WTI, for COMMITTEE INFORMATION. Check if th s is a new name. SA: -A AI A-Di.5

Transcription

1 %-i9u/tpcsc cuttfax REPORT OF RECEPTS AND EXPENDTURES Orr A POLTCAL COMMTTEE State Form 4606 (R3-05) ndiana Election Commission (C ) NSTRUCTONS: Please type or print legibly N BLACK NK all information on th assistance in completing this form. see instructions on the reverse side. S THS AN AMENDMENT? Yes E No WT, for (CFA-4) Summary Sheet FLE NUMBER `alit TOTAL PAGES N ENTRE CFA-4 REPORT ' Full Name of Committee (as on Statement of Organization) M bet COMMTTEE NFORMATON Check if th s is a new name SA: -A A A-Di.5 C., 2 Acronym or Abbreviated Name (if any) 3. Committee Telephone Number C 2- ) 4. Mailing Address (address where all campaign finance correspondence is received) Check if this is a new address j)'7 5. City. State, ZP Afa MA-e---7 "4 L. Ki k( (-bp- i-kaq 7. Full Name of Candidate (include any nickname LA de a P itoe Cnr 6. Party Affiliation (if applicable)r CANDDATE NFORMATON (For Candidate's Committees Only) 9 Office Sought (nclude district number, if any. Not required for exploratory committee.). Check one: C TYPE OF REPORT Pre-Primary g'ke-election Annual Nomination Other Final Disbands committee Pines C, lg. and 20 must o Outgoing Treasurer em cays amend Statement of Groanzatton; 2. Reporting Period: From: '"f/t(4 (4; Through: 0/q 3. Cash on hand and investments at the beginning of this reporting period. 4. Cash on hand and investments January, current year. CONTRBUTONS AND RECEPTS (Note: these amounts include in-kind contributions and loans, as well as cash contributions.) 5a. temized (use Schedule A) 5b. Unitemized 5c. Add lines 5a and 5b in both columns 6. Add lines 3 and 5c in Column A and lines 4 and 5c in Column B EXPENDTURES (Note: These amounts include in-kind expenditures and loan repayments.) 7a. temized (use Schedule B) (Public Question: use Schedule C) 7b. Unitemized 7c. Add lines 7a and 7b in both columns 8. Cash on hand and investments at close of this reporting period (subtract 7c from 6 in Oath columns) 9. Debts OWED BY the committee (use Schedule D) 20. Debts OWED TO the committee (use Schedule E) Signature of Trea,4. 4iir -. 40,... proic CERTFCATON SUBTOTAL 8. Party Affiliation or f ndepen TOTAL 4-7" 0. County of Residence r77 CO ate NJ CONVENTON CANDDATES ONLY Check one: This Period " , Pre-Convention Post-Convention Year to Date /67,57, 4t i(-0 S7S i? ' 837c ne /vs,. es" SUBTOTAL D- TOTAL J of to. c'-/ /-70 0 CERTFY THAT HAVE EXAMNED THS STATEMENT. TO THE BEST OF MY KNOWLEDGE AND BELEF T S TRUE. CORRECT AND COMPLETE es Titl Date o S- Date, WAR ny information co : 40, - -: ) /CV/ 4/ sro : rt may not be copied for sale or used for any commercial purpose. ( ) A person who knowingly fives a fraudulent report commits a Class D felony. (C,' A person who fails to tie a complete or accurate radon as required by na ndiana i Can-ma:an Finance Law commits a Class B msde.meanor. (0, and may be subiect to cvii perattes r): C , C & 4fer-ec, *.5-.9, /.y o...3-tize.0 3o AS7S-.4-`i 4 (0. S7 FOR OFFCE USE ONLY

2 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4605 (R3-05) ndiana Election Commission (C ) NSTRUCTONS: LST ONLY CONTRBUTONS BY NDVDUALS ON THS SCHEDULE. Please type or print legibly N BLACK NK 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 TEM 5a of the Summary Sheet. All cumulative contributions from individuals OVER $00 per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular party committee). All cumulative receipts, (such as loan proceeds and repayments, refunds, rebates, returns of deposit, proceeds from sales, interest or other income) OVER $00 per contributor, within a calendar year, MUST be itemized on this schedule (over $200 if regular party committee). A contributor's occupation is required if an individual makes at least $000 in contributions during the calendar year. Otherwise, this is optional. (CFA-4 SCHEDULE A-) CONTRBUTONS BY NDVDUALS temized Contributions and 2 CONTRBUTOR'S FULL NAME AND OCCUPATON FULL MALNG ADDRESS (street, number, city, state, ZP code) kcse -7- V.0003 be azo( -(, fr i_f_ Contributor's Occupation Of required! 4 ic e,... ee,--_,ek.,,a,,, TYPE OF CONTRBUTON OR OTHER RECEPT Contriipb ons' Lgtbirect ' nterest Loan Misc jspecify) Cont' ions: di Direct AMOUNT THS 4 zoo CUMULATVE YEAR-TO-DATE -Wis /-670 DATE RECEVED RECEVED BY n 0 2c.xD 2L'o ',Vi/ti- ' nterest Loan Contributor's Occupation (if required) 3 Contributions: Direct : N nterest Loan Contributor's Occupation (if required,: 4 Contributions Direct. nterest Loan Contributors Occupation (if mowed! 5. Contributions - 0 Direct ll in-kind (describe) nterest E, Loan Misc. (specify Contributors Occupation (if requled. SUBTOTAL THS PAGE OF SCHEDULE A $ TOTAL'OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 5a of the Summary Sheet) bc.)

3 REPORT OF RECEPTS AND EXPENDTURES ;4 t OF A POLTCAL COMMTTEE i; State Form 4605 tr3-05) ndiana Election Commission (C ) : NSTRUCTONS: LST ONLY CONTRBUTONS BY CORPORATONS ON THS SCHEDULE. Pease type or print legibly N BLACK NK 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 TEM 5a of the Summary Sheet. All cumulative contributions from corporations OVER S00 per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular party committee). All cumulative receipts, (such as loan proceeds and repayments, refunds, rebates. returns of deposit, proceeds from sales, interest or other income) OVER SUM per contributor, within a calendar year. MUST be itemized on this schedule (over $200 if regular party committee). (CFA-4 SCHEDULE A-2) CONTRBUTONS BY CORPORATONS temized Contributions and Page CONTRBUTOR'S FULL NAME AND FULL MALNG ADDRESS (street, number, city, state, ZP code) M 0E4= TYPE OF CONTRBUTON OR OTHER RECEPT Contrjbutions: 2- :Av,(Ly Oul/4.5n-- ^tr Direct : nterest Loan AMOUNT THS `# 2_00 DATE CUMULATVE RECEVED YEAR-TO-DATE RECEVED BY utions G -e y ticitt(l. S pt. y Direct Con 5 zoo nterest Loan M:sc. (specify) Contributions Direct ' nterest Loan Misc. (specify; Contributions: Direct nterest Loan 5 Contributions: Direct U nterest _2; Loan us: rscecify, SUBTOTAL THS PAGE OF SCHEDULE A S TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 5a of the Summary Sheen S c.

4 c.7-r& REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4605 (R3-05) ndiana Electron Commission (C i NSTRUCTONS: LST ONLY CONTRBUTONS BY POLTCAL ACTON COMMTTEES ON THS SCHEDULE. Please type or Orin; leoioly N BLACK NK 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 TEM 5a of the Summary Sheet At cumulative contributions from political action committees OVER $00 per contributor, within a calenoar year MUST be itemized on this schedule (over 5200, if regular party committee). All transfers-in and in-kind contributions reaardiess of amount from political action committees MUST be itemized on this sdiedule. All cumulative receipts, (such as loan proceeds and repayments. refunds, rebates. returns of deposit, proceeds from sales. interest or other income) OVER $00 per contributor, within a calencar year. MUST be itemized on this schedule (over 5200 if regular party committee). e.n2,4),,u3vs --02 Contributions' ect (CFA-4 SCHEDULE A-4) CONTRBUTONS BY POLTCAL ACTON COMMTTEES temized Contributions and CONTRBUTOR'S FULL NAME AND TYPE OF CONTRBUTON DATE FULL MALNG ADDRESS OR OTHER RECEPT AMOUNT THS CUMULATVE RECEVED (street, number, city, state, ZP code) YEAR-TO-DATE RECEVED BY -C-AST C+ ie./-c-0 : nterest Loan Misc (specify) A 4 35c( C-;, TO Assoc Contritaubons. Direct : nterest Loan Misc (specrly ec.) -- Lc, cpc_ 3 C-t-ticAtr ppck..-r,sa&l Pkc--- 5iltribtjtions: (tech nterest Loan Contributions: Direct n- Kind (describe) ' nterest Loan Misc (specify) 5. Contributions' Direct n-kind (describe! nterest L. j Law - Misc ispec(fr: SUBTOTAL THS PAGE OF SCHEDULE A $ 75-0 TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 5a of the Summary Sheet)! S /5 S-)

5 REPORT OF RECEPTS AND EXPENDTURES Of A POLTCAL COMMTTEE State Form 4605 (R3-05) ndiana Election Commission (C (CFA-4 SCHEDULE B) TEMZED EXPENDTURES NSTRUCTONS: Please type or print legibly N BLACK NK al information on trim scnedure For assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document expenditures totaled on TEM 7a of the Summary Sheet. All cumulative expenses paid to individuals, businesses, labor organizations and other entities OVER S00 per recipient. within a calendar year MUST be itemized on this schedule (over $200. if regular party committee). All cumulative expenses, including in-kind regardless of amount paid to political committees, (such as transfers-out from candidate. legislative caucus, political action, or regular party committees) MUST be itemized on this schedule. Page FLE NUMBER of RECPENTS NAME AND MALNG ADDRESS (street, number, city, stste,,zp code) RECPENTS OCCUPATON OFFCE SOUGHT (if applicable) TYPE OF EXPENDTURE and PURPOSE (be specific) AMOUNT THS CUMULATVE YEARTO.DATE DATE OF EXPENDTURE.9. m-knct 0 Payment e Debt # 0.). G-. t-j. b&-pc-- D Returned Contibution 32-0 / //7/4i--.A. 727 (64 -refiz_4y6- Otne t...a.k..c. S -ēac r, c,,, : 0 4.E.:- CE-,- -rre-- g`f S--- V- ' -L- S. GA-e-'4...t. c(6 (k,.., 4.040fs ēst a.- no 0 ay te nt of Deb: 0 Returned Contnnutior - is 0 0 ane A Q- ablast,... E in-kinc i Li Payment of Deb t 5Pat-exj ---,--,-. 0 Returned Contnpupor Pk 0 0 Otnv 'd-x9 C. -5 C A' Fieliy6;V 4._ -, ic--,,si b6x-r 27 CEsrP-Ac- AY& "-... ' ( ek-, PA-4 S ()Crr Le, 0 ( 5ROPcb U. CiAty- _ad '-(6 v 6, -2 u..,..":,..t 0 in-kmc,., Lj Payment of Deb: Z.S-, Returne3 connbac, ' 00:ner., Dder,.' to-kind 7 Payment of Deb: 7 Returneo.7,onmoutlor, r=:ime A, i /"v, erect r- Kr, D Payment of Deo: )0 i A-C--:-,, 'QC. D Returned Contnbunon Z.2-5pother 360 ( Pi kw -r. : purpo E alasr 09.47,46,0 -(,e(a3 GC> 6.s /(2-'0 3 ' # Lf Cf /( ,S--- = //8/e s- t fi / al/s 4 9z 0 --5///rj- Coce c:7 'Elko Reimer.; Rammed C.c-,triputc- DO:ne P:rocze SUBTOTAL THS PAGE OF SCHEDULE B TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on TEM 7a of the Summary Sheet) S M/.2

6 le -% OF A POLTCAL COMMTTEE State Form 4606 (R3/-05) W/ ndiana Election Commission (C REPORT OF RECEPTS AND EXPENDTURES (CFA-4 SCHEDULE B) TEMZED EXPENDTURES NSTRUCTONS: Please type or print legibly N BLACK NK 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 TEM 7a of the Summary Sheet. All cumulative expenses paid to individuals, businesses, labor organizations and other entities OVER $00 per recipient, within a calendar year MUST be itemized on this schedule rover $2(X, if regular party committee). All cumulative expenses, including in-kind, regardless of amount paid to political committees, (such as transfers-out from candidate. legislative caucus, political action, or regular party committees) MUST be itemized on this schedule. Page FLE NUMBER RECPENT'S NAME AND MALNG ADDRESS (street, number, city, slate, ZP code) RECPENT'S OCCUPATON OFFCE SOUGHT (if applicable) TYPE OF EXPENDTURE and PURPOSE (be specific) AMOUNT THS CUMULATVE YEAR-TO-DATE DATE OF EXPENDTURE A c'... )6_, 6.4 b re---edir -7 2_,-- CE-..t TE44.4"/E (4 r4s- - STX ri Oki, /V t(c c(c.-s- 2-6; rul in-kind Payment o' Debt 0 'Returned Contributtor 0 Other : Q.., (.* it (60/ * -ze-)- c, 5/24, ' 0 Pc-) if>,_--,-/ E- t,i. c t-i7 eic5i p"6"tient n-kind Payment of Debt Retumed Cont riutto b r 0tne : 4 2j c( z / Li 5 7 Dye:: L. to-king Payment of Debt Returned Contribution 0 Othr. ' Direct in-kind Payment of Debt Returned Contribution oine, : ; Cant n-kina 0Payment of Deb: 7 Returned Contriouuor Other Clued! n-kind Payment of Debt Returned Contributor 0tner n. Druz n.kind Payment of Deo! 7 Returned Contnoutor 0 Other Purboss SUBTOTAL THS PAGE OF SCHEDULE B i S TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on TEM 7a of the Summary Sheet) /<-(e %

7 REPORT OF RECEPTS AND EXPENDTURES OF APOLTCAL COMMTTEE State Form 4606 (R3/-05) ndiana Election Commission (C ) (CFA-4 SCHEDULE D) DEBTS OWED BY THS COMMTTEE NSTRUCTONS: Please type or print legibly N BLACK NK all information on this schedule. For assistance in completing this schedule, see instructions on the reverse side. List all debts and loans, reaardless of the amount. OWED BY the committee during the reporting period. include all amounts owed for or to lend institutions, indivduais. credit purchases. committee credit card accounts, etc. List each vendor paid by credit card issued in the name of the committee in the ENDORSER'S column. r, lenders occupation is required if an individual makes loans of at least $.000 during the calendar year. Otherwise, this is optional. FLE NUMBER Page of CREDTOR'S OR LENDER'S NAME & MALNG ADDRESS (street, number, city, state, ZP code) ENDORSER'S OR VENDOR'S NAME & MALNG ADDRESS (if any) (street, number, city, state, ZP code) AMOUNT NATURE OF DEBT DATE DEBT NCURRED CUMULATVE PAD YEAR-TO-DATE OUTSTANDNG BALANCE THS LAG &T"TA SP/ Ws Aro& LENDER:5 OCCPATn S c--,< W 4-4 E- 4)(--ff 4 ` /c) Vbfir" -4j- LENDERS ODCLPATON LENDER'S ODCLPAtiON RNDEN-"S 0-`,PATON DSSLEN,7 ON LEZEESS CrSDURANCN SUBTOTAL THS PAGE OF SCHEDULED S /7, TOTAL OF ALL PAGES OF SCHEDULE DON THE LAST PAGE ONLY (Enter total on TEM 9 of the Summary Sheet) 70