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1 REPORT OF RECEIPTS AND PENDITURES OF A POLITICAL COM State Form 4606 (R13/11-05) Indiana Election Commission (IC3 INSTRUCTIONS: Please type or print leg BLACK INK all information on this form assistance in completing this form, see instructions on the reverse side. IS THIS AN AMENDMENT? EYes fa, No (CFA-4) Summary Sheet PUUL' TOTAL PAGES IN ENTIRE CFA-4 REPORT COMMITTEE INFORMATION 1. Full Name of Committee (as on, Statement of Omanizati n) Check if this is a new name f\, A 1,c,vcisi.S: (-k r,pi'.r- 2. Acronym or Abbreviated Name (if any) 13. Committee Telephone Number I( 2- ) 4? ) (2). ) ' t fig ce) b 4. Mailing Addre address where all campaign finance correspondence is received) Check if this is a new address 5. City, State, ZIP Z -1 1" (X (Lt...._ eth 1 r) I b CANDIDATE INFORMATION (For Candidate's Committees Only) 7. Full Name of Candidate (include any nickname) Ct r 101 rl 0 t 51 ILWIONNilitilllimmtvimmanasl, 9. Office Sought (Include district number, if any. Not required for exploratory corn i ttee.) C 1 L. it'l 40U r 6( 11. Check one: TYPE OF REPORT III Pre-Primary Pre-Election Annual Nomination Other FinallDisbands Committee (lines 18, 19, and 20 must be "01 Outgoing Treasurer (within 10 days amend Statement of Organization) 12. Reporting Period: 6. Party Affiliation (if applicable) ' 4_,(\/1,) C Party Affiliation or If Independent Candidate L A q --ii (.../ 10. County of Residence gik.."4 (J..) CONVENTION CANDIDATES ONLY Check one: Pre-Convention Post-Convention From: ' 1 - ) 1 - lc / 4 4f ' lc Through: This Period Year to Date 13. Cash on hand and investments at the beginning of this reporting period 0 G 3X illi 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) 15b. Unitemized So -125u 15c. Add lines 15a and 15b in both columns SUBT 4 "S2.5- l'-c Add lines 13 and 15e in Column A and lines 14 and 15c in Column B 3 TOTAL EXPENDITURES (Note: These amounts include in-kind expenditures and loan repayments.) 5.,r1:" 15 Liss- 7a. Itemized (use Schedule B) (Public Question: use Schedule C) _ 0 17b. Unitemized 17c. Add fines 17a and 17b in both columns. Lb SUBTOTAL 2.4) c 18.Cash on hand and investments at close of this reporting period (subtract 17c from 16 in bo 19. Debts OWED BY the committee (use SchedueVY 09 NO1 20. Debts OWED TO the committee (use Schedule Efi N '.racim., :minximp,. CD (136 3y i 'ygir..6 6 G 4,3 'I I CERTIFY THAT I HAVE EXAMINED THIS ST MENT. Signature of Tre r CERTIF:CATION El ST OF MY KNOWLEDGE AND BELIEF IT IS TRUE. CORRECT AND COMPLETE. Title 7 fti/m at f- Date/ 171f- FOR OFFICE USE ONLY Signatur Card if a icable I 1 )"*C. WARNING: Any information 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 D felony. (IC ) A person who fails to file a complete or accurate report as required by, the Indiana Campaign Finance Law commits a Class B misdemeanor. (IC ) and may be subject to civil penalties. ((C , IC , IC ) Date
2 it REPORT OF RECEIPTS AND EXPENDITURES Indiana Election Commission (IC ) 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, 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 $200 if regular party committee). A contributors occupation is required if an individual makes at least in contributions during the calendar year. Otherwise. this is optional. (CFA-4 SCHEDULE A 1) CONTRIBUTIONS BY INDIVIDUALS Itemized Contributions and Other Receipts FILE NUMBER 1. CONTRIBUTOR'S FULL NAME AND OCCUPATION FULL MAILING ADDRESS kkav LA '')10 [Al. frlil g, Av e CtoLd'N P"4. \ ''''') 1/ TYPE OF CONTRIBUTION OR OTHER RECEIPT AEP Direct Interest Loan fi Oa 'L S _- DATE RECEIVED RECEIVED BY / 0-/6-Ir /AI A.Ideise, Contributor's Occupation (I required) Direct Interest Loan Contributor's Occupation Onstruired) 3. Direct Interest Loan Misc. (specify Contributor's Occupation (Inquired) 4. Direct Interest Loan Contributor's Occupation (if required) 5. Direct Interest Loan Contributor's Occupation (if require* SUBTOTAL THIS PAGE OF SCHEDULE A $ lv" TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY v-ou (Enter total on ITEM 15a of the Summary Sheet) $ 1,5 -..
3 ) REPORT OF RECEIPTS AND EXPENDITURES Indiana Election Commission (IC ) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY CORPORATIONS 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 corporations 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 of 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-2) CONTRIBUTIONS BY CORPORATIONS Itemized Contributions and Other Receipts FILE NUMBER CONTRIBUTOR'S FULL NAME AND FULL MAILING ADDRESS (street, number, city, state, ZP code) TYPE OF CONTRIBUTION OR OTHER RECEIPT Direct in-kind (describe) DATE RECEIVED RECEIVED BY Interest Loan 2. Direct Interest Loan 3. Direct Interest Loan Misc. (speciv 4. Direct Interest Loan 5. Direct Interest Loan II SUBTOTAL THIS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on ITEM 15a of the Summary Sheet),.
4 iar t REPORT OF RECEIPTS AND EXPENDITURES State Form 4606 (R13!11-05) INSTRUCTIONS: LIST ONLY CONTRIBUTIONS BY LABOR ORGANIZATIONS ON THIS SCHEDULE. Please type or print legibly IN BLACK INK d 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 labor organizations OVER 5100 per contributor, within a calendar year MUST be itemized on this schedule (over $200, if regular party committee). AD cumulative receipts, (such as loan 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 5200 if regular party convn/tlee). (CFA-4 SCHEDULE A-3) CONTRIBUTIONS BY LABOR ORGANIZATIONS Itemized Contributions and Other Recei ts Page FILE NUMBER of CONTRIBUTOR'S FULL NAME AND FULL MAILING ADDRESS '[. A10 IT' (A/ 54 " rj 19 1 rniet vr- CJA t 1 k41.5 S. rtvini St. AA/ mutt, ill-jrt, * Al ) ful TYPE OF CONTRIBUTION OR OTHER RECEIPT Contributions! s-- Direct Interest Loan misc. (specify). 1) 4 ca6 DATE RECEIVED RECEIVED BY / 0-25" - Ir /VOL frfraft ff..., 2. Direct Interest Loan 3. Direct Interest Loan 4. Direct Interest Loan 5, Contributions. Direct Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A S )0 0 TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on ITEM 15a of the Summary Sheet), Ns.... POO
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. At cumulative contributions from political action committees OVER $100 per contributor, within a calendar year MUST be itemized on this schedule (over $200, N 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 from sales, interest or other income) OVER 5100 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 Itemized Contributions and Other Receipts 1. CONTRIBUTOR'S FULL NAME AND FULL MAILING ADDRESS TYPE OF CONTRIBUTION OR OTHER RECEIPT Direct DATE RECEIVED RECEIVED BY Interest Loan 2. Direct Interest Loan 3. Direct Interest Loan Direct Other Receipts - 0 Interest Loan 5. Direct Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on ITEM 15a of the Summary Sheet). '''
6 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 at 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 158 of the Summary Sheet At cumulative contributions from other entities OVER $100 per contributor, within a calendar year MUST be itemized on this schedule (over if regular party committee). All transfers-hi and ih-kind contributions reciardless of 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 of deposit, proceeds from sales, interest or other income) OVER $100 per contributor, within a calendar year. MUST be itemized on this schedule (over S200 if regular party committee). (CFA-4 SCHEDULE A-5) CONTRIBUTIONS BY OTHER ORGANIZATIONS Itemized Contributions and Other Recei is 1. CONTRIBUTOR'S FULL NAME AND FULL MAILING ADDRESS TYPE OF CONTRIBUTION OR OTHER RECEIPT Direct DATE RECEIVED RECEIVED BY Interest Loan 2. Direct Interest Loan 3. Direct Interest Loan 4. Direct Interest Loan 5 Direct Interest Loan SUBTOTAL THIS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on ITEM 15a of the Summary Sheet)
7 Indiana Election Commission (IC (CFA-4 SCHEDULE B) ITEMIZED EXPENDITURES INSTRUCTIONS: Please type cr 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 5200, 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. FILE NUMBER MN= Page of RECIPIENT'S NAME AND MAILING ADDRESS RECIPIENT'S OCCUPATION OFFICE SOUGHT (if applicable) TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE 0 I ( rov l Ga-r.k, ti3 At w,s(6.fin so- kixo., #, Yidi 11 4 " 1- Direct In-Kind 1E1 Payment of Debt Returned Contribution 00,,,er warmth Patti/ imiti t 0,,,,r y,irto CI c, kg 1(00 IOU 0 I "I, t im...is.)" ti ctuj /fie, 5 1.1,41 L-A4Ae PATIO id (.4HW sect 0 In-Ki nd g-dplayment of Debt Returned Contribution Dow 4h:1.6/hill, IA- ea-i ti 4-44 'el I id0 / a d (1 bilir _ I 0 Direct In Kind 0 Payment of Debt 0 Returned Ccotribution 0ther Direct0 In-Kind 0 Payment of Debt Returned Contribution 0 Other 0 Direct 0 In-Kind 0 Payment of Debt Returned Contribution Domes 0 Direst IrkKind 0 Payment of Debt 0 Returned Contribution 0ther 0 Direct 0 In-Kind 0 Payment of Debt Returned Contribution 0 Otn er SUBTOTAL THIS PAGE OF SCHEDULE B $ 2 0 " TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY (Enter total on ITEM 17a of the Summary Sheet) $ z,,,, '''''
8 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. All cumulative expenses or transfers-out, regardless of amount paid to political committees supporting or opposing a public question, MUST be itemized on this sdiedule. (CFA-4 SCHEDULE C) ITEMIZED EXPENDITURES For Public Questions FILE NUMBER Enter Text of Public Question PUBLIC QUESTION INFORMATION Page 0 of r2 Type of Question: Statewide Local Position: Supported Opposed RECIPIENTS NAME AND MAILING ADDRESS RECIPIENT'S OCCUPATION TYPE OF EXPENDITURE and PURPOSE (be specific) DATE OF EXPENDITURE I Direct In-IGnd Payment of Debt Returned Contribution 0ther Purpose Direct In-Kind Payment of Debt Returned Contribution 0ther 0 Direct D In-Kind Payment of Debt Returned Contribution 0ther 0 Direct In-Kind Payment of Debt Returned Contribution Other 0 Direct In-Kind Payment of Debt Rebelled Contribution 0ther 0 Direct 0 In-Kind Payment of Debt Returned Contribution 0ther SUBTOTAL THIS PAGE OF SCHEDULE C TOTAL OF ALL PAGES OF SCHEDULE C ON THE LAST PAGE ONLY (Enter total on ITEM 17a of the Summary Sheet) S s
9 19 (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 amounts, 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 51,000 during the calendar year. Otherwise, this is optional. CREDITOR'S OR LENDER'S NAME & MAILING ADDRESS ENDORSER'S OR VENDOR'S NAME & MAILING ADDRESS (if any) AMOUNT NATURE OF DEBT DATE DEBT INCURRED PAID OUTSTANDING BALANCE THIS LEPERS (=PON LENDER'S OCCUPATION CROWS OCCUPATION LENDER'S OCCOPAVON LZICERS OCCUPATION usoovesc=upation LEIDER 5 0=UPATIM SUBTOTAL THIS PAGE OF SCHEDULED S TOTAL OF ALL PAGES OF SCHEDULE D ON THE LAST PAGE ONLY (Ente total on ITEM 19 of the Summary Sheet)
10 (CFA-4 SCHEDULE E) DEBTS OWED TO 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 TO the committee during the reporting period. Include all amounts the committee has loaned to others. BORROWER'S NAME & MAILING ADDRESS CO-SIGNER'S NAME & MAILING ADDRESS (if any) a 3 '6 z w a- P. 111 z F DATE DEBT INCURRED PAID OUTSTANDING BALANCE THIS SUBTOTAL THIS PAGE OF SCHEDULE E TOTAL OF ALL PAGES OF SCHEDULE EON THE LAST PAGE ONLY (Enter total on ITEM 20 of the Summary Sheet)
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