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1 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE 7 State Form 4606 (813/11-05) ndiana` lection Commission (C ) NSTRUCTONS: Please type or print legibly N BLACK NK all information on thi assistance in completing this form see instructions on the reverse side. S THS AN AMENDMENT? Yes No (CFA-4) Summary Sheet FLE NUMBER TOTAL PAGES N ENTRE CFA-4 REPORT 1. Full Name of Committee (as on Statement of Organization) 12. Reporting Period: From: if tt 5 Through: 13. Cash on hand and investments at the beginning of this reporting period. 14. Cash on hand and investments January 1. current year. CONTRBUTONS AND RECEPTS (Note: these amounts include in-kind contributions and loans as well as cash contributions.) 15a. temized (use Schedule A) 15b. Unitemized 15c.Add lines 15a and 15b in both columns 16. Add lines 13 and 15c in Column A and lines 14 and 15c in Column B EXPENDTURES SUBTOTAL L t TOTAL (Note: These amounts include in-kind expenditures and loan repayments.) 17a. temized (use Schedule B) (Public Question: use Schedule C) 7 17b. Unitemized zr":a. COMMTTEE NFORMATON This Period 17c.Add lines 17a and 17b in both columns (-0/-2-) 18.Cash on hand and investments melon of this repo rt ng period hm(w&wt17cfrom Olc g04113 Check if this is a new name 3. Acronym or Abbreviated Name (if any) 3. Committee Telephone Number z (4 4. Mailing Address (address where all campaign finance correspondence is received) (21 Check if this is a new address 5. City. State. ZP r k.1. r ) r L i ( Party Affiliation (if applicable) 8. CANDDATE NFORMATON (For Candidate's Committees Only) 7. FuName 1 of Candidate (include any nickname) 7ffiliation or f ndependent Candidate k-c DA -s.-v ") o t- 9. Office Sought (nclude district number. if any. Not required for exploratory committee.) 10. County of Residence Z r t 11. Check one: TYPE OF REPORT Pre-Primar FPre-Election Annual Nomination Other FinaVDisbands Committee lanes t F and 20 must be '07) Outgoing Treasurer (Mean 10 days amend Statement o! Organization) 19. Debts OWED BY the committee (use Schedule )) a t")0 20. Debts OWED TO the committee (use Schedule E) 8S 8 WU SOli CONVENTON CANDDATES ONLY Check one: Pre-Convention Post-Convention Year to Date O(2 S. 3 Zi4 1Z t 3 CERTFCATON CERTFY THAT HAVE EXAMNE TH ī TEMEN 0 THE BEST OF MY KNOWLEDGE AND BELEF T S TRUE. CORRECT AND COMPLETE. Signature of Treasurer' 1 Title Date -r r; -k's 41 -c-e' '''' Signature of Candidate A51111 et Date A. ] 1 t` t( '5' (S. : WARNNG: Any information con. nd in thi report may not be coped for sale or used for any commercial purpose. (C ) A person wno knowingly fees a fraudulent report commits a Class 0 r ony. (C ) A person who fails to file a compete or accurate report as required by the ndiana Campaian Finance Law commits a Class B misdemeanor (C ) and may be subiect to civil penalties. (C C C FOR OFFCE USE ONLY
2 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4505 (R ) ndiana Ejection Commission ) 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 soedule is used to document contributions and receipts totaled on TEM 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 if regular party committee). All cumulative receipts (such as tan 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 committee). A contributor's occupation is required it an individual makes at least in contributions during the calendar year. Otherwise this is octionat (CFA-4 SCHEDULE A-1) CONTRBUTONS BY NDVDUALS temized Contributions and Other Receipts Page FLE NUMBER of 1. CONTRBUTOR'S FULL NAME AND OCCUPATON FULL MALNG ADDRESS A \\ yok.... 3s...4L... _c06-1 f\si 4 \ V (c'-'"" 'T i e " - t -"Tr..) LK/.3.-i 1- : Contributor's Occupation (it re... iik P-' 414' ' 2. k : 1 4. C.... Wt./A A \ t...".. OL k 1 ktk L.--' \. k m k.196 / 1 r Contributor's Occupation (if required) 3. 1/1A/ i 3 (i 7 tom TYPE OF CONTRBUTON OR OTHER RECEPT Contributions' 14 Direct - n-kind (+describe) Receipts! nterest sk. Loan 0 Direct AMOUNT THS PEROD f-' 11. '5.- 3 L'. ' : 7b 43" CUMULATVE / DATE RECEVED RECEVED BY y / y 111-Krd (descripe) _ 1 Li 41 '. 1.1 t illcasul r.-ff Other Receiph- nterest Loan 1._ j Misc. (speci Direct.. nterest Loan Contributor's Occupation (if recu rred) 4. Contributions! Direct Otner Receipts: nterest Loan li Contributor's Occupation (if reauired) 5. Contributions' Direct / n-kind (describe} Contributor's Occupation (f reuskedi Other Receipts -. nterest Loan misc. (specify) SUBTOTAL THS PAGE OF SCHEDULE A i $ 7 kia TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 15a of the Summary Sheet)
3 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4506 (R ) ndiana Election Commission (C ) (CFA-4 SCHEDULE A-2) CONTRBUTONS BY CORPORATONS temized Contributions and Other Receipts NSTRUCTONS: LST ONLY CONTRBUTONS BY CORPORATONS ON THS SCHEDULE. Please type or phnt legibly N BLACK NK 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 TEM 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 5200 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 S200 if regular party committee). CONTRBUTOR'S FULL NAME AND FULL MALNG ADDRESS TYPE OF CONTRBUTON OR OTHER RECEPT AMOUNT THS PEROD CUMULATVE DATE RECEVED RECEVED BY 1. Direct nterest Loan 2. Direct. nterest Loan 3. Direct Other Receipts. nterest Loan 4. Contributions Direct Other Receipts nterest 7 Loan i 5. Direct nterest Loan Misc. fspecify SUBTOTAL THS PAGE OF SCHEDULE A TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 15a of the Summary Sheet) S '
4 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4606 (R ) ndiana Election Commission (C ) NSTRUCTONS: LST ONLY CONTRBUTONS BY LABOR ORGANZATONS 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 15a of the Summary Sheet All cumulative contributions from labor organizations OVER $100 per contributor within a calendar year MUST be itemized on this schedule (over S200 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 5100 per contributor. within a calendar year MUST be itemized on this schedule (over S200 if regular party committee). (CFA-4 SCHEDULE A-3) CONTRBUTONS BY LABOR ORGANZATONS temized Contributions and Other Recei ts FLE NUMBER t. CONTRBUTOR'S FULL NAME AND FULL MALNG ADDRESS TYPE OF CONTRBUTON OR OTHER RECEPT Direct AMOUNT THS PEROD CUMULATVE DATE RECEVED RECEVED BY nterest Loan D misc. (specify) Direct Other Receipts El nterest Loan 3. Direct nterest Loan 1. Direct nterest U Loan 111 l 5. 1 Contributions' Direct Other Receipts. nterest 0 Loan SUBTOTAL THS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 15a of the Summary Sheet) ''
5 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4606 (R ndiana Election Commission (C ) NSTRUCTONS: LST ONLY CONTRBUTONS BY POLTCAL ACTON COMMTTEES 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 relots totaled or TEM 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. if regular party committee). All transfers-in and in-kind contributions reaardless 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 $100 per contributor. within a calendar year MUST be itemized on this schedule (over S200 if regular party committee). (CFA-4 SCHEDULE A-4) CONTRBUTONS BY POLTCAL ACTON COMMTTEES temized Contributions and Other Receipts Page FLE NUMBER of CONTRBUTOR'S FULL NAME AND FULL MALNG ADDRESS TYPE OF CONTRBUTON OR OTHER RECEPT Contributions. Direct AMOUNT THS PEROD CUMULATVE DATE RECEVED RECEVED BY Other Receipts' 0 nterest Loan 2. Contributions. Direct nterest Loan Misc. (specify] contrthutions' Direct a n-k:nd (describe) Other Receipts nterest Loan 4. Direct Other Receipts - nterest Loan Msc (specify) 5. Contributions Direct n-kind (describe} Other Receipts. nterest Loan SUBTOTAL THS PAGE OF SCHEDULE A S TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY s (Enter total on TEM 15a of the Summary Sheet)
6 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4606 (R13(11-05) ndiana Elecbon Commission (C ) NSTRUCTONS: LST ONLY CONTRBUTONS BY ORGANZATONS OTHER THAN CORPORATONS LABOR ORGANZATONS POLTCAL ACTON COMMTTEES AND NDVDUALS ON THS SCHEDULE. Please type or print legibly N BLACK NK all information on this saredule. For assistance in completing this schedule see instructions on the reverse side. This schedule is used to document contributions and receipts totaled on TEM 15a 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-in and in-kind contributions regardless of amount from candidates. legislative Calais. and regular party committees MUST be itemized on this schedule. At 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 committee). (CFA-4 SCHEDULE A-5) CONTRBUTONS BY OTHER ORGANZATONS temized Contributions and Other Receipts Page FLE NUMBER CONTRBUTOR'S FULL NAME AND FULL MALNG ADDRESS TYPE OF CONTRBUTON OR OTHER RECEPT Direct AMOUNT THS PEROD CUMULATVE DATE RECEVED RECEVED BY nterest Loan Direct Other Receipts. nterest Loan 3. Direct Lj nterest Loan Mtsc. (specify) 4. Direct nterest Loan Direct Other Receipts; nterest Loan Misc. (specify} SUBTOTAL THS PAGE OF SCHEDULE A $ TOTAL OF ALL PAGES OF SCHEDULE A ON THE LAST PAGE ONLY (Enter total on TEM 15a of the Summary Sheet)
7 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE 14 State Farm 4E306 (R ) ndiana Election Commission (C (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 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). Ali cumulative expenses. including in-kind regardless of amount paid to political committees (such as transfers-out from candidate )eaislative caucus. political action: or regular party committees) MUST be itemized on this schedule. 1111=1111 Page 1 of i RECPENT'S NAME AND MALNG ADDRESS RECPENT'S OCCUPATON OFFCE SOUGHT (if applicable) TYPE OF EXPENDTURE and PURPOSE (be specific) AMOUNT THS PEROD CUMULATVE DATE OF EXPENDTURE (C.).'. * t "? " ' ; koil.-c1 f-tt.6.-a T'''' L.0" Com C 6 VS... 0 ff (. c 7 i{`'.) %.. L. tk L.-4 c- -.. 't. code... Y..' i ) 0 ly '42-` ji. Y^/!--.. 9A.A.4 i L i 1 D t n.kind i 0 Payment of Debt Returned Contribution Dother 1' ti ril Dre n Payment of Debt Returned Contnbuf.ion Dome Purpose: D Dec: n.hin. 0 Payment of Debt Returned Conmbution 0 Omer P rect Payment f Debt n-kind Returned Conributtor ['Other Purpos Li WA ' '' L S (-3 - {-lef's.. (1 Lib 3// til&- )^' 0 ' L 1 0 ti iki X / / 31 1 Direst n Kmd Payment of Debt 0 Returned Contribution 0 Otrw Purpose. code 0 Cutact n.kind Payment of Debt Returned Contribution 0the.: Purpose: 0 Direct inkm1 Payment of Deb: Returned Contribution 0 Other Purpose: SUBTOTAL THS PAGE OF SCHEDULE B S 7 ta t TOTAL OF ALL PAGES OF SCHEDULE B ON THE LAST PAGE ONLY s (Enter total on TEM 17e of the Summary Sheet)
8 REPORT OF RECEPTS AND EXPENDTURES OF A POLTCAL COMMTTEE State Form 4606 (R13/11-05) ndiana Election Commission oc ) NSTRUCTONS: Please type or print legibly N BLACK NK al information on this schedule. For assistance in completing this schedule see instructions on the reverse side. All cumulative expenses or transfers-out. regardless of 1 amount paid to political committees supporting or opposing a public question. MUST be itemized on this schedule. (CFA-4 SCHEDULE C) TEMZED EXPENDTURES For Public Questions FLE NUMBER Page of Enter Text of Public Question PUBLC QUESTON NFORMATON Type of Question: U Statewide Local Position: Supported Opposed RECPENT'S NAME AND MALNG ADDRESS RECPENT'S OCCUPATON TYPE OF EXPENDTURE and PURPOSE (be specific) AMOUNT THS PEROD CUMULATVE DATE OF EXPENDTURE 1 0 Direct n Kind Payment of Debt Returned Contribution Dottie r Purpose. 0 Diect n n Kind Payment of Debt 0 Returned Contribution bother. Purpose' 0 Direct in-kind Payment of Debt Returned Contribution bother Purpose' 0 Direct M n-kind Payment of Debt 0 Returned Contribution DOther Purpose: 0 Direst 0 in-kint 0 Payment of Debt Returned Contribution bother Purpose. 1 0 Direct Din-Kind Payment of Debt 0 Returned Contribution 00tner i... Purpose: SUBTOTAL THS PAGE OF SCHEDULE C S TOTAL OF ALL PAGES OF SCHEDULE C ON THE LAST PAGE ONLY _(Enter total on TEM 170 of the Summary Sheet)
9 REPORT OF RECEPTS AND EXPENDTURES.OF A POLTCAL COMMTTEE tlij0.11 State Form 4606(R13/11-05) '.±./ ndiana Election Commission (C ) (CFA-4 SCHEDULE D) DEBTS OWED BY THS COMMTTEE 1 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 bans. regardless of the amount OWED BY the committee 1 during the reporting period nclude 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 1 lenders occupation is required if an individual makes loans of at least $1 000 during the calendar year. Otherwise this is optional. FLE NUMBER CREDTOR'S OR LENDER'S NAME & MALNG ADDRESS ENDORSER'S OR VENDOR'S NAME & MALNG ADDRESS (it any) AMOUNT NATURE OF DEBT DATE DEBT NCURRED CUMULATVE PAD YEAR.TO-DATE OUTSTANDNG BALANCE THS PEROD 4.. LECEP:5 OCCUPATV Btif) AV N..3 t(f)3 trz- (..).4) 4'1 ' i---' LE:;;:RS 77.:;'.PATC.ṫ r AVS:ER i) =AT 1.11:'EP S 0a:OAT O': 1 1 i ; E: :DE ''':LP --. SUBTOTAL THS PAGE OF SCHEDULED S 1 ''C' ' 5) TOTA. OF Al 1 PAOFS OF SC-F111 F ON THE LAST PAGE ONLY -4 (Enter total on TEM 19 of the Summary Sheet) O'Cr
10 REPORT OF RECEPTS AND EXPENDTURES 1 OF A POLTCAL COMMTTEE State Form 4606 (R13/ ndiana Election Commission (C ) (CFA-4 SCHEDULE E) DEBTS OWED TO 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. regardless of the amount OWED TO the committee during the reporting period. nclude all amounts the committee has bailed to others. BORROWER'S NAME & MALNG ADDRESS CO-SGNER'S NAME & MALNG ADDRESS (if any) ORGNAL AMOUNT NATURE OF DEBT DATE DEBT NCURRED CUMULATVE PAD OUTSTANDNG BALANCE NS PEROD SUBTOTAL THS PAGE OF SCHEDULE E $ TOTAL OF ALL PAGES OF SCHEDULE E ON THE LAST PAGE ONLY $ (Enter total on TEM 20 of the Summary Sheet)
WTI, for COMMITTEE INFORMATION. Check if th s is a new name. SA: -A AI A-Di.5
%-i9u/tpcsc cuttfax REPORT OF RECEPTS AND EXPENDTURES Orr A POLTCAL COMMTTEE State Form 4606 (R3-05) ndiana Election Commission (C 3-9-5-4) NSTRUCTONS: Please type or print legibly N BLACK NK all information
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