4-n-cr. 475: bb 'b. Unitemized. (CFA-4) Summary Sheet. < Hz ) XT-o-nn. nc^hj^ WMn'G,^Ta3 fi lbbj> WUsb CONVENTION CANDIDATES ONLY. /JltAdS?

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1 AOR:34 PCVD REPORT OF RECEIPTS AND EXPENDITURES State Forni 4606 (R13/11-05) (CFA-4) Summary Sheet INSTRUCTIONS: Please type or print legibly IN BLACK INK all information on this form. For assistance in completing this form, see instructions on the reverse side. IS THIS AN AMENDMENT? Yes No TOTAL PAGES IN ENTIRE CFA-4 REPORT COMMITTEE INFORMATION 1. Full Name Committee (as on Statement Organization) >*'il Check if this is a new name 2. Acronym or Abbreviated Name (if any) 3. Committee Telephone Number < Hz ) XT-o-nn X. Mailing Address (address where all campaign finance correspondence is received) O Check if this is a new address MX C. fitua.iai 1?C0D. >. City, State, ZIP 6. Party Affiliation (if applicable) nc^hj^ WMn'G,^Ta3 fi lbbj> CANDIDATE INFORMATION (For Candidate's Committees Only). Full Name Candidate (include any nickname) I\K<s A S?*>«or 8. Party Affiliation or If Independent Candidate. Office Sought (Include district number, if any. Not required for exploratory committee.) 10. County Residence 1. Check one: ^Pre-Primary L] Pre-Election [j TYPE OF REPORT Annual O Nomination [_] Other _J Final/Disbands Committee (lines tfl, 19, and 20 must be V) LJ Outgoing Treasurer (wrffwi 10 days amend Statement Organization) WUsb CONVENTION CANDIDATES ONLY Check one: I I Pre-Convention I I Post-Convention 2. Reporting Period: rom: 'j^/^vv-^ [ ^0(-5" Through: f\q&(l. io,szt>(s 3. Cash on hand and investments at the beginning this reporting period. * 1M 4. Gash on hand and investments January 1, current year. This Period Year to Date /JltAdS? 4ote: these amounts include in-kind contributions and loans, as well as cash contributions.) 5a. Itemized (use Schedule A) LlNb.bo 5b. Unitemized J hp.(>r> /go. 6o 5c. Add lines 15a and 15b in both columns SUBTOTAL 66. >o 5. Add lines 13 and 15c in Column A and lines 14 and 15c in Column B TOTAL 1 EXPENDITURES lote: These amounts include in-kind expenditures and loan repayments.) i 'a. Itemized (use Schedule B) (Public Question: use Schedule C) 475: bb 'b. Unitemized \yssb c. Add lines 17a and 17b in both columns SUBTOTAL L,5*0>,5~fc. Cash on hand and investments at close this reporting period (subtract 17c from 16 in both columns) TOTAL \34rx\ ix.67. Debts OWED BY the committee (use Schedule D). Debts OWED TO the committee (use Schedule E) CERTIFICATION ERTIFY THAT I HAVE EXAMINED THIS STATEMENT. TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS TRUE, CORRECT AND COMPLETE. Title ft & Date 4-n-cr Date FOR OFE m w b VIGO COUNTY SUPERIOR COU APR trnfng: Any information containechn this report may not be copied for sale or used for any commercial purpose. (IC ) A person who knowingly? a fraudulent remit commits a Class D felonv. IIC ) A nerson who fails to file a comdlete or accurate redort as reauired bv the Indiana

2 State Forni 4606 (R13/11-05) (CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS 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 15a the Summary Sheet. All cumulative contributions from individuals OVER $100 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 deposit, proceeds from sates, interest or other income) OVER $100 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 $1,000 in contributions during the calendar year. Otherwise, this is optional. CONTRIBUTOR'S FULL NAME AND OCCUPATION TYPE OF CONTRIBUTION OR OTHER RECEIPT DATE RECEIVED 1. Direct 32 (5 /Oi Sivrn I I In-Kind (describe) 4/lflS I I Interest O Contributor's Occupation (ifrequired) M 2. I I In-Kind (describe) I I Interest 3. r~l In-Kind (describe) I I Interest 0 n Misc. (specify) 4. I I In-Kind (describe) I I Interest LJ [Zl Misc. (specify) Contributor's Occupation (Urequired) 5. In-Kind (describe) I I Interest CH l~1 Misc. (specify) (Enter total on ITEM 15a the Summary Sheet)

3 INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY POLITICAL ACTION COMMITTEES 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 15a the Summary Sheet. All cumulative contributions from political action committees OVER $100 per contributor, within a calendar year MUST be itemized on his schedule (over $200, if regular party committee). All transfers-in and in-kind contributions regardless amount from political action committees MUST be itemized on this schedule. All cumulative receipts, (such as loan proceeds and repayments, refunds, ebates, returns deposit, proceeds from sales, interest or other income) OVER $100 per contributor, within a calendar year, MUST be itemized on this schedule (over $200 if regular party committee). (CFA-4 SCHEDULE A-4) CONTRIBUTIONS BY POLITICAL ACTION COMMITTEES CONTRIBUTOR'S FULL NAME AND TYPE OF CONTRIBUTION OR OTHER RECEIPT DATE RECEIVED B^Direct f~ In-Kind (describe) I I Interest d i?0 Contpbutions: O'Direct I! In-Kind (describe) p.b. B*>K?6 I I Interest d 3\0 ooo 3^0b.Oo m LJ In-Kind (describe) O Interest d r~l Misc. (specify) F~l In-Kind (describe) d Interest d d Misc. (specify) d Direct In-Kind (describe) d Interest d

4 (CFA-4 SCHEDULE A-5) CONTRIBUTIONS BY OTHER ORGANIZATIONS INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY ORGANIZATIONS OTHER THAN CORPORATIONS, LABOR ORGANIZATIONS, POLITICAL ACTION COMMITTEES AND 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 15a the Summary Sheet Ail cumulative contributions from other entities OVER $100 per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular parly committee). All transfers-in and in-kind contributions regardless amount from candidate's, legislative caucus, and regular party committees MUST be itemized on this schedule. All cumulative receipts, (such as loan proceeds and repayments, refunds, rebates, returns deposit, proceeds from sales, interest or other income) OVER $100 per contributor, within a calendar year, MUST be itemized on this schedule (over $200 if regular oarty committee). CONTRIBUTOR'S FULL NAME AND TYPE OF CONTRIBUTION DATE RECEIVED (street number, city, state, ZIP code) OR OTHER RECEIPT 0-tfirect QmeS 4- -flhfla8va LLP f~~l In-Kind (describe) 4/(/(5 L3?o»fV4fonr(^ 4)6^o4- fl Interest \3 [~~l Misc. (specify) IjDcb.bO ~l In-Kind (describe) (~1 Interest \3 f~l Misc. (specify) f~ In-Kind (describe) I I Interest [3 I I In-Kind (describe) I I Interest \3 l~1 Misc. (specify) I I In-Kind (describe) f~l Interest [3 $UoQ.6fr

5 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 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 $200, if regular parly committee). All cumulative expenses, including in-kind, regardless 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. L=*=L RECIPIENT'S NAME AND MAILING ADDRESS RECIPIENT'S OCCUPATION OFFICE SOUGHT (if applicable) TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE XL \A<& 'Zvcz l-ter E-etrect In-Kind f~l Returned Contribution *7re fvr B*T)irect In-Kind Purpose gg ^ > - 0 T ) US-bo vw In-Kind In-Kind In-Kind In-Kind In-Kind SUBTOTAL THIS PAGE OF SCHEDULE B TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on ITEM 17a the Summary Sheet)