REPORT OF RECEIPTS AND DISBURSEMENTS

Transcription

1 09/20/ 17 : 42 Image# FE FORM 3X REPORT OF REEIPTS AND DISBURSEMENTS For Other Than An Authorized ommittee Office Use Only PAGE 1 / NAME OF OMMITTEE (in full) TYPE OR PRINT Example: If typing, type over the lines. 12FE4M5 ADDRESS (number and street) PO Box 2409 heck if different than previously reported. (A) A FE IDENTIFIATION NUMBER ITY STATE ZIP ODE IS THIS NEW AMENDED REPORT (N) OR (A) 4. TYPE OF REPORT (hoose One) (a) Quarterly Reports: April 15 Quarterly Report (Q1) July 15 Quarterly Report (Q2) October 15 Quarterly Report (Q3) January 31 Year-End Report (YE) (b) Monthly Report Due On: (c) 12-Day (12P) (12G) Runoff (12R) PRE-Election Feb 20 (M2) May 20 (M5) Aug 20 (M8) Mar 20 (M3) Jun 20 (M6) Sep 20 (M9) Apr 20 (M4) Jul 20 (M7) Oct 20 (M10) Jan 31 (YE) Report for the: onvention (12) Special (12S) Election on in the State of Nov 20 (M11) (Non-Election Year Only) Dec 20 (M12) (Non-Election Year Only) July 31 Mid-Year (d) 30-Day Report (Non-election Year Only) (MY) POST-Election (30G) Runoff (30R) Special (30S) Report for the: Termination Report (TER) in the Election on State of 5. overing Period 01 through 31 I certify that I have examined this Report and to the best of my knowledge and belief it is true, correct and complete. or Print Name of Treasurer Tom Grueskin Signature of Treasurer Tom Grueskin [Electronically Filed] Date NOTE: Submission of false, erroneous, or incomplete information may subject the person signing this Report to the penalties of 2 U.S.. 437g. Office Use Only FE FORM 3X Rev. 12/2004

2 Image# OF REEIPTS AND DISBURSEMENTS FE Form 3X (Rev. 02/2003 ) Page 2 Write or ommittee Name SUMMARY PAGE Report overing the Period: From: 01 To: 31 OLUMN A This Period OLUMN B alendar Year-to-Date 6. (a) ash on Hand January 1, Y Y Y Y (b) ash on Hand at Beginning of Reporting Period... (c) Total Receipts (from Line 19)... (d) Subtotal (add Lines 6(b) and 6(c) for olumn A and Lines 6(a) and 6(c) for olumn B) Total Disbursements (from Line 31) ash on Hand at lose of Reporting Period (subtract Line 7 from Line 6(d)) Debts and Obligations Owed TO the ommittee (Itemize all on Schedule and/or Schedule D) Debts and Obligations Owed BY the ommittee (Itemize all on Schedule and/or Schedule D) This committee has qualified as a multicandidate committee. (see FE FORM 1M) For further information contact: Federal Election ommission 999 E Street, NW Washington, D Toll Free Local

3 Image# DETAILED SUMMARY PAGE of Receipts FE Form 3X (Rev. 06/2004 ) Page 3 Write or ommittee Name Report overing the Period: From: 01 To: 31 I. Receipts 11. ontributions (other than loans) From: (a) Individuals/Persons Other Than Political ommittees (i) Itemized (use Schedule A)... (ii) Unitemized... (iii) TOTAL (add Lines 11(a)(i) and (ii)... (b) Political Party ommittees... (c) Other Political ommittees (such as PAs)... (d) Total ontributions (add Lines 11(a)(iii), (b), and (c)) (arry Totals to Line 33, page 5) Transfers From Affiliated/Other Party ommittees All Loans Received Loan Repayments Received Offsets To Operating Expenditures (Refunds, Rebates, etc.) (arry Totals to Line 37, page 5) Refunds of ontributions Made to Federal andidates and Other Political ommittees Other Federal Receipts (Dividends, Interest, etc.) Transfers from Non-Federal and Levin Funds (a) Non-Federal Account (from Schedule H3)... (b) Levin Funds (from Schedule H5)... (c) Total Transfers (add 18(a) and 18(b)).. OLUMN A Total This Period OLUMN B alendar Year-to-Date Total Receipts (add Lines 11(d), 12, 13, 14, 15, 16, 17, and 18(c)) Total Federal Receipts (subtract Line 18(c) from Line 19)

4 Image# DETAILED SUMMARY PAGE FE Form 3X (Rev. 02/2003 ) of Disbursements Page 4 II. Disbursements 21. Operating Expenditures: (a) Allocated Federal/Non-Federal Activity (from Schedule H4) (i) Federal Share... (ii) Non-Federal Share... (b) Other Federal Operating Expenditures... (c) Total Operating Expenditures (add 21(a)(i), (a)(ii), and (b)) Transfers to Affiliated/Other Party ommittees ontributions to Federal andidates/ommittees and Other Political ommittees Independent Expenditures (use Schedule E) oordinated Party Expenditures (2 U.S.. 441a(d)) (use Schedule F) Loan Repayments Made Loans Made Refunds of ontributions To: (a) Individuals/Persons Other Than Political ommittees... (b) Political Party ommittees... (c) Other Political ommittees (such as PAs)... OLUMN A Total This Period OLUMN B alendar Year-to-Date (d) Total ontribution Refunds (add Lines 28(a), (b), and (c)) Other Disbursements Federal Election Activity (2 U.S.. 431(20)) (a) Allocated Federal Election Activity (from Schedule H6) (i) Federal Share... (ii) "Levin" Share... (b) Federal Election Activity Paid Entirely With Federal Funds... (c) Total Federal Election Activity (add.. Lines 30(a)(i), 30(a)(ii) and 30(b)) Total Disbursements (add Lines 21(c), 22, 23, 24, 25, 26, 27, 28(d), 29 and 30(c)) Total Federal Disbursements (subtract Line 21(a)(ii) and Line 30(a)(ii) from Line 31)

5 Image# DETAILED SUMMARY PAGE FE Form 3X (Rev. 02/2003 ) of Disbursements Page 5 III. Net ontributions/operating Expenditures OLUMN A Total This Period OLUMN B alendar Year-to-Date 33. Total ontributions (other than loans) (from Line 11(d), page 3) Total ontribution Refunds (from Line 28(d)) Net ontributions (other than loans) (subtract Line 34 from Line 33) Total Federal Operating Expenditures (add Line 21(a)(i) and Line 21(b)) Offsets to Operating Expenditures (from Line 15, page 3) Net Operating Expenditures (subtract Line 37 from Line 36)

6 Image# SHEDULE A (FE Form 3X) ITEMIZED REEIPTS NAME OF OMMITTEE (In Full) PAGE 11a 11b 11c 12 OF A. Avalon apital Group, Inc. ity State Zip ode A FE ID number of contributing federal political committee. Name of Employer 5786 Blvd. Occupation Date of Receipt 31 Transaction ID : SA11AI.4451 Amount of Each Receipt this Period In-kind - IT Services & Supplies Receipt For: Other (specify) Aggregate Year-to-Date B. Avalon apital Group, Inc Blvd. ity State Zip ode FE ID number of contributing federal political committee. Name of Employer A Occupation Date of Receipt 31 Transaction ID : SA11AI.4472 Amount of Each Receipt this Period In-kind - Administrative Support Services Receipt For: Other (specify) Aggregate Year-to-Date Theodore Waitt ity State Zip ode A FE ID number of contributing federal political committee. Name of Employer Avalon apital Group, Inc. Receipt For: Other (specify) 5786 Blvd Occupation EO Aggregate Year-to-Date SUBTOTAL of Receipts This Page (optional)... Date of Receipt 13 Transaction ID : SA11AI.4468 Amount of Each Receipt this Period 2500 FE Schedule A (Form 3X) Rev. 02/2003

7 Image# SHEDULE A (FE Form 3X) ITEMIZED REEIPTS NAME OF OMMITTEE (In Full) PAGE 11a 11b 11c 12 OF A. KNSD - TV ity State Zip ode San Diego A Name of Employer 225 Broadway FE ID number of contributing federal political committee. Occupation Date of Receipt 31 Transaction ID : SA Amount of Each Receipt this Period Media Buy Refund - Support for A Non-Federal andidate Receipt For: Other (specify) Aggregate Year-to-Date B. Date of Receipt ity State Zip ode FE ID number of contributing federal political committee. Name of Employer Occupation Amount of Each Receipt this Period,,. Receipt For: Other (specify) Aggregate Year-to-Date,,.. Date of Receipt ity State Zip ode FE ID number of contributing federal political committee. Name of Employer Occupation Amount of Each Receipt this Period,,. Receipt For: Other (specify) Aggregate Year-to-Date SUBTOTAL of Receipts This Page (optional) FE Schedule A (Form 3X) Rev. 02/2003

8 Image# SHEDULE B (FE Form 3X) ITEMIZED DISBURSEMENTS PAGE 8 OF 13 21b a 28b 28c 29 30b NAME OF OMMITTEE (In Full) A. Date of Disbursement Avalon apital Group, Inc Blvd. ity State Zip ode A In-kind - IT Services & Supplies andidate Name B. Date of Disbursement Avalon apital Group, Inc. Other (specify) ity State Zip ode A In-kind - Administrative Support Services andidate Name 5786 Blvd. Other (specify) ategory/ ategory/. Date of Disbursement Transaction ID : SB21B Transaction ID : SB21B ity State Zip ode andidate Name Other (specify) ategory/,,. SUBTOTAL of Disbursements This Page (optional) FE Schedule B (Form 3X) Rev. 02/2003

9 Image# SHEDULE B (FE Form 3X) ITEMIZED DISBURSEMENTS PAGE 9 OF 13 21b a 28b 28c 29 30b NAME OF OMMITTEE (In Full) A. Date of Disbursement aplin & Drysdale One Thomas ircle NW Su ity State Zip ode Washington D Legal Fees andidate Name B. Date of Disbursement Direct File ity State Zip ode Fresno A Internet Based A Filing Software andidate Name. Date of Disbursement Direct File 504 Van Ness Ave 504 Van Ness Ave Other (specify) Other (specify) ategory/ ategory/ Transaction ID : SB Transaction ID : SB ity State Zip ode Fresno A Internet Based A Filing Software andidate Name Other (specify) ategory/ Transaction ID : SB SUBTOTAL of Disbursements This Page (optional) ,,. FE Schedule B (Form 3X) Rev. 02/2003

10 Image# SHEDULE B (FE Form 3X) ITEMIZED DISBURSEMENTS PAGE 10 OF 13 21b a 28b 28c 29 30b NAME OF OMMITTEE (In Full) A. Date of Disbursement Robert J Emma 5998 Alcala park Unit 8104 ity State Zip ode San Diego A ontract Pay andidate Name B. Date of Disbursement ity State Zip ode A Proposal - Business Plan andidate Name. Date of Disbursement LJ Strategies LL Paypal 2877 Via Posada P.O. Box Other (specify) Other (specify) ategory/ ategory/ Transaction ID : SB Transaction ID : SB ity State Zip ode Omaha NE Service Fee andidate Name Other (specify) ategory/ Transaction ID : SB SUBTOTAL of Disbursements This Page (optional) ,,. FE Schedule B (Form 3X) Rev. 02/2003

11 Image# SHEDULE B (FE Form 3X) ITEMIZED DISBURSEMENTS PAGE 11 OF 13 21b a 28b 28c 29 30b NAME OF OMMITTEE (In Full) A. Date of Disbursement UPS PO Box ity State Zip ode Los Angeles A Express Mail Packages andidate Name B. Date of Disbursement UPS ity State Zip ode Los Angeles A Express Mail Packages andidate Name. Date of Disbursement Wells Fargo PO Box Girard Ave. Other (specify) Other (specify) ategory/ ategory/ Transaction ID : SB Transaction ID : SB ity State Zip ode A Bank Fee andidate Name Other (specify) ategory/ Transaction ID : SB SUBTOTAL of Disbursements This Page (optional) ,,. FE Schedule B (Form 3X) Rev. 02/2003

12 Image# SHEDULE B (FE Form 3X) ITEMIZED DISBURSEMENTS PAGE 12 OF 13 21b a 28b 28c 29 30b NAME OF OMMITTEE (In Full) A. Date of Disbursement Wells Fargo 7714 Girard Ave. ity State Zip ode A Bank Fee andidate Name B. Date of Disbursement Other (specify) ategory/ 31 Transaction ID : SB ity State Zip ode andidate Name Other (specify) ategory/. Date of Disbursement,,. ity State Zip ode andidate Name Other (specify) ategory/,,. SUBTOTAL of Disbursements This Page (optional) FE Schedule B (Form 3X) Rev. 02/2003

13 Image# SHEDULE D (FE Form 3X) DEBTS AND OBLIGATIONS Excluding Loans NAME OF OMMITTEE (In Full) (Use separate schedule(s) for each numbered line) PAGE 13 OF A. of Debtor or reditor Mailhimp Nature of Debt (Purpose): Management Advanced By Avalon apital Grp, Inc 512 Means St. Su, 404 ity State Zip ode Atlanta GA Outstanding Balance Beginning This Period Amount Incurred This Period Payment This Period B. of Debtor or reditor Mailhimp 1 Transaction ID : SD Outstanding Balance at lose of This Period Nature of Debt (Purpose): Management Tool Means St. Su, 404 ity State Zip ode Atlanta GA Outstanding Balance Beginning This Period Transaction ID : SD Amount Incurred This Period Payment This Period Outstanding Balance at lose of This Period 6 6. of Debtor or reditor Nature of Debt (Purpose): ity State Zip ode Outstanding Balance Beginning This Period,,. Amount Incurred This Period,,. Payment This Period,,. Outstanding Balance at lose of This Period,,. 1) SUBTOTALS This Period This Page (optional)... 2) TOTALS This Period (last page this line number only)... 3) TOTAL OUTSTANDING LOANS from Schedule (last page only)... 4) ADD 2) and 3) and carry forward to appropriate line of Summary Page (last page only) FE Schedule D (Form 3X) Rev. 02/2003