(CFA-4 SCHEDULE A-1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts

Transcription

1 REPORT OF RECEIPTS AND EXPENDiTUIQE State Form 4606 (R13/11-05) (CFA-4) Summa Sheet INSTRUCTIONS: Please type or print legibly IN BLACK MIK all information on this form. For assistance in completing this form, see instructions on the reverse side. IS THIS AN AMENDMENT? Yes QNo COMMITTEE INFORMATION 1. Full Name of Committee (as on Statement of Organization) U Check if this is a new name CTE MARK KALWINSKI 2. Acronym or Abbreviated Name (if any) 3. Committee Telephone Number ( Mailing Address (address where all campaign finance correspondence is received) U Check if this is a new address 4037 JOHNSON AVENUE 5. City, State. ZIP Code HAMMOND IN Full Name of Candidate (include any nickname) MARK KALWINSKI 6. Party Affiliation (if applicable) DEMOCRAT CANDIDATE INFORMATION (For Candidate's Committees Only) 9. Office Sought (Include district number, if any. Not required for exploratory committee.) COUNCILMAN 1ST DISTRICT HAMMOND TYPE OF REPORT 11. Check one: 111 Pre-Primary r Pre-Election U Annual Nomination Other Final/Disbands Committee fines , and 20 must be V) Outgoing Treasurer (w44/i, 10 days amend Statement of (Varna: ) 12. Reporting Period: From: 4/11/15 Through: 10/9/ Cash on hand and investments at the beginning of this reporting period. 14. 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) 8. Party Affiliation or If Independent Candidate DEMOCRAT 10. County of Residence LAKE CONVENTION CANDIDATES ONLY Check one: This Period Pre-Convention Post-Convention 2, Year to Date , , b. Unitemized 2, , c. Add lines 15a and 15b in both columns SUBTOTAL 9, , 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.) 12, a. Itemized (use Schedule B) (Public Question: use Schedule C) 7, b. Unitemized , c. Add lines 17a and 17b in both columns SUBTOTAL 8, , Cash on hand and investments at close of this reporting period (subtract 17c from 16/n both columns) TOTAL 4, , Debts OWED BY the committee (use Schedule D) 20. Debts OWED TO the committee (use Schedule E) CERTIFICATION C V ±-1 t! -.:.-,,-! I CERTIFY THAT I HAVE EXAMINED THIS STATEMENT. TO THE BEST OF MY KNOWLEDGE AND BELIEF it Is TRUE, CORRECT tte CQMP L4 Signatu e Treasurer 6kw-c-A.44: Title Treasurer Date 10/12/15 Signature of Crdidate (if applicable) /1"talfi it<-)- Date 10/12/15 WARNING: Any inforrt ti contained in this report may not be copied for sale or used for any commercial purpose. (IC ) A person who knowingly, files a fraudulent report commits a Class 0 felony. (IC ) A person who fails to file a complete or accurate report as required by the Indiae Campaign Finance Law commits a Class B misdemeanor, (IC ) and may be subject to civil penalties. (IC , C Z IC ) FOR OFFICE USE ONLY ct 130 SIO2

2 State Form 4606 (R13/11.05) (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 15a of 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, rehires of deposit proceeds from sales, interest or other income) OVER $100 per contributor. within a calendar year, MUST be itemized on this schedule (over 5200 if regular patty committee). A contributor's occupation is required if an individual makes at least 51,000 in contributions during the calendar year. Otherwise, this is optional. Page 1 of 2 1. CONTRIBUTOR'S FULL NAME AND OCCUPATION Direct Interest Ii Loan 1, , DATE RECEIVED Contributors Occupation (drew-red) 2. Leo and Cindy Barron 2020 Stanton Whiting IN Direct 4/23/15 Interest II Loan Contributor's Occupation fit recurred) 3. Berger, Robert 3912 Highway Ave Highland IN Contributor's Occupation (if required) 4. Dean Button 1850 Maiden LN Whiting, IN Direct 6/5/15 Interest Loan 1 Direct Contributor's Occupation firrequkedi 5. Litavecz, Al & Ursula 2703 Hart Rd Highland IN Contributors Occupation (il rebuked) Interest Loan J Direct $ Ig 575 fnnd fnr hindrairpr Interest Loan misc. (specify) SUBTOTAL THIS PAGE OF SCHEDULE A S 1, (Enter total on ITEM 15a of the Summary Sheet),

3 State Form 4606 (R13/11-05) (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 15a of the Summary Sheet. At cumulative contributions from individuals OVER $100 per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular parry committee). All cumulative receipts, (such as ban proceeds and repayments, refunds, rebates returns of deposit, proceeds from sales, interest or other income) OVER $100 per contributor, within a calendar year, MUST be itemized on this schedule (over 5100 if regular party committee). A contributors occupation is required if an individual makes al least 91,000 in contributions during the calendar year. Otherwise, this is optional. Page 2 of 2 i CONTRIBUTOR'S FULL NAME AND OCCUPATION Marty Vyielgos 7119 Higgins Park West Ave, Hammond IN PI Direct DATE RECEIVED 6/5/2015 Interest Loan Contributors Occupation (if required) 2 Ron & Karen Lubas 2034 Wespark Whiting, IN Contributors Occupation Of required) 3. Christopher and Angela Moore th St. Highland IN Contributors Occupation (11 required) 4. iii Direct Interest Loan Direct In Kind (describe) Interest Loan 12] Direct /16/2015 Contributors Occupation (i requaed) 5. Interest 0 Loan Direct Interest Loan a Contributor's Occupation al required) SUBTOTAL THIS PAGE OF SCHEDULE A $ (Enter total on ITEM 15a of the Summary Sheet) 2,875.83

4 State Form 4606 (R13/11-05) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY CORPORATIONS ON THIS SCHEDULE. Please BLACK INK all information on this schedule. For assistance in completing this schedule, see instructions schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. All from corporations OVER $100 per contributor, within a calendar year MUST be itemized on this s party committee). All cumulative receipts, (such as loan proceeds and repayments, refunds. rebat from sales, interest or other income) OVER $100 per contributor, within a calendar year, MUST be $200 i 1 regular party committee). (CFA-4 SCHEDULE A-2) CONTRIBUTIONS BY CORPORATIONS Itemizegtontributions and Other Receipts Pe legibly IN side. This e contributions $200, if regular of deposit proceeds on this schedule (over Page 1 Of 1 CONTRIBUTOR'S FULL NAME AND 1. Gateway Triangle Corp. 850 Indpls. Blvd. Hammond IN El Direct DATE RECEIVED 4(27/15 Other Receipts : Interest 111 Loan 1, , Stolarz, Jeff DDS Corp th St Whiting, IN Direct Interest U Loan Direct I. Interest Loan Mist (specify) 4. 1 Direct NI Interest Loan S. 11 Direct IN Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A 5 1, (Enter total on ITEM 15a of the Summary Sheet) 5

5 State Form 4606 (R ) 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 of the Summary Sheet. All cumulative contributions from political action committees OVER 5100 per contributor, within a calendar year MUST be itemized on this schedule lover $200, if regular party committee). All transfers-in and in-kind contributions regardless of amount from political action committees MUST be itemized on this schedule. All cumulative receipts, (such as loan proceeds and repayments. refunds. rebates, returns of deposit, proceeds hom sales, interest or other income) OVER 5100 per contributor, within a calendar year, MUST be itemized on this schedule (over 5200 if regular party committee). (CFA-4 SCHEDULE A-4) CONTRIBUTIONS BY POLITICAL ACTION COMMITTEES Itemized Contributions and Other Recei ts CONTRIBUTOR'S FULL NAME AND DATE RECEIVED 1. Boilermakers Local 374 State & Local PAC 6333 Kennedy Ave. Hammond IN Direct In -Kind (describe) Other Receipts Interest Loan /5/ DPBG PAC 7260 Shadeland Sta. Indianapolis IN L Direct Interest Loan III Hammond Firefighters PAC P.O. Box 1085 Hammond IN II Direct 6/5/2015 Interest Loan Direct Interest Loan 5. Direct Other Receipts' Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A 5 1, (Enter total on ITEM 15a of the Summary Sheep e 4.

6 1.* State Form 4606 (R13/11.05) ' 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 rot assistance in completing this schedule, see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on ITEM 15a of the Summary Sheet. All cumulative contributions from other entities OVER S100 per contributor, within a calendar year MUST be itemized on this schedule (over 52oa if regular party committee) All transfers-in and in-kind contnoutions regardless Of amount from candidate's, legislative caucus, and regular party comminees MUST be itemized on this schedule. All cumulative receipts. (such as loan proceeds and repayments, refunds, rebates, returns of deposit, proceeds from sales,!merest or other income) OVER $100 per contributor, within a calendar year, MUST be itemized on this schedule (over 5200 if regular party committee) (CFA-4 SCHEDULE A-5) CONTRIBUTIONS BY OTHER ORGANIZATIONS Itemized Contributions and Other Recei ts 1. CONTRIBUTOR'S FULL NAME AND Grisolia Concrete Work 1434 Calumet Whiting IN RI Direct in-kind (describe) U Interest Loan DATE RECEIVED 2. Hutton & Hutton Architects & Engineers LLC 6832 Calumet Hammond, IN Direct In -Kind (describe) 6/5/15 Interest Loan 3. Ed Krusa d/b/a Krusa Consulting 7217 Knickerbocker Pkwy Hammond IN E Direct II Interest Loan 4. CTE T. McDermott PO Box 2477 Hammond, IN fie Direct In -Kind (describe) Interest Loan S. Kevin Smith / Steve Sersic 9301 Calumet Ave Ste 1F Munster IN ] Direct 0 Interest IS Loan SUBTOTAL THIS PAGE OF SCHEDULE A $ 1, (Enter total on ITEM 15a of the Summary Sheet)

7 State 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 sch schedule, see instructions on the reverse side. This schedule is used to document Summary Sheet. All cumulative expenses paid to individuals, businesses, labor organ stance in completing this otaled on ITEM 17a of the nd other entities OVER $100 per recipient, within a calendar year MUST be itemized on this schedule (over $200, if pally 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 1 of 2 RECIPIENT'S NAME AND MAILING ADDRESS RECIPIENT'S OCCUPATION OFFICE SOUGHT (if applicable) TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE Code F American Legion # Gostlin Hammond IN IM Direct In-Kind 0 Payment of Debt Retumea Contribution 0ther hall rental /8/15 Code C Buncich Boosters PO Box Merrillville IN Code A 1 CR Publications 640 Conkey Hammond, IN Code 0 I HA Democratic Precinct Org Olcott Hammond IN Direct In-Kind Payment of Debt 0Mer fund raiser CI Direct In-Kind Payment of Debt 2, , other fliers, shirts, hats, signs Direct In-Kind Payment of Debt 0 Returned Contributon 2, , ther endorsement fee 7/23/15 7/7/ /15 Code 0 I Gretchen 4525 N. Campbell Chicago IL E Direct In-Kind 0 Payment ol Debt pother media content. writing, revis ans, web updates /21/15 Code F 1 Dave Krause Legion Post Gostlin Hammond IN Direct In-Kind 0 Payment of Debt Dover hall cleanup /8/15 Code A Menards th Hammond, IN Q Direct in-kind Payment of Debt 0 0ther /27/15 sign hardware and supplies SUBTOTAL THIS PAGE OF SCHEDULE B $ 5, TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY s (Enter total on ITEM 17a of the Summary Sheet)

8 State 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 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 $200, if regular patty 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 2 of 2 RECIPIENT'S NAME AND MAILING ADDRESS RECIPIENT'S OCCUPATION OFFICE SOUGHT (if applicable) TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE Code C I Polish American Heritage Fund c/o G. Tarka 315 Mason St Calumet City IL IE Direct In-Kind 0 Payment of Debt Returned Conribution 0tter donation /24/2015 Code Staples 7951 Calumet Ave Munster, IN it Direct In-Kind Payment of Debt 0ther loner, paper, supplies /15/2015 Code 0 I Cavalier Inn 735 Gostlin Direct 0ther meetings In-Kind Payment of Debt /30/15 Code F J GFS Marketplace rd St. Lansing, IL Direct In-Kind Payment bit Debt Returned Conthbution ['Other supplies for fund raiser 4/15/15 Code 0 I 4037 Johnson Hammond IN Direct In-Kind Payment of Debt 0 0Mer /9/15 Code F I Lindys Ace Hardware 6220 Kennedy Avenue, Hammond, IN Direct In-Kind 0 Payment of Debt 0 0ther supplies for fund raiser /16/15 Code Direct In-Kind Payment of Debt Other SUBTOTAL THIS PAGE OF SCHEDULE B $ 1, TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on ITEM 17a of the Summary Sheet) S 7,050.16

9 State Form 4606 (R13/11-05) (CFA-4 SCHEDULE D) DEBTS OWED BY THIS COMMITTEE 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. List all debts and loans regardless of the amount, OWED BY the committee during the reporting period. Include all amounts owed for or to lend institutions, individuals, 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. A lender's occupation is required if an individual makes loans of at least $1,000 during the calendar year. Otherwise, this is optional. Page 1 of 1 CREDITOR'S OR LENDER'S NAME & MAILING ADDRESS ENDORSER'S OR VENDOR'S NAME & MAILING ADDRESS (if any) (street, number, city, slate, ZIP code) AMOUNT NATURE OF DEBT DATE DEBT INCURRED PAID OUTSTANDING BALANCE THIS Hammond, IN /31/ prior year loan LENDER LL OD,CEPATION 2, prior year loans 12/31/03 5/31/04 10/17/05 11/13/ , LENDER'S DCCUEATELL, LENDER S OCCUPATION prior year loan 5, /13/07 10/12/07 13/30/07 12/1/08 12/21/09 12/31/ , ip,..er s cccurkizl. prior year loan ,. 4/3/11 10/1/11 10/24/12 12/19/13 12/31/ , , /9/15 1, , loan i ENDER S OCCUPATION LENDERS ODDLLPILTIDN LENDERS CCCOADDLL SUBTOTAL THIS PAGE OF SCHEDULED $ 13, TOTAL OF ALL PAGES OF SCHEDULED ON THE LAST PAGE ONLY (Enter total on ITEM 19 of the Summary Sheet) $