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1 REPORT OF RECEIPTS A OF A POLITICAL COMM-. State Form 4606 (R13/11-05) Indiana Election Commission (IC ) INSTRUCTIONS Please type or pnnt IN BLACK INK all information on assistance in completing this form, see instructions on the reverse side. IS THIS AN AMENDMENT? Yes )2---No "st RES COMMITTEE INFORMATION F (CFA-4) Summa Sheet FILE NUMBER 2-I S - lo%oy TOTAL PAGES IN ENTNE CFA-4 REPORT M _ 1. Full Name of Committee (as on Statement of Organization) Check if this is a new name )> r- _C -I ri CTE. MICHELLE R. FAJMAN - (--) 2. Acronym or Abbreviated Name (if any) 3. Committee Telephone tembern Mailing Address (address where all campaign finance correspondence is received) Check If this is a new add*s 9" c, c; cp 5. City, State, ZIP Code 6. Party Affiliation (if applicable) DEMOCRAT CANDIDATE INFORMATION (For Candidates Committees Only) 7. Full Name of Candidate (Include any nickname) 8. Party Affiliation or If Independent Candidate MICHELLE R. FAJMAN DEMOCRAT 9. Office Sought (Include district number, if any. Not required for exploratory committee.) 10. County of Residence LAKE COUNTY RECORDER LAKE TYPE OF REPORT 11. Check one: Check one: CONVENTION CANDIDATES ONLY Pre-Primary Pre-Election laannual Nanination Other Pm-Convention Finalasbarkis Committee (ties 14 19, and 10 ova be 177 I Outgoing Treasurer Meer TO days amend Statement of ageizatice) Post-Convention 12. Reporting Period: From: Thr. i ti: CC LI.i.1N A his Perloci 13. Cash on hand and investments at the beginning of this reporting period Cash on hand and investments January 1, current year. CONTRIBUTIONS AND RECEIPTS (Note: these amounts include In-kind contributions and loans, as well as cash contributions.) 15a. Itemized (use Schedule A) b.Unitemized CO: JMN 13,, t,tr to DLIte 15c. Add lines 15a and 15b in both columns SUBTOTAL Add lines 13 and 15c in Column A and lines 14 and 15c In Column B TOTAL EXPENDITURES (Note: These amounts Include in-kind expenditures and loan repayments.) 17a. Itemized (use Schedule 8) (Public Question: use Schedule C) 17b. Unitemized 17c. Add lines 17a and 17b In both columns SUBTOTAL Cash on hand and investments at close of this reporting period (subtract 17c from 16 in both columns) TOTAL Debts OWED BY the committee (use Schedule D) (alt..(: ), Sc 20. Debts OWED TO the committee (use Schedule E) CERTIFICATION I CERTIFY THAT I HAVE EXAMINED THIS STATEMENT. TO THE BEST OF MY KNOWLEDGE AND BEUEF IT IS TRUE, CORRECT AND COMPLETE. Signature of Treasurer Trite Date FOR OFFICE USE ONLY Signs of and e (Happy Date 131 "12 WARNIN : Any information conlained in kis report may not be copied for sale or used for any commercial purpose. (IC )A pawnwho knowingly files a fraudulent report commits a Class 0 felony. (IC 3-14-/-13)A person who fads to file a complete or accurate report as required by the Indiana Campaign Finance Law commits a Class B misdemeanor. (IC ) and maybe subject to civil penalties. (IC IC Z IC )

2 OF A POLITICAL COMMITTEE State Farm 4606 (R ) Indiana Election Commission (IC ) (CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY INDIVIDUALS ON THIS SCHEDULE. Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 14 of the Summery Sheet M cumulative contributions from inthviduals OVER $100 per contributor, within' a calendar year MUST be itemized on this schedule (over pal if regular party coetnertee). All cumulative receipts, (such as loan proceeds and repayments, reheat rebates, rearms of deposit proceeds from sales. interest or other!acme) OVER $100 per contributor, within a calendar year, MUST be itemized on this schedule (over $200 ff regular party committee). A contributor's occupation is required if an individual makes at least $1,000 in contributions during the calendar year. Othenvise. this is optional. CONTRIBUTOR'S FIJI I NAME AND OCCUPATION FULL MAILING ADDRESS (street. flambe,. crty. state. ZIP CO(10) 1. MICHELLE R. FAJMAN TYPE OF CONTRIBUTION OR OTHER RECEIPT Contrbutions: In-Kind *scribe) COLUMN A AMOUNT THIS PERIOD C0.1 LIMN B CUMULATIVE YEAR.TO-DATE DATE RECEIVED RECEIVED E;' ( Contrkutor's Occupation li I requie0 2- MICHELLE R. FAJMAN Interest 0 Loan Misc.- (specify) CP DEMO ORGArr Iri-Ifind (describe) $98.00 $ comma's oxupason Wet/tried) 3. MICHELLE R. FAJMAN Interest 0 Loan Misc. (spedy) AV CTE CHAD JEFFRIES $ ) \ Contributor's Occupadon (if requirer# 4. MICHELLE R. FAJMAN CLARK ST Interest 0 Loan Misc. (specify) LC DEMO Ccotributions: III Direct $ Contributor's Occupation Pequivd) 5. MICHELLE R. FAJMAN Other Receipts; Interest 1_ Loan Misc. (speedy) CTE PAT HAVVROT Condit:it:1km: $ ContrUxaces Occupation di roaqurer# Other Receipts6/' Interest Loan Misc., (specify).3sf., DYER DEMO t i S,1 $30.00 SUBTOTAL THIS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY, (Enter total on ITEM 15a of the Summary Sheeny.

3 OF A POUTICAL COMMITTEE State F1=4606 (R ) Indiana Election Commission (IC ) INSTRUCTIONS: UST ONLY CONTRIBUTIONS BY INDIVIDUALS ON THIS SCHEDULE. Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributices and receipts totaled on ITEM 15a of the Summary Sheet. All cumulative contributions from individuals OVER $100 per contributor, wit in a calendar year MUST be itemized on this schedule (over 5200 if repidar parry committee). Al cumulative receipts, (such as loan proceeds and repayments, refunds, rebates, returns of deposal proceeds hem sales, interest or other broom) OVER $100 per contributor, OW a calendar year, MUST be itemized on this schedule (over S200 ifregularpatty committee). A contributor's occupation is required ti an individual makes at least $1,000 in contributions during the calendar year. Otherwise, this is optional. (CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts CONTRIBUTOR'S FULL NAME AND OCCUPATION FULL MAILING ADDRESS (street. ncimbel, c:ity. state. ZIP code! 1. MICHELLE R. FAJMAN TYPE OF CONTRIBUTION OP OTHER RECEIPT E Direct COLUMN A AMOUNT THIS PERIOD COLUMN B CUMULATIVE YEAR-TO-DATE CATE RECEIVED _ RECEIVED BY Contributoes Occupation (if rewind) 2. MICHELLE R. FAJMAN CROWN POINT IN Interest IZI Loan Misc. (specify) ii,"3 CP DEMO ORG 0 Direct $30.00 $ Contributor's Occupation Peddled) 3. MICHELLE R. FAJMAN Interest 2] Loan Nix- (specify) LiSLf LK STATION DEMO Direct $ Contributor's Occupation lirequired) 4. Interest P4 Loan Misc. (specify) 42,55 GRIFFITH DEMO Direct $10.00 interest Loan Misc. (specify) Contributor's Occupation (l requied) 5. Direct Contritutor's Occupation at/waled) Interest Loan Misc. (specify) DYER DEMO SUBTOTAL THIS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on ITEM 15a of the Summary Sheet) $

4 1 OF A POLITICAL COMMITTEE Slate Form 4606 (R ) Indiana Election Commission (IC (CFA-4 SCHEDULE B) ITEMIZED EXPENDITURES INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instuctions on the reverse side. This schedule is used to document expenditures totaled on ITEM 17a of the Summary Sheet. A6 cumulative expenses paid to individuals, businesses, labor organizations and other entities OVER $100 per recipient, within a calendar year MUST be itemized on this schedule (over $200, if regular patty commetee). Al cumulative expenses, including in-kind, regardless of amount paid to political committees, (such as transfers-out from candidate, legislative caucus, political action or regular patty cominirees)must be itemized on this schedule. 1.'l I ';I ' 11, N.:1 1, IRI ' 1 ', ki ( l'"f. NI.{-,', Ei: OFFICE SOUGHT,tf applicable: { II': 1 :)I '.1.)r :'. HI ' t)ili 7j 1, ( IiI..1%ji Ii I I '. ',, AP 11 11,o; 0 Cited Ned Code C Payment of Debt LAKE COUNTY WOMENS DEMO Returned Contribution 3639 WIRTH RD 0ther $ HIGHLAND IN S 2-4. as L.--2.0,(.. Lt LA ZS (,-,1 -,--, 2 0 %all c-...) VI Direct In-ted Code 0-- I Payment of Debt LAKE COUNTY WOMENS DEMO Returned Cana:06on % I Lk- ZS 3639 WIRTH RD Other..--- $ HIGHLAND IN g-9 (--' '%, izi (ohs Code e... 1 izoin. i., LAKE STATION DEMO PCT ORG LAKE STATION IN CROWN POINT DEMO PCT ORG Payments( Debt Returned Gordrimem --q4. Doe $ ro oiled le-itind Payment al Debt, O V-3L3 C15.(33 3/1011S 0 Returned Gontrirate 928 VETERANS LN Daher,..-$ z 'LO CROWN POINT IN Code Co I 0 Direct In-Kind Payment of Debt GRIFFITH DEMO PCT ORG 0 Returned Conte:mem TH CT Oahe,,, $10.00 $ GRIFFITH IN Code C I CA Moot tri-kititi Payment ci Debt CIE DONNA CATALANO Returned Gontaxition 963 CEDAR DR., Daher --- $25.00 $ Code C 1 ge,,irect In-Kind PaYrnetit a Debt CTE BERNIE ZEMEN 0 Returned Gontaution RD ST Der.v$40.00 $ HIGHLAND IN Purpose SUBTOTAL THIS PAGE OF SCHEDULE B $ TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY, (Enter total on ITEM 17a of the Summary Sheet) "

5 OF A POLITICAL COMMITTEE State Form 4606 (R13/11-05) Indiana Election Commission (IC (CFA-4 SCHEDULE B) ITEMIZED EXPENDITURES INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document expenditures totaled on ITEM 17a of the Summary Sheet All cumulative expenses paid to individuals, businesses, labor organizations and other entities OVER $100 per recipient, within a calendar year MUST be itemized on this schedule (over S2( it regular party committee). All cumulative expenses, including in-kind, regardless of amount paid to political committees, (such as transfets.out from candidate, legislative caucus, political action, or reguhr party committees) MUST be itemized on this schedule. Pt 1 NI'', ro,n AND f/t il IT,r.,IMIII.,`, t Itottrt,,,, fly...)tt Ir, 0 '' I I 1 If f,'r.'i'/mr.';'; OFFICE SOUGH7 frl dppilcahit. i', i ili i,, '.1 :IN' f, ;;;,.., f 1 i.. I (:11r,".:/, 1,I,If 0 f:i 11'I-. _I, 'I Crillr,IM' I Irl, I I%1I". 11 I. (1!, Code C I CTE CHAD JEFFRIES 416 S. MADISON ST 0 Direct In-Kind Payment of Debt 0 Returned Contributim 0ther,.-- $20.00 $ Code C LAKE COUNTY DEMO CENTRAL 1000 E 80TH PL STE 510 SOUTH MERRILLVILLE IN Code C I CTE PAT HAWROT 3226 MARYANN LN DYER IN Code C DYER DEMOCRAT PCT ORG 3226 MARYANN DYER IN Direct In-Kind Payment of Debt Returned Conbibution Dow Ptspose: 0 Direct wand Payment of Debt Rotuma:I Contribute,,--$55.00 $55.00 Ober,,,$50.00 $ Disci In-land Payment of Debt Returned Contribution LN / $30.00 $ Other Code I Direct In4Cod Payment el Debt Returned Contribution 0tber Purpose Code I 0 Direct 0 In-Kid Payment cl Debt Returned Con won 0tber Code _I In-Kind Payment Morn Returned Contributico Dotter SUBTOTAL THIS PAGE OF SCHEDULE B $ TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on ITEM I7a of the Summary Sheet) $

6 -PORTOFRECEIPTSAND EXPENDITURES. F APOLITICALCOMMITTEE Slate Form 46CE frin Indiana Sedan Commissixt (IC (CFA-4 SCHEDULE D) DEBTS OWED -BY THIS COMMITTEE Please type or OM legbly IKBLACK INK all intanabon on this schedule. For assistance. in cornet-lag kis see instnsdons on are Merle side. List all debts tep011i119 and barn, reaardess of the amount, OWED BY the commitlee =ans. etc. list period. each Induce all amounts owed kr or b iend imitations, individuals, credit purchases, commillee urea 'Vendor paid by cfecfil card issued in the nann of the conuntee in the ENDOP.SUYS cam. A is occupation is requiecf II an incbridual mates bans of al least S1,000 dieing the nalendar year. Itemise, Hs is oficoal FILE LAMER LlIEDTTER'SURLE.11:IIER'S L'A7,1E: CIAILIOCADDM. (soroli r.uinbrj nip, stilo ZIP crie) VIZOR:METD ITI:=ET, (ii in') (zfirt., I, numb:; al! I-11:c,, ZPccd.7) NATURE OF DEET tizt;_nzin. cullulatilla zurryzu Tvo - Yer.R.TOD:ITE OLITSTALID1((13 13/11.4VICIF.TIES PEILICD MICHAEL AND MICHELLE F 3, , S OCCUPATION. MICHELLE R. FAJMAN 3,80_ NOWSOCCWAUW 3, ,-kke.4-ewc. F--..\ri\b/\ v_ka t...ttni :1117,11-3 CCINPA ITEM OCCLMIkat MWMaee UCCIPA1 0=CUP atuk SUBTOTAL THIS PAGE OF SCHEDULE. D S TOTAL OF ALL PAGES OF SCHEDULE DON THE LAST PAGE ONLY (Enter total on ITEM 19 of the Summary..7he)

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