subpart 3: (Town Committees ONLy)

l!ir1Yes (lfyes, go to Section L3 Purcbases of Advertising Space in a Program Book and complete requIred information) o No

I

0 Yes (I/yes, enter Total Reeeipts from small purcbll~ $

• Did your committee sell food or beverage at a fair or similar mass I gathering held within the state?

I

0 No

Fundraising Event # Date of Fundraiser

Letter

Description

Location:

Street Address

City

State

Zip Code

Subpart 1: (All Committees) Was this fundraising event hosted at a personal residenee?

I

I

IDid this fundraiser include it:m~ ~onated by a business entity of up to . $)00 or items donated by an mdlvldual of up to $50?

Was this fundraiser a tag sale, auction, or other sale of donated items with purchases from an individual of up to S50?

DYes (I/yes, go to Section L4 In-kind Donations not Considered Contributions and complete reqUIred information for purchases made by host(s) for food, beverage and invitations) ONo DYes (l/yes, go to Section L4 In-kind Donlltions not Considered Contributions and complete required mformation.)

Ohio DYes (lfyes, go to Section L2 Proceeds from Tag Sale, Auction, or Other Sale of Donated Items.)

0 . Subpart 1: (Town Committees and Municipal Candidate Committees ONLy) \ Were there purchases of advertising space in a program book associated with this fundraiser?

I

I Subpart 3: (Town Committees ONLy) I Did your comml:te~ sell food or beverage at a fair or SimIlar mass I gathering held wlthm the state?

0 Yes (I/yes, go to Section L3 Purcbllses of Advertising Splice in a Program Book

o

and complete required information) No

DYes (I/yes, enter Total Receipts from small purchllses here~

o

I$

No

SUBTOTAL Section Ll (Town Committees ONLy) Total Receipts-This Page TOTAL of additional Section Ll Pages +

TOTAL OF ALL RECEIPTS FROM SECTION Ll (Enter total on Line 16a ofSummary Page)

I

II. FUNDRAISING EVENT ACTMTY

Page 8 oC 17

NAME OF COMMITTEE

JFlLING DUE DA TE

J7 /l1-YV\ fL~~ '1L.fL () 2 L2. Proce'eds from t'ag Sale, Auction, or Other Sale of Donated Items

f7' .'-1' /( C >

J

I

Name of Purchaser Last Name (Individuals ONL1') Residential Street Address

I

First rate

lily

Method of payment: Cash Personal Check D.te Received vent

o

CreditlDebit Card

Aggregate AmountoC Purchases

o

CreditIDebit Card

Aggregate AmountoC Purchases

Method of payment: Cash Personal Check Date Received I Event #

o

Credit/Debit Card

Aggregate AmountoC Purchases

Method of payment' Cash Personal Check Date Received JEvent #

o

Credit/Debit Card

Aggregate AmountoC Purchases

MI

Method of payment' Cash Personal Check Date Received JEvent #

o

CreditIDebit Card

Aggregate AmountoC Purchases

I MJ

Method of payment: Cash Personal Check

o

CreditfDebit Card

Aggregate AmountoC Purchases

o

CreditIDebit Card

Aggregate AmountoC Purchases

o

CreditIDebit Card

JZiP Code

Method of payment: Cash Personal Check Date Received JEvent#

Aggregate Amount of Purchases

o

CreditlDebit Card

IZiP Code

Method of payment: Cash Personal Check Date Received JEvent #

Aggregate Amountol Purchases

MI

[liP Code

o

o

r

#

Items purchased Name of Purchaser Last Name (Individuals ONL1')

MI

r

tate

Residential Street Address rly Items Purchased Name of Purchaser Last Name (Individuals ONL1') Residential Street Address

I

[ First

I MI

IS tate

lily

o

o

Date Received

Ili P Code

I Firsr

Method of payment: Cash Personal Check

IliP Code

o

IEvent #

o

Items Purchased

I

Name of Purchaser Las! Name (Individuals ONL1') Residential Street Address

I

Firs!

IS tate

lily

MI

Ili P Code

o

o

Items Purchased Name of Purchaser Last Name (Individuals ONL1')

Residential Street Address Items Purchased

I

r lY

Name of Purchaser Last Name :(Individuals ONLy)

Residential Street Address

I

First rate

Jli P Code

I first Jstate

ICily

JliPCOde

o

o

o

o

Date Recelved

JEvent #

Items Purchased Name of Purchaser Last Name (Individuals ONLY)

Residential Street Address

IItems Purchased 'Name of Purchaser Last Name !(Indlviduals ONLy)

Residential Street Address Ilems Purchased

I

First

r

lY

o

Istate

IZi P Code

I

First

r

lY

Istate

First

ICily

o

rate

o

Date Received

o

I

Name of Purchaser Last Name (IItdividuals ONL 1)

Residential Street Address

Method of payment: Cash Personal Check IEvent#

o

o

Items Purchased

SUBTOTAL Section L2-This Page TOTAL of additional Section L2 Pages TOTAL OF ALL SMALL PURCHASES FROM TAG SALES, AUCTIONS OR OTllER SALES OF DONATED ITEMS (Enter total on Line 16b .ro.

Palle)

_()

0 ()

n.

FUNDRAISING EVENT ACTMTY

Fr}r "tel.;[

d-­

~~

f/1k~

Page 9 ofl7 I

IFILING DUE DATE I A~~ t' ?OU~

NAME OF COMMrTTEE

L3. Purchases of Advertisin2 in a ProRl'8m Book (Municipal Candidate and TflWn Committees ONLy) Business Entity

Name of Purchaser

G..--Jt'l\aA

(;0)'-'" eerl>-S

Street Address

(O'C> .... 1

3

Sycq-

ffl>C/ to' e ES

/ ~

I~~ ~~~

ICity~

Name of Purchaser

"2c; / -t' Z

( ; 0 Y\.

LL C-

G "-'), f-r..u-N 9 '"

~r~. ~vJr;;u/~ .!J c; 1.-0,:/ C/' r

Street Address

c::? l\.t-......h <.t-S'

:J.)

Name of Purchaser

j

Street Address

J-ql)

S.

6fCi6-c/ )t.

Name of Purchaser

Street Address

-

I

City

rt~7 ~i~~~l

Name of Purchaser

Street Address

I I

Street Address

tc r06~j~

Vta!e

Street Address

I I Name of Purchaser Sueet Address

I State

I

Zip Code

r

ity

ICity

.rity

I

State

I

Zip Code

~ame

r

late

IState

I Zip Code

I

Zip Code

Streer Address

Ffyes ONo

Event)

DYes ONo

DYes ONo

DYes ONo

ICity

ISt.te

I Zip Code

ity r ICity

IState

I

State

I

Zip Code

ICity

I

State

r

ity

I

State

DYes ONo

Zip Code

I

Zip Code

I

Zip Code

DYes ONo

Aggregate Purchases for All Events

,JC-I,,,.­

Amount of Purchase

)--0 J:J

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for AI! Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purcbase

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purchase

Aggregate Purchases for All Events

Amount of Purchase

Event #

Event #

Event #

SUBTOTAL Section 1.3-This Page i

~~,._ro

Event #

Business Date Received Entity DYes ONo

2P

Amount of Purchase

Event #

Business Date Received Entity DYes ONo

Aggregate Purchases for All Events

.) 5"""'0.00

Event #

Business Date Received Entity

J

~¢,oa

Amount of Purchase

Event #

Business Date ReceIved Entity DYes ONo

Aggregate Purchases for All Events

Event #

Business Date Received Entity DYes ONo

I

Event #

; Business Date Received Entity

of Purchaser

I

/

Business Date Received Entity

Name of Purchaser

Street Address

Event #

Business Date'Received Entity

Name of Purchaser

i

ONo

.¥f'2-j /jr.J '1

Name of Purchaser

t

~Yes

Business Date Received Entity

Name of Purchaser

I Street Address

Business Date Received Entity

Business Date Received Entity

Name of Purcbaser

Street Address

Event;

ONo

.9fJ1jot7

-~J'\.-C-.

rA~

>CJ Yes

Dj/:e;;~d9

TOTAL of additional Section 1.3 Pages TOTAL OF ALL PURCHASES OF ADVERTISING IN A PROGRAM BOOK (Enter total on Line 16c ofSummary Page)

;f)7/ 0

S-SV

i

n. FUNDRAISING EVENT ACTIVITY NAME OF COMMITTEE

Page lOof17

FILING DUE DATE

I L4. In-Kind Donations Not Considered Contributions Name of Donor Street Address

Description of donation

r

ity

Donation given by: ISt.te

Zip Code

Date Received

Description ofdonation

r

IState

Aggregate value for this event

Date Received

Event #

Description ofdonntion

Donation given by路

r

ity

Istate

fity

Aggregate value for this event

Date Received

Event #

Donation given by路

I

State

Description of'donation

I

City

Aggregate value for this event

Date Received

Event #

Donation given by:

I

State

I

Zip Code

Description of donation

r

ity

jstate

Description of donatIon

r

ity

Aggregate value for this event

Date Received

Event #

Donation given by:

r

tate

Aggregate value for this event

Date Received

Event #

Donation given by:

Description of donation

I City

r

tate

o Individual o Business Entity

Zip Code

Name of Donor Street Address

o Individual o Bus iness Entity

Zip Code

Name of Donor

Street Address

i

Fair Market Value of Donation

Fair Market

Value of Donation

Fair Market Value of Donation

Event #

Donation given by

Name of Donor Street Address

o Individual o Business Entity

Fair Market Value of Donation

Aggregate value for this event

Date Received

Description of donation

o Individual o Business Entity

Zip Code

Name of Donor Street Address

o Individual o Business Entity

Zip Code

Name of Donor

Street Address

o Individual o Business Entity

Zip Code

Name of Donor

Street Address

Event #

Donation given by: ity

Fair Market Value of Donation

Aggregate value for this event

Name of Donor

Street Address

o Individual o Business Entity

o Individual o Business Entity

Zip Code

Aggregate value for this: event

Date Received

Event #

Fair Market Value of Donation

Fair Market Value of Donation

Fair Market Value of Donation

SUBTOTAL Section L4-This Page TOTAL of additional Section lA Pages TOTAL OF ALL IN-KIND DONATIONS NOT CONSIDERED CONTRIBUTIONS (Enter total on Line 21 ofSummary Pa/le)

D

ID. NONMONETARY RECEIPTS

Page 11 oft7

NAME OF COMMITTEE

IFILING DUE DATE

of:足

Fr-Je"dS Name Street Address

77.r

~/4JA. /fff/Klc jl{l~f d-d J<

[s contributor a lobbyist, spouse, or dependent child of a lobbyist?

~(~/09 fltl)

7~~tdreJu,

!LD-~e / ;1\.e r .J.a,-r~-

\

:9 6nO

Zip

d

9/R/o9

I

Type of Contributor: Fair Market Value of this Individual : Contribution Committee 0 Other (Applicable only to Referendum Committees) i

8'

0 Yes

[f contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said mumcipality valued at more than $5,00Q? DYes fir No Aggregate contributions Description ofln-Kind Contribution [s this contribution associated with a Yes fundraising event listed in ction Ll ') No Ifyes, list Event #

Date Received

Name

Jt.,.e ICity

I

l'1a10f足 fLol-tr:::!e u M. In-Kind Contributions

~ No

g

1

-e.. Cv....-Sh.f! I'\.足

C){OA7

R:J

Is conthbutor a lobbyist, spouse, or dependent child of a lobbyist?

Dale Received

5/'2f/v9

ICity~

IState

Cr

Pood

Zip Code

Dh clfO

0 Yes 8r No

r

ity

Is contributor a lobbyist, spouse, or dependent child of a lobbyist?

cI r'S c.

IState

Zip Code

.3

J

Type of Contributor: 0 Individual 0 Committee 0 Other (Applicable oilly to Referendum Committees)

[J Yes D No

3.)0. {)-::J Fair Market Value oHbis Contribution

[f contribution is in excess of $400 to a candidate committee for a chief executive officer of a mUnicipality, does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,000'7 DYes No Aggregate contributions Description onn-Kind Contribution Is this contribution associated with a DYes fundraising event Iisted in Section L I? 0 No /fyes, list Event #

o

Name Street Address

Istate

ICity

Zip Code

Type of Contributor.

0 Individual 0 Committee 0 Other (Applicable only to Referendum Committees)

0 Yes 0 No

Fair Market Value of this Contribution

[f contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,000?

DYes No Aggregate contributions Description of In-Kind Contribuuon [s this contribution assOCIated with a DYes

Is contriblltor a lobbyist, spouse, or dependent child of a lobbyist?

o

fundraising event listed in Section LI 0 /fYes, list Event #

0 No

'Name

Street Address

IStale

ICity

Is contnbutor a lobbyist, spouse, or dependent child of a lobbyist0 Dare Received

?cr,p~ Fair Market Value oHbis Contribution

o

..>g

Street Address

Date Received

S'r

[f contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated WIth have a contract with said municipality valued at more than $5.000') DYes No Aggregate contributions Description ofln-Kind Contribution Is this contribution associated with a Yes fundraising event listed in Section L I? No ocfl-e. ~JU.vj /fyes, list Event # /

Name

Date Received

'J. e/7.

Type of Contributor: IS?' Individual 0 Committee 0 Other (AppUcable only to Referendum Committees)

Zip Code

Type of Contributor: 0 Individual 0 Committee 0 Other (Applicable only to Referendum Committees)

Fair Market Value of this Contribution

0 Yes 0 No

If contribution is in excess of $400 to a candidate committee for a chief executive officer of a municipality does contributor or business he/she is associated with have a contract with said municipality valued at more than $5,000?

DYes D No Aggregate contributions Description of In-Kind Contribution Is this contribution associated with a 0 Yes fundraising event Iisted in Section L I? D No Ifyes, list Event #

SUBTOTAL Section M-This Page TOTAL ofadditional Section M Pages

"/ if'!. efT 0

'f '19 .J'( TOTAL OF ALL IN-KIND CONTRIBUTIONS (Enter total on Line 22 ()fSummary Page) (NOTE: This section refers only to advances of deposits by individuals from

N. Refundable Deposit to Telephone Company Last Name oflndividual

first

Residential Street Address

City

personalfunds to benefit the committee, not deposits made by the committee.)

Dare Deposit Made Amount of MI Deposit IZiP Code IState

I

Name ofrelephone company Street Address

ICity

IState

IZiPcode

Total Section N (Enter total on Line 23 ()fSU1II1nIlry Page)

m.

NONMONETARY RECEIPTS

Page 12 of17 JFILlNG DUE DATE

NAME OF COMMITTEE

1LJl~ /j ). Atr.::kJI.t~ O. Non..(t\,fonetary Receipts of Organization Expenditures Made By Le!rlslative Leadership. Let!islative Caucus. and Party Committee

I

fr;..e <1.-J s

Name of Committee (Legislative Leadership, Legislative Caucus, and Party Committees ONLY)

7'~-7

!l'.me of Treasurer

Date Notice Received

Street Address

City

SJ

I State

Fair Market Value ofDonatioD

Aggregate Donations

I Zip Code

I

Purpose of Expenditure (see Instructions)

Description of Donation

()

DADBDcDDDE l'ame of Committee (Legislative Leaduship, Legislative CauClls, and Party Committees ONLY)

IName ofTreasurer

Date Notice Received

Street Address

City

I

State

I

Aggregate Donations

Zip Code

I

Description of Donation

Purpose of Expenditure (see instructions)

Name of Committee (Legislative Leadership, Legislative Caucus, and Party Committees ONLy)

DA DB Dc DD DE

J

Name ofTreaslirer

Date Notice Received

Street Address

City

jst.te

I

J

I

Purpose of Expenditure (see Instructlt)lls)

Name of Committee (Legislallve Leadership, Legislative Caucus, and Party Committees ONLy)

DA DB DC DD DE

I

Name of Treasurer

Date Notice Received

Street Address

I State

Fair Market Value of Donation

Aggregate Donations

I Zip Code

IPurpose of Expenditure (see Instructions)

Description ofDonalion

Name ofCOlnmittee (Legislative Leadership, Legislative Caucus, and Party Committees ONLY)

DA

I

0 B DC 0 D DE

Name ofTreasurer

Date Notice Received

Street Address

City

Fair Market Value of Donation

Aggregate Donations

Zip Code

Description of Donation

City

Fair Market Value of DonatiOD

JSlate

J

i

Fair Market Value of Donation

Aggregate Donations

Zip Code

I

Description ofDon arion

Purpose of Expenditure (see instruct/ons)

DA DB Dc DD DE Name of Committee (Legislative Leadership, Legislative CauClls, and Party Committees ONLy)

IName of Treasurer !

Date Notice Received

Street Address

City

\ State

I

Purpose of Expenditure (see instructions)

Name of Committee (LegishItive Leadership, Legislative Caucus, and Party Cammll:tees ONLy)

I

DA DB Dc DD DE

Name of Treasurer

Date Notice Received

Street Address

Description of Donation

Aggregate Donations

I Zip Code

Description of Donation

City

Fair Market Value of Donation

I

State

I

Zip Code

Fair Market Value ofDonation

Aggregate Donations

JPurpose of Expenditure (see instruct/ons)

DA DB Dc DD DE

Total Section 0 (Enter total on Line 24 ofSummary Paf!e)

V

IV. EXPENDITURES

Page 13 ofl7

IFILmG DUE DATE

NAME OF COMMITTEE

FrlC~ Name-Ti:..yee

..t.

s

~ At?t(r~~.J,lvS~

Street Address

It C(Dv..A...

Purpose of Expenditure (by code)

~~.

A足 rv'Etv5

~

City Descnplion

Date of Payment

~

~-

Type of Expenditure (if applicable): o Coordinated with reimbursement sought Coordinated without reimbursement sought L1 Independent o Organization (see Instructions) oA DB Dc Do DE

I ~J; '-V,,?

(L.,"'-~ I't~ P. Expenses Paid by Committee

of足

IState

$/~J(

IliP Code

ur足 OM1-u

~.r1~

,-. ~

Candidate(s) Name (if applicable)

..

~----'-L1 o Debit Card o Supported o Opposed

Street Address

City

Purpose of Expenditure (by code)

Description

Istate

Method of Payment

o Debit card Event iI

Cand,dale(s) Name (if applicable)

Office Sought

gSupported o Opposed

$

, Name of Payee

Date of Payment

I

City

IState

Method of Payment

o

Event #

Candid.teis) Name (if applicable)

o Supported

Office Sought

o Opposed

o

$

DA DB Dc Do DE Date of Payment

Name of Payee , Street Address

City

Purpose of Expenditure (by code)

IState

Method of Payment

Amount

o Check

IZiPcOde

o Debit Card

Description

Type of Expenditure (if applicable): o Coordinated with reImbursement sought o Coordinated without reimbursement sought o Independent o Organization (see Instruct/ons)

Amount

Check # o Debit Card

\Zi P Code

Description

Type of Expenditure (If applicable) o Coordinated with reimbursement sought Coordinated without reimbursement sought , 0 Independent I 0 Organization (see Instructions)

Amount

o Check

fiPCOde

o o

Purpose of Expenditure (by code)

3vJ>.J'1 $

Date of Payment

IStreet Address

Amount

Event:;

Office Soug6t

l' arne of Payee

Type of Expenditure (if applicable): o Coordinated with reimbursement sought Coordinated without reimbursement sought Independent o Organization (see Instructions) DA DB Dc 00 DE

Method of Payment

Event #

Candidale(s) Name (if applicable)

o Supported o Opposed

Office Sought

$

oA DB Dc 0 0 DE IDate of Payment

Narne of Payee

Method of Payment

Amount

!

Street Address

City

Purpose of Expenditure (by code)

Description

Type of Expenditure (ifapplicable): o Coordinated with reimbursement sought o Coordinated without reimbursement sought o Independent Organization (see Instructions) oA DB DC Do DE

Istate

Candidate(s) Name (If applicable)

oCheck#_ _ _ o Debit Card

IZi P Code

Event #

Office Sought

o

Supported oOpposed

o

$

SUBTOTAL Section P-This Page

30;揃'Y

TOTAL of additional Section P PaRes TOTAL OF ALL EXPENSES PAID BY COMMITfEE (Enter total onLine 19 o/Summary Page) 3~, -,

Y

IV. EXPENDITURES

Page 140117

IFILING DUE DATE

NAME OF COMMITTEE

rr''eAi,{

u1 (,

Name ofPaye.

Street

(NM ~~n~o

(by code)

I

tU:,~

City

p f9 sI

fM.-!r,~ Description

.

Date of Payment IState t(~

0°

[ZiP

te

Iff!>

· (by code) i

p f?- N )

rt~tp~ylj¥

Street Address

11'i(",

1IJJU;l,

rbUy':S;e~f~;rru;; Name of Payee S treel A ddr.ss

Ch M

Date of Payment IZi P Code

CityLft.--

OlrtffV'

Ie;

tJ S

IPurpose of Expenditure

Is Reimbursement Claimed?

City~

Date of Payment

ISta~/_IZiP ca;;;6l(J u

t& Yes

o No

jL~L7

Is Reimbursement Claimed?

f/t~ldL

No

-

;?-Cl5~~ Date of Payment Istate

Amount

gYes Event #

Description

City

Amount

<;;",~J

Name of Payee (Name of Vendor who candidate paid directly) Street Address

Jr." "

Event #

0'. ~·I C--e..

r~

Amount

[]eYes

o No

o/t flu 7

Description

(Nam~andidi~7t~ dir0P-4~

Purpose of EXPerlp"e • (by code)

-

Is Reimbursement Claimed?

t"Lk...

r \ Pif; ~

~)r-

y,/ frU

Event #

;)l-r,~

Amount

~Yes

o No

glIb/v?

Descrjption

Name of Payee (Name of Vendor who candidate paid directly)

· i

Date of Payment

wf'd­

IPurpose of Expendi

f'!Lrjv~

5~~S

City

Airtt CJ., rlJ

Is Reimbursement Claimed?

Event #

Name of Payee (Name of V~~/;ate paid directly)

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o No

Event #

Description

· (by code) !

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City

Purpose of Expenditure (by code)

Description

Date of Payment IState

[s Reimbursement Claimed?

Amount

DYes

I Zip Code

ONo Event #

Name of Payee (Name of Velldor who candidate paid directly)

I Street Address Purpose of Expenditure (by code)

City

Dare of Payment istate

I

, Purpose ofExpenditure · (by code)

o No Event #

Description

City

Date of Payment

tare

Purpose ofExpenditure (by code)

Description

Amount

DYes

o No Event #

Name of Payee (Name of Vendor who candidate paid directly) City

Is Reimbursement Claimed?

TZiPCOde

Description

Street Address

Amount

DYes

Zip Code

Name of Payee (Name of Vendor who candidate paid directly) Street Address

Is ReImbursement Claimedry

Date of Paymenr

lSlar.

Is Reimbursement Claimed?

Amount

DYes

fZiP Code

o No Event #

SUBTOTAL Section

Q-This Page ]~1...1J

i

TOTAL ofadditional Section Q Pages TOTAL OF ALL EXPENSES PAID BY CANDIDATE (Enter total on Line 26 0/ Summarv P(lfle

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71

IV. EXPENDITURES NAME OF COMMITTEE

Page 150f17

Fr"-'l-V;

fV1~ rL;;[k -1 I ~cft ?-()..) J 'R. Expeii'ses Incurred on Committee Credit Card

Name olIssuing Institution

Type of Credit Card:

0

Visa

0

Other

i Name of 'iendor

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Purpose of Expenditure (by code)

Purpose of Expen diture (by code)

City

I State

Purpose ofExpenditure (by code)

Description

Date ofTransacllon City

I State

Event #

Date ofTransaclion

tate

Purpose of Expenditure (by code)

Event #

Date ofTrans8ction

I State

Description

Event #

Purpose of Expenditure (by code) ~ame

Date of Transaction

City

rate

Event #

of Vendor

Date of Transaction

City

Purpose of Expenditure

Description

Amount

JZiPCOde

Description

Street Address

Amount

rpCOde

Name of Vendor

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Amount

IZiPCOde

Description

City

Amount

IZi P Code

Description

CIty

Amount

Event #

: Name of Vendor

Street Address

o Discover o American Express

IZi P Code

Name of Vendor

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Master Card

Date of Transaction

Name of Vendor

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o

I State

Amount

IZi P Code

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(by code) Name of Vendor

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I

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Date ofTransacdon City

Amount

IZi P Code

Description

I

State

Amount

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Purpose of Expenditure (by code)

Description

Event #

SUBTOTAL Section R-This Page TOTAL of additional Section R Pages TOTAL OF ALL EXPENSES INCURRED ON COMMITTEE CREDIT CARD (Enter total 011 Line 27 ofSummarv Paflei

i I

IFlUNG DUE DATE

f)

IV. EXPENDITURES NAME OF COMMITTEE

rr: vuis

Name ofc,edito'6 C ~ Street

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l1rt..vf {j,.. 12 c:LAtJ s.'Lpk~ S. Expenses Incurred by dSmmittee but Not Paid Durinltthis Period Date Incu~L L$j u 1 Spec: aL f-..t

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Amount Incurred (Estimate Or A ctlla I)

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Amount Incurred (Estimate or Actll.al)

Event #

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Date

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9

Office Sought

Candid.te(s) Name (If applicable)

SpeC ,Ial f-..t

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Event # Zi

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Description

Street Address

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Type of Expenditure (if applkable): Coordinated with reimbursement sought Coordinated without reimbursement sought Independent OSupponed Organization (see Instructions) OOpposed OAOBOCOnOE

A~JtGN

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of足

ISel'

Purpose of Expenditure (by code)

Name oferedito,

Page 16 of17 IFILING DUE DATE

Candidate(s) Name (if applicable)

Office Sought

Type of Expenditure (if applicabler Coordinated with reimbursement sought Coordinated without reimbursement sought Independent OSupponed Organization (see Instructions) OOpposed OA DB Dc On DE Date Incurred

o o o o

{II %7(J Amount Incurred (Estimate or Actllal)

Street Address

Event #

City

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Purpose of Expenditure (by code)

Description

IZi P Code

Candidate(s) Name (if applicable)

Office Sought

Type of Expenditure (if applkable): Coordinated with reimbursement sought Coordinated without reimbursement sought Independent OSupponed Organization (see Instructions) OOpposed DA DB Dc On DE

o o o o

Name of Creditor

Date tncurred

Street Address

Event #

Amount Incurred (Estimate or Actllal)

i

City

IState

'Purpose of Expenditure (by code) Description

IZi P Code

Candidate(s) Name (if applicable)

Office Sought

Type of Expenditure (if applicable) Coordinated with reimbursement sought Coordinated without reimbursement sought Independent Supported Organization (see Instructions) OOpposed OAOBOCOnOE

o o o o

o

?J/YOr S7

SUBTOTAL Section S-This Page TOTAL ofadditional Seetion S Pages TOTAL OF ALL EXPENSES INCURRED BY COMMITTEE DURING THIS PERIOD BUT NOT PAID

(Enter total on Line 28 ofSummary Page) Previously reported Expenses Unpaid and stiU Outstanding TOTAL OF ALL EXPENSES INC1JRRED BY COMMITTEE BUT NOT PAID (Enter total on Line 28a ofSummarv PQue)

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IV. EXPENDITURES NAME OF COMMITTEE

Page l7 of!7 IFILING DUE DATE

..-,

A~ ~11.d....e.I T. Itemh:ation of Reimbursements to Committee Workers and Consultants

Frve.-\.~5

.

I

Last Name of Worker/Consultant

1M!

Firs!

Secondary Payee

Date of Payment

Purpose of Expenditure (by code)

I

Street Address

1

o Check o Debit Card Zip Code

State

City

Amount

Method of Payment

Description

Type of Expenditure (ifapplicable): Coordinated with reimbursement sought Coordinated without reimbursement sought o Independent o Organization (see Instructions)

Candidate(s) Name (If applicabk)

o o

oA DB Dc On DE

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I

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First

Secondary Payee

Date of Payment

Purpose of Expenditure (byeode)

I

Street Address

I

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Amount

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Descripti on

Candidate(s) Name (If applicabk)

Type of Expenditure (If applicable): o Coordinated with reimbursement sought o Coordinated without reimbursement sought o Independent o Organization (see Instructions)

oA 0 B Dc 0 n DE

Last Name of Worker/Consultant

o Supported

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o Opposed

$

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IMI

First

Date of Payment

Amount

Method of Payment

I

Secondary Payee

Purpose of Expenditure (by code)

I

Street Address

I

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Description

Candidate(s) Name (if applicable)

Type of Expenditure (if applicable) Coord mated with reimbursement sought o Coordinated without reimbursement sought o Independent o Organization (see Instructions)

o

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I

Last Name of WorkerICon suitant

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I

Street Address

City

I

State

Amount

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Zip Code

Description

Type of Expenditure (if applicable): o Coord mated with reimbursement sought Coordinated without reimbursement sought Independent Organization (see Instructions)

o o o

Candidate{s) Name (if applicable)

Office Sought

o Supported o Opposed S

oA DB Dc On DE SUBTOTAL Section T-This Page TOTAL ofadditional Section T Pages TOTAL OF ALL REIMBURSEMENTS TO COMMITfEE WORKERS AND CONSULTANTS

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