WBlx4l12 A-17,94, hereby certify that the information in this Name of Poiiriral Treasurer

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1 CAMPAGN FNANCAL DSCLOSURE REPORT SUMMARY PAGE Please Print r Type) C- 2 Rev artinn Name Candidate r Plitical Cmmittee and Chairpersn elyecca F/R U n /-' v2 /- i-r ND in ing rens me OMOT bcal treasurer Rdbecc-11Z A'il'l rìl u Mailing Aildress F,, -,, Urty and Lip 832 Change f address fr: Candidate r Plitical Cmmittee Plitical Treasurer Sectin TYPE OF REPORT This filing is an: Original Amendment This reprt is fr the perid frm -ZlZ thrugh lo Office Sught ( if candidate) ACHOCim wsvm_ r- Hme Flnne a ne City and Zip me ne Wrk Frine Disldct (if any) k, za8f#1 Zs Octber 10 Pre - Reprt 7 Day Pre - Reprt 30 Day Pst - Reprt Annual Reprt Semi -Annual Reprt ( Statewide Candidates Only s this a Terminatin Reprt: Yes N Sectin STATEMENT OF NO CONTRBUTONS OR EXPENDTURES Directins: f yu had n cntributins r expenditures during this reprting perid, check the bx next t the statement belw and sign this reprt. Be sure t carry frward the apprpriate "Calendar Year t Date" figures in Clumn, Sectin V. Sectin V hereby certify that have received n cntributins and have made n expenditures during this reprting perid. T reach yur Calendar Year t Date figure: Add this reprt' s Clumn figures t the Clumn figures f yur previus reprt (except n line 6). Line 1: Cash n Hand January 1, This Calendar Year" Line 2: Enter Beginning Cash Balance" Line 3: Ttal Cntributins ( Enter amunt frm line 5, page 2) SUMMARY COLUMN This Perid COLUMN Calendar Year t Date XXXXXX 25n %." XXXXXX l ZZS. 3 Z Line 4: Subttal ( Add lines 1, 2 and 3) Line 5: Ttal Expenditures ( Enter amunt frm line 11, page 2) Line 6: Enter Ending Cash Balance ( Subtract line 5 frm line 4) Line 7: Outstanding Debt t Date ( Enter amunt frm line 18, page 2) s This same figure shuld be entered n line 1 f all reprts filed this calendar year. This is the figure n line 6 f the last Campaign Financial Disclsure Reprt filed. f this is yur first reprt, this amunt is 0. Nte: The clsing cash balance fr the current reprting perid appears n the next reprt as the beginning cash n hand. Return This Reprt T: Sectin V Ada cunty Highway District stacey Wrkman, clerk 3775 Adams Street Garden City, 1D WBlx4l12 A-17,94, hereby certify that the infrmatin in this Name f Piiriral Treasurer reprt is a true, cmplete and crrect Ca n Financial Disc sur Reprt by law. Page 1 Signature f Plitical Treasurer swrkman@achdidah.rg

2 DETALED SUMMARY Name f Candidate r Cmmittee: `_ 01 cc k AXAl L p tf A e_ - /fj Ttal This Perid Cntributins Unitemized Cntributins ($ 50 and less) # f Cntributrs temized Cntributins ( Ttal f all Schedule A sheets) n -Kind Cntributins ( Ttal f all Cntributin amunts frm Schedule C sheets) 5_3.3_ =_ Lans ( Ttal f all New Lan amunts frm Schedule D sheets) Ttal Cntributins ( Transfer this figure t page 1, Sectin V, Line 3) i Expenditures Expenditures Unitemized Expenditures (Less than $ 25) # f Expenditures temized Expenditures (Ttal f all Schedule B sheets) n -Kind Expenditures ( Ttal f all Expenditure amunts frm Schedule C sheets) Lan Repayments ( Ttal f all Lan Repayment amunts frm Schedule D sheets) Credit Card and Debt Repayments (Ttal f all Repayment amunts frm Schedule E sheets) Ttal Expenditures ( Transfer this figure t page 1, Sectin V, Line 5) _ Z $ Lans, Credit Cards and Debt Outstanding Balance frm previus reprting perid rj rr2, 07 New Lans received during this reprting perid Ttal f all New Lan amunts plus Accrued nterest frm Schedule D sheets) _ New Credit Card and Debt incurred this reprting perid Ttal f all New ncurred Debt amunts frm Schedule E sheets) Subttal Repayments f Lans made during this reprting perid Ttal f all Lan Repayment amunts frm Schedule D sheets) Repayments f Credit Card and Debt this reprting perid Ttal f all Debt Repayment amunts frm Schedule E sheets) Ttal Outstanding Balance at clse f this perid ( Transfer this figure t page 1, Sectin V, Line 7) Cntributins Unitemized Pledged Cntributins ($ 50 and less) # f Pledges + $ temized Pledged Cntributins this Perid ( Ttal f all Schedule F sheets) + $ Ttal Pledged Cntributins this perid _ $ Page 2

3 SCHEDULE A TEMZED CONTRBUTONS / f mre than Fifty Dllars ($ 50. ) this perid Name f Candidate r Cmmittee: Rebecca A Ktj a t= e_ Nr -w b, page Date Received Full Name, Mailing Address and Zip Cde f Cntributr Cash r Check general 1. l7uyfas F. fpenheir er zgr2 & ekeler LN 130se, s, ` 03' r tv ZS Calendar Year -T -Dale 2. WinsTr3 JkA- rc m 1 0 Lp Mere ctp" Y f3 X Sz4 z z` ny- _ CalendarYear-T- Date 3. TeF r cl W. Nr i0 G rsr g3' ri- ZZ-4- ng " l3' Calendar Year -Mate a 0Pri ary 4. M Frd irre_tl 4. t O tttz W. Asl, b rnepr. 0D 10 CalendarYear-T-Date 5. cl esr LNc hµ- 17 to. PrestdenT 01- l ( 5 aryz l 7r f7 33'ji3 10 efal 6. } i 4e rvn sse 50p Z L'{ E. 49klanciVle.J9 r. 50 l Ca ru eneral CalendarYear- T-Date nary Z- eral 027// G Elry Pr a 7' C0.rl yn Ter lel i Z050 F. -ra3ce 2 R r isu(' 14"'1yy Ltn4-ra-a+ vrs ( kss ciafi n SOw. -Kwfcr sd S- C) PNS LZO( i N p1sc6v6, r Waa.) 5u-rkc N Tj1se S O ` 6311,3 30 0'' p Ttal This Page: 53 Transfer the cmbined ttal f all Schedule A pages t the Detailed Summary n page 2line 2.

4 SCHEDULE B TEMZED EXPENDTURES Twenty -Five Dllars ($ 25. ) r mre this perid age Name f Candidate r Cmmittee:? Z r -73c C( '/+- Ae V U 1-6 C J -->- A c t/ 0 1 A B C D E F G H L M All Travel Expenses ( Airfare, Fuel, Ldging & Mileage) Bradcast Advertising ( Radi, TV, nternet & Telephne) Cntributins t Candidates & PAC's Dnatins & Gifts Event Expenses Fd & Refreshments Operatinal Expenses ndependent Expenditures Literature, Brchures, Printing Management Services N Newspaper& Other Peridical Advertising 0 Other Advertising ( Yard Signs, Buttns, etc.) P Pstage S T U W Y Z Surveys & Plls Tickets ( Events) Utilities Wages, Salaries, Benefits & Bnuses Petitin Circulatrs Preparatin & Prductin f Advertising a e Spent FU1arae, Mailing Address and Zip Cde f Recipienturpse e s) Uasri r ec 1. 4 da C u t -h-/ L e* r C lzlld G 3. esp L 4. ESP P2f A' Yrab k Ake:(, A 010 Ja = , / Ttal This Page: 9% a9 Transfer the cmbined ttal f all Schedule B pages t the Detailed Summary n page 2line 7.

5 SCHEDULE C N- KND CONTRBUTONS and EXPENDTURES Page Name f Candidate r Cmmittee: Purpse Cdes ( Enter up t 3 purpse cdes per Expenditure.) A All Travel Expenses ( Airfare, Fuel, Ldging & Mileage) N Newspaper& Other Peridical Advertising B Bradcast Advertising ( Radi, TV, nternet & Telephne) 0 Other Advertising ( Yard Signs, Buttns, etc.) C Cntributins t Candidates & PAC' s P Pstage D Dnatins & Gifts S Surveys & Plls E Event Expenses T Tickets ( Events) F Fd & Refreshments U Utilities G Operatinal Expenses W Wages, Salaries, Benefits & Bnuses H ndependent Expenditure Y Petitin Circulatrs L Literature, Brchures, Printing Z Preparatin & Prductin f Advertising M Management Services 1. Cntributr Cntributr Name, Name, Mailing Mailing Address Address and and Zip Zip Cde Cde Expenditure Name, Mailing Address and Zip Cde Purpse Cde( s) 2. Cntributr Name, Mailing Address and Zip Cde J / Expenditure Name, Mailing Address and Zip Cde Purpse Cde( s) 3. Cntributr Name, Mailing Address and Zip Cde Expenditure Name, Mailing Address and Zip Cde Purpse Cde( s) 4. Cntributr Name, Mailing Address and Zip Cde Expenditure Name, Mailing Address and Zip Cde Purpse Cde(s) Expenditure Ttal: Transfer the cmbined ttal f all Expenditures n Schedule C pages $ t the Detailed Summary, page 2 line 8) Cntributr Ttal, Transfer the cmbined ttal f all Cntributrs n Schedule C pages t the Detailed Summary, page 2 line 3)

6 SCHEDULE D - LOANS Name f Candidate r Cmmittee: Rr'/%ccca A 2N d e. - 9CYL t- c G -fl) Each Lender t yur campaign shuld be listed separately. Each time a lan is received r yu lan mney t the campaign, it must be listed as a separate item. Each new lan frm any Lender must be listed as a new item frm that Lender. Yu may have the same Lender listed mre than nce. Except fr a candidate making a lan t his r her wn campaign, lans frm any Lender cannt exceed cntributin limits laid ut in Sectin A, dah Cde, even if it is repaid in full. Any lan( s) with a balance( s) appearing n the last reprt must be listed belw with the amunt in the Previus Balance clumn. Any new lan amunts shuld be listed in the New Lan clumn. Any interest accrued shuld be listed in the nterest Accrued clumn. f a payment was made n the lan, list it in the Repayments clumn. Nte: Any lan that was repaid in full in a previus reprting perid des nt need t be listed. The Outstanding Balance clumn is the Previus Balance plus new lans and accrued interest less any repayments. Name, Mailing Address and Zip Previus Balance New Lan amunt nterest accrued Repayments f Lan Balance Cde f Lender f lan at the received during this during this during this reprting utstanding at Candidate. ndividual r Business) end f the last reprting perid reprting perid perid the end f this reprting perid 1. FCA ecca A ( r ( z r t A« a 2 Jt TU f137 4 reprting perid 3 Dale: q JrOOU. C q z 5l7 z/ l $ Previus Received nterest Repayments Ending Balance Previus Ttal eceived ta: Transfer the cmbined ttal f all received lans t the $ Detailed Summary, page 2 line 4) nterest Ttal: $ Repayments Ttal: Transfer the cmbined ttal f all lan repayments t the $ Detailed Summary, page 2 line 9 & 16) Ending Balance Ttal: $ Z 597 y/ NOTE: Transfer the cmbined ttal f all Accrued nterest and Received Lans t the Detailed Summary, page 2line 13)

7 SCHEDULE E - CREDT CARDS and DEBT Name f Candidate r Cmmittee: Each incurred expense nt yet paid ( i. e. credit card purchases and debt) shuld be listed n a separate line. Each time yu make purchases with a credit card r incur debt, it is cnsidered t be a separate item. Hwever, yu will maintain a single item fr each credit card and add purchases t that item. Each Creditr listed belw with a New Debt amunt must have a Schedule E- 1 accmpanying it. The Schedule E- 1 lists where and when the debt was incurred. Credit Cards are cnsidered debt t the campaign. Regardless f whether the credit card is repaid when the statement is received, all credit card transactins will appear n Schedule E and E- 1. Hwever, nly Repayments f Debt during this reprting perid appear in the Expenditure Sectin f the Detailed Summary Page. Any creditr(s) with a balance(s) appearing n the last reprt must be listed belw with the amunt in the Previus Balance clumn. Any new debt shuld be listed in the New Debt clumn, including any accrued interest. f a payment was made n the debt, list it in the Repayments clumn. Nte: Any debt that was repaid in full in a previus reprting perid des nt need t be listed. The Outstanding Balance clumn is the Previus Balance plus New Debt less any Repayments f Debt. Name, Mailing Address and Zip Cde f Previus Balance f New Debt amunt Repayments f Debt Balance utstanding Creditr debt at the end f the incurred during this during this reprting at the end f this Candidate, ndividual r Business) last reprting perid reprting perid perid reprting perid i. 2 3, Dale: Previus ncurred Repayments Ending Balance Previus Ttal: $ ncurred Ttal: Transfer the cmbined ttal f all incurred debt t the $ Detailed Summary, page 2 line 14) Repayments Ttal: Transfer the cmbined ttal f all debt repayments t the $ Detailed Summary, page 2 line 10 & 17) Ending Balance Ttal: $

8 SCHEDULE E- 1 - CREDT CARD and DEBT TEMZATON age Name f Candidate r Cmmittee: Name f Creditr frm Schedule E: Each Creditr listed n Schedule E with a New Debt amunt must have a Schedule E- 1 accmpanying it. The Schedule E- 1 lists where and when the debt was incurred. Purpse Cdes ( Enter up t 3 purpse cdes per Expenditure.) A All Travel Expenses ( Airfare, Fuel, Ldging & Mileage) M Management Services B Bradcast Advertising ( Radi, TV, nternet & Telephne) N Newspaper& Other Peridical Advertising C Cntributins t Candidates & PAC' s 0 Other Advertising ( Yard Signs, Buttns, etc.) D Dnatins & Gifts P Pstage E Event Expenses S Surveys & Plls F Fd & Refreshments T Tickets ( Events) G Operatinal Expenses U Utilities H ndependent Expenditure W Wages, Salaries, Benefits & Bnuses nterest Accrued & Finance Charges Y Petitin Circulatrs L Literature, Brchures, Printing Z Preparatin & Prductin f Advertising Date incurred FullName, mailing refs an p Ude t Lxpenditure urpse deis) FullName, mailing refs an p Ude t Lxpenditure urpse deis) mun / Ttal This Page: The ttal f itemizatin fr this creditr shuld equal the new lan amunt listed n Schedule E fr this creditr.

9 SCHEDULE F PLEDGED CONTRBUTONS BUT NOT YET RECEVED age Name f Candidate r Cmmittee: Directins: Cmplete this schedule if yu were prmised and agreed t accept a cntributin during this reprting perid but have nt actually received the mney, gds r services ffered befre the end f the reprting perid. D nt include these entries n Schedule A until yu actually receive the cntributin. Pledged Fr Date Pledged Full Name, Mailing Address and Zip Cde f Cntributr Amunt Pledged Ttal Amunt f Pledged Cntributins: $ Transfer the cmbined ttal f all Schedule F pages t the Detailed Summary n page 2 line 20.