CAMPAIGN FINANCIAL DISCLOSURE REPORT SUMMARY PAGE (Please Print or Type)

Transcription

1 CAMPAGN FNANCAL DSCLOSURE REPORT SUMMARY PAGE (Please Print or Type) C-2 Rev Section Name of Candidate or Political Committee and Chairperson Office Sought (if candidate) District (if any) reasurer Change of address for: Candidate or Political Committee D Political Treasurer D Section TYPE OF REPORT This filing is an: D Original D Amendment This report is for the period from / / through!!. D 7 Day Pre-Primary Report D 30 Day Post-Primary Report D October 10 Pre-General Report D 7 Day Pre-General Report D 30 Day Post-General Report D Annual Report 0 Semi-Annual Report (Statewide Candidates Only) s this a Termination Report: D Yes D No Section ll STATEMENT OF NO CONTRBUTONS OR EXPENDTURES Directions: f you had no contributions or expenditures during this reporting period, check the box next to the statement below and sign this report. Be sure to carry forward the appropriate "Calendar Year to Date" figures in Column, Section V. D hereby certify that have received no contributions and have made no expenditures during this reporting period. Section V SUMMARY To reach your Calendar Year to Date figure: Add this report's Column figures to the Column figures of your previous report (except on line 6). Line 1: Cash on Hand January 1, This Calendar Year* Line 2: Enter Beginning Cash Balance** Line 3: Total Contributions (Enter amount from line 5, page 2) COLUMN This Period COLUMN Calendar Year to Date xxxxxx xxxxxx Line 4: Subtotal (Add lines 1, 2 and 3) Line 5: Total Expenditures (Enter amount from line 11, page 2) Line 6: Enter Ending Cash Balance (Subtract line 5 from line 4) Line 7: Outstanding Debt to Date (Enter amount from line 18, page 2) *This same figure should be entered on line 1 of all reports filed this calendar year. **This is the figure on line 6 of the last Campaign Financial Disclosure Report filed. f this is your first report, this amount is 0. Note: The closing cash balance for the current reporting period appears on the next report as the beginning cash on hand. Section V Return This Report To: Lawerence Denney Secretary of State PO Box83720 Boise D Phone: (208) Fax: (208) , ,..,----=-=-...,..-c-= hereby certify that the information in this Name of Political Treasurer report is a true, complete and correct Campaign Financial Disclosure Report as required by law. Page 1 Signature of Political Treasurer

2 DETALED SUMMARY Name of Candidate or Committee: Expenditures Unitemized Expe~?i!~~~~-(Less than 25)~- ~ - Total Expenditures (Transfer this figure to page 1, Section V, Line 5) #of Expenditurev_.s:_======--~ ~ - -~~--: :l'~- -- @) ' Loans, Credit Cards and Debt Outstanding Balance from previous reporting period ~ - - -~ - New Loans received during this reporting period... (!?t~l of all New Loan amounts plus Accrued nterest from Schedule D sheets).... New Credit Card and Debt incurred this reporting period (Total of all New ncurred Debt amounts from Schedule E sheets) Subtotal Repayments of Loans made during this reporting (!?~~l?f all Loan ~~payfl1ent amounts from Schedule D sheets) Repayments of Credit Card and Debt this reporting period (Total of all Debt Rep~ment amounts from Schedule E 1 Total Outstanding Balance at close of this period (Transfer this figure to page 1, Section V, Line 7) @ Page 2

3 SCHEDULE A TEMZED CONTRBUTONS of more than Fifty Dollars (50.00) this period of j Name of Candidate or Committee: Date Received Full Name, Mailing Address and Zip Code of Contributor Cash or Check Total This Page: Transfer the combined total of all Schedule A pages to the Detailed Summary on page 21ine 2.

4 SCHEDULE B TEMZED EXPENDTURES Twenty-Five Dollars (25.00) or more this period of N Newspaper & Other Periodical Advertising 0 Other Advertising (Yard Signs, Buttons, etc.) P Postage Donations & Gifts Event Expenses Food & Refreshments S T U Surveys & Polls Tickets (Events) Utilities General Operational Expenses W Wages, Salaries, Benefits & Bonuses ndependent Expenditures Literature, Brochures, Printing Management Services Y Z Petition Circulators Preparation & Production of Advertising Date Spent run Name, Mailing Aooress ana Lip ~,;ooe at Hec1p1ent [FTurposeU>Oe(s Gasn or ~,;neck Total This Page: Transfer the combined total of all Schedule B pages to the Detailed Summary on page 2 line 7.

5 SCHEDULE C N-KND CONTRBUTONS and EXPENDTURES of j Name of Candidate or Committee: Purpose Codes {Enter up to 3 purpose codes per Expenditure.) A All Travel Expenses {Airfare, Fuel, Lodging & Mileage) N Newspaper & Other Periodical Advertising B Broadcast Advertising {Radio, TV, nternet & Telephone) 0 Other Advertising {Yard Signs, Buttons, etc.) C Contributions to Candidates & PAC's P Postage D Donations & Gifts S Surveys & Polls E EventExpenses T Tickets {Events) F Food & Refreshments U Utilities G General Operational Expenses W Wages, Salaries, Benefits & Bonuses H ndependent Expenditure Y Petition Circulators L Literature, Brochures, Printing Z Preparation & Production of Advertising M Management Services _,_,_ 1. Contributor Name, Mailing Address and Zip Code 0 Primary 0 General Expenditure Name, Mailing Address and Zip Code Purpose Code(s) 2. Contributor Name, Mailing Address and Zip Code 0 Primary 0 General Expenditure Name, Mailing Address and Zip Code Purpose Code(s) _,_,_ 3. Contributor Name, Mailing Address and Zip Code 0 Primary 0 General Expenditure Name, Mailing Address and Zip Code Purpose Code{s) 4. Contributor Name, Mailing Address and Zip Code 0 Primary 0 General Expenditure Name, Mailing Address and Zip Code Purpose Code(s) Expenditure Total: {Transfer the combined total of all Expenditures on Schedule C pages to the Detailed Summary, page 2 line 8) Contributor Total: {Transfer the combined total of all Contributors on Schedule C pages to the Detailed Summary, page 2 line 3)

6 \Name of Candidate or Committee: SCHEDULE D - LOANS Each Lender to your campaign should be listed separately. Each time a loan is received or you loan money to the campaign, it must be listed as a separate item. Each new loan from any Lender must be listed as a new item from that Lender. You may have the same Lender listed more than once. Except for a candidate making a loan to his or her own campaign, loans from any Lender cannot exceed contribution limits laid out in Section OA, daho Code, even if it is repaid in full. Any loan(s) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new loan amounts should be listed in the New Loan column. Any interest accrued should be listed in the nterest Accrued column. f a payment was made on the loan, list it in the Repayments column. Note: Any loan that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus new loans and accrued interest less any repayments. Name, Mailing Address and Zip Previous Balance New Loan amount nterest accrued Repayments of Loan Balance Code of Lender of loan at the received during this during this during this reporting outstanding at (Candidate, ndividual or Business) end of the last reporting period reporting period period the end of this reporting period reporting period 1. Date: Date: 2. Date: Date: ~ 3. Date: Date: ~ 4. Date: Date: _1_1_ ~ 5. Date: Date: _1_1_ ~ 6. Date: Date: ~ 7. Date: Date: Previous Total Received Total: (Transfer the combined total of all received loans to the Detailed Summary, page 2 line 4) ~ Previous Received nterest Repayments Ending Balance nterest Total: Repayments Total: (Transfer the combined total of all loan repayments to the Detailed Summary, page 21ine 9 & 16) Ending Balance Total: (NOTE. Transfer the combined total of all Accrued nterest and Rece1ved Loans to the Detailed Summary, page 211ne 13)

7 J Name of Candidate or Committee: SCHEDULE E - CREDT CARDS and DEBT Each incurred expense not yet paid (i.e. credit card purchases and debt) should be listed on a separate line. Each time you make purchases with a credit card or incur debt, it is considered to be a separate item. However, you will maintain a single item for each credit card and add purchases to that item. Each Creditor listed below with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Credit Cards are considered debt to the campaign. Regardless of whether the credit card is repaid when the statement is received, all credit card transactions will appear on Schedule E and E-1. However, only Repayments of Debt during this reporting period appear in the Expenditure Section of the Detailed Summary Page. Any creditor(s) with a balance(s) appearing on the last report must be listed below with the amount in the Previous Balance column. Any new debt should be listed in the New Debt column, including any accrued interest. f a payment was made on the debt, list it in the Repayments column. Note: Any debt that was repaid in full in a previous reporting period does not need to be listed. The Outstanding Balance column is the Previous Balance plus New Debt less any Repayments of Debt. Name, Mailing Address and Zip Code of Previous Balance of New Debt amount Repayments of Debt Balance outstanding Creditor debt at the end of the incurred during this during this reporting at the end of this (Candidate, ndividual or Business) last reporting period reporting period period reporting period 1. Date: Date: 2. Date: Date: 3. Date: Date: 4. Date: Date: 5. Date: Date: 6. Date: Date: Previous Total: Amount Previous ncurred Repayments Ending Balance ncurred Total: (Transfer the combined total of all incurred debt to the Detailed Summary, page 21ine 14) Repayments Total: (Transfer the combined total of all debt repayments to the Detailed Summary, page 2 line 10 & 17) Ending Balance Total:

8 ~ S_C_HE_D_U_L_E_E-_1_-_CR_E_D_T_C_A_R_D_a_nd_D_E_B_T_T_EM ~_T_O_N, \~Pag-e~(--~ 1 Name of Candidate or Committee:. Name of Creditor from Schedule E: Each Creditor listed on Schedule E with a New Debt amount must have a Schedule E-1 accompanying it. The Schedule E-1 lists where and when the debt was incurred. Purpose Codes (Enter up to 3 purpose codes per Expenditure.) A B C D E F G H L All Travel Expenses (Airfare, Fuel, Lodging & Mileage) Broadcast Advertising (Radio, TV, nternet & Telephone) Contributions to Candidates & PAC's Donations & Gifts Event Expenses Food & Refreshments General Operational Expenses ndependent Expenditure nterest Accrued & Finance Charges Literature, Brochures, Printing M Management Services N Newspaper & Other Periodical Advertising 0 Other Advertising (Yard Signs, Buttons, etc.) P Postage S Surveys & Polls T Tickets (Events) U Utilities W Wages, Salaries, Benefits & Bonuses Y Petition Circulators Z Preparation & Production of Advertising uate 1ncurrea rurname,l'vamng Aaaress ana Lip ~,;oae ot cxpena1ture [Purpose ~,;oae(s) 1. Amount _1_ _1_1_ 9. 1_1_ Total This Page: The total of itemization for this creditor should equal the new loan amount listed on Schedule E for this creditor.

9 SCHEDULE F PLEDGED CONTRBUTONS BUT NOT YET RECEVED of j Name of Candidate or Committee: Directions: Complete this schedule if you were promised and agreed to accept a contribution during this reporting period but have not actually received the money, goods or services offered before the end of the reporting period. Do not include these entries on Schedule A until you actually receive the contribution. Pledged For Date Pledged Full Name, Mailing Address and Zip Code of Contributor Amount Pledged )_/_ /_ Total Amount of Pledged Contributions: Transfer the combined total of all Schedule F pages to the Detailed Summary on page 2 line 20.