1. Report Type 2. Filing is being made on behalf of: Candidate or Public Official Filing Office Use Only E-Filed on Original Report 4/3/12 8:20 pm C2011005736 - Duane K. Piper Sheriff 3. Identifying and Contact Information (1) Duane K. Piper Full Name of Candidate or Non-Candidate Campaign Committee (3) 4595 Carriage Walk Ln. Mailing Address (4) Telephone number is unavailable. Contact Phone Number (We will understand the release of this information as permission to call your office if necessary.) (2) 03/28/ Today's Date Use Earlier of Post Mark or Hand Delivered Date (5) If a Candidate or Public Official, is there a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the campaign, or file the reports? NO (6) If so, is the Committee registered with the State Ethics Commission? NO (7) Name of Chairperson and / or Treasurer of Committee 4. Period for which you are Reporting My Non Election Year My Election Year Run-Offs (Report Require Only if you are in a Run Off Election) Special Elections (Report Require Only if you are in a Special Election) June 30, Dec. 31, Persons elected to office in each year following the year in which the election occurs Persons leaving office with excess funds until such funds are expended as provided in the Act Unsuccessful candidates with excess funds, or who receive contributions to retire debt incurred, until such funds are expended, or such unpaid debts are satisfied (December 31 filing only) X March 31, June 30, September 30, October 25, December 31, 6 days before Run-Off, 6 days before General Run-Off, 6 days before Special Run-Off, 6 days before Special Run-Off, 15 days before Special, 15 days before Special, Dec. 31, The electronic filing of this document constitutes an affirmation that the statement is true, complete, and correct. As per modifications of the Ethics in Government Act, filing a separate notarized affidavit is no longer required. See O.C.G.A. 21-5-34.1(e) and 21-5-50(e). for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Summary Report CONTRIBUTIONS RECEIVED 1 I Have: The following contributions, including Common Source, to report: In-Kind Estimated Value Cash Amount 2 Total contributions previously reported. $7,250.00 3 Total amount of all itemized contributions received in this reporting period which are listed on the "Itemized Contributions" page. $8,700.00 3a All loans received this reporting period. $40,000.00 3b Interest earned on campaign account this reporting period. 3c Total amount of investments sold this reporting period. 3d Total amount of cash dividends and interest paid out this reporting period. 4 Total amount of all separate contributions of $100.00 or less received in this reporting period and not listed on the "Itemized Contributions" page. "Common Source" contributions must be aggregated on the "Itemized Contributions" page. $3,105.00 5 Total contributions reported this reporting period. (Line 3 + 3a + 3b +3c + 3d + 4) $51,805.00 6 Total contributions to date. (Line 2 + 5) $59,055.00 EXPENDITURES MADE 7 I Have: The following expenditures to report: In-Kind Estimated Cash Amount 8 Total expenditures made and reported prior to this reporting period. $5,689.51 9 Total amount of all itemized expenditures made in this reporting period which are listed on the "Itemized s" page. $18,571.57 10 11 Total amount of all separate expenditures of $100.00 or less each that were made in this reporting period and not listed on the "Itemized s" page. Total expenditures reported this reporting period. (Line 9 + 10) $2,895.59 $21,467.16 12 Total expenditures to date. (Line 8 + 11) $27,156.67 INVESTMENTS 13 Amount of investments at the beginning of this reporting period. 14 Total amount of investments at the close of this reporting period. 15 Net Balance On Hand. (Line 6-12 + 14) $31,898.33 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Outstanding Indebtedness Indebtedness Amount 1 2 3 4 5 6 7 Outstanding indebtedness at the beginning of this reporting period. Loans received this reporting period. Deferred payments of expenses this reporting period. Payments made on loans this reporting period. Credits received on loans/deferred payments this reporting period. Payments this period on previously deferred expenses. Total indebtedness at the close of this reporting period. (line 1 + 2 + 3-4 - 5-6) $100.00 $40,000.00 $40,100.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Itemized Contributions Must list contributions received by a single contributor for which the aggregate total is more than $100.00 Full Name of Contributor Mailing Address (Affiliation of Committee if any) Received Date Contribution Type Contributor In-Kind Contributions a. Occupation & Election Cash Estimated Value b. Employer Cycle Amount Description Barrett, Roy 5740 Old Dahlonega Hwy Murrayville, GA 30564 01/28/ a. Construction b. Barrett & Blevins LLC $120.00 Beniamino, Denise 4295 Bobbins Way 01/28/ a. Credit Card Processing b. Cost Plus $1,250.00 Brumbalow, Jodie 4520 Sloan Ridge Cumming, GA 30028 03/12/ a. Dental Hygenist b. Cumming Dental Partners $800.00 Brumbalow, Troy 4520 Sloan Ridge Cumming, GA 30028 03/27/ a. Builder b. Self $300.00 Burris, Melissa 1025 Old Dallas Rd Marietta, GA 30064 01/28/ a. Manager b. Cost Plus $120.00 Cost Plus Processing, LLC 7799 Roswell Rd Atlanta, GA 30350 01/25/ $1,250.00 Culberson, Lee 1570 Brook Knoll Ln 02/07/ a. Engineer b. RTS Engineering $200.00 Davis, Ralph 6300 Browns Bridge Rd 01/28/ a. Builder b. Self $440.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Ellis, Ed 3874 Beacon St Marietta, GA 30062 01/28/ $240.00 Gawlik, Richard 5895 Shady Grove Rd 01/28/ a. Contractor b. Retro Contracting $240.00 Hamilton, Lincoln 5835 Falls Landing Dr 01/28/ a. Programmer b. Blue Mammoth Games $120.00 Hughes, Kevin 51035 Herrea Dr Acworth, GA 30102 01/28/ a. Engineer b. Aetna $120.00 Kalin, Andy 9075 Forest Path Dr Gainesville, GA 30506 01/28/ a. Investigator b. Forsyth County D.A. $250.00 Kolassa, Jim 985 Brook Knoll Ln 01/28/ a. Sales b. ASG Inc $120.00 Naegele, Jim 6845 Woodspring Way 01/28/ a. Sales Mgmt b. Siemans $120.00 Nester, Ken 1155 Alfa Dr Alpharetta, GA 30004 02/07/ a. Accountant b. Valve Solutions $500.00 Nichelson, Randy 8417 Majors Rd 01/28/ a. Real Estate b. Self $120.00 Priore, John 2001 Westside Pkwy Ste 155 Alpharetta, GA 30004 01/24/ a. Self Employed b. Priority Payment Systems $120.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Roach, Andy 4610 Carriage Walk Ln 01/28/ a. Builder b. Self $240.00 Rojas, Alex 4580 Carriage Walk Ln 01/28/ a. Self Employed b. Self $200.00 Rorke, Kevin 1065 Blinken St Knoxville, TN 37932 01/30/ a. Project Mgr b. Alstom Inc $150.00 Rorke, Robert 03/22/ $300.00 Rorke, Robert 01/28/ $600.00 Schneider, Hal 6785 Scottsfield Trace Cumming, GA 30028 01/28/ $240.00 Tom, Brian 2845 Aquitania Ln 01/28/ a. Accountant b. Xerox $120.00 Vandevelde, Scott 6435 Westchester Pl 01/28/ a. Property Mgmt b. Real Estate Mgmt Specialist $120.00 Voshall, Steve 6230 Westchester Pl 01/28/ a. Insurance b. Self $300.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Summary of Itemized Contributions Received In-Kind Total for this period: Cash Contributions Total for this period: $8,700.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Loan Reporting Name of Lender Mailing Address Date of Loan Amount of Loan Election Cycle Person(s) responsible for repayment of loan Mailing Address Occupation & Place of Employment Fiduciary Relationship Piper, Duane 4595 Carriage Walk Ln Cumming,GA 30040 1/5/ $10,000.00 Piper, Duane 4595 Carriage Walk Ln Cumming,GA 30040 2/23/ $30,000.00 Duane Piper 4595 Carriage Walk Ln Cumming,GA 30040 Retired Retired for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Itemized s Must list expenditures made to a single recipient for which the aggregate total is more than $100.00 List Name and Mailing Address of Recipient Date Type Occupation & Employer Purpose Amount Paid Alpha Office Products 201 Kelly Mill Rd 01/25/ Campaign Literature $200.00 America's Sign & Printing Solutions 6010 Buford Hwy Norcross, GA 30071 02/13/ Campaign Signs $1,313.88 America's Sign & Printing Solutions 6010 Buford Hwy Norcross, GA 30071 02/06/ Campaign Literature $242.21 America's Sign & Printing Solutions 6010 Buford Hwy Norcross, GA 30071 03/07/ Campaign Signs $2,625.63 America's Sign & Printing Solutions 6010 Buford Hwy Ste B Norcross, GA 30071 02/14/ Campaign Literature $242.21 Best Buy Store# 1408 Market Place Blvd 01/24/ Fundraiser Prizes $684.99 Best Buy Store# 1408 Market Place Blvd 02/02/ Campaign Computer $599.18 BJ's Wholesale 1725 Market Place Blvd 01/27/ Fundraiser Supplies $102.02 Chris Savas Photography 260 Greencrest Ct Marietta, GA 30068 02/20/ Campaign Photography $600.00 Cumming Square Citgo 1410 Atlanta Hwy 02/15/ Postage for campaign mailers $135.00 Forsyth County 110 East Main St 02/23/ Open Records Charges $358.93 Forsyth County 110 East Main St 03/14/ Precinct Maps $125.00 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Home Depot 1000 Market Place Blvd 02/24/ Campaign Sign Materials $201.44 Impressions Delivered LLC 01/09/ Campaign Mgmt $400.00 Impressions Delivered LLC 03/14/ Campaign Mgmt $830.00 Impressions Delivered LLC 02/02/ Campaign Mgmt $415.00 Impressions Delivered LLC 02/14/ Campaign Mgmt $415.00 Jos A Bank 410 Peachtree Pkwy 01/25/ Campaign Clothing $372.90 Landmark Communications 11300 Atlantis Place Alpharetta, GA 30022 02/20/ Campaign Consultant $1,000.00 Landmark Communications 11300 Atlantis Place Alpharetta, GA 30022 02/20/ Campaign Stickers $200.00 Landmark Communications 11300 Atlantis Place Ste F Alpharetta, GA 30022 01/12/ Campaign Consultant $2,500.00 LD Products 2500 Grand Ave Long Beach, CA 90815 02/16/ Printer Cartridges $156.57 Longhorn Steakhouse 925 Market Place Blvd 01/25/ Fundraiser Prize $120.00 No Longer Bound 2725 Pine Grove Rd 03/28/ Campaign Bumper Stickers $137.50 North Georgia Promotions 6820 Meadowridge Ct Ste A-8 Alpharetta, GA 30005 02/02/ Campaign promotional items $764.38 Publix 4900 Atlanta Hwy Alpharetta, GA 30004 01/28/ Fundraiser Supplies $250.55 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Pure Funk Designs 3076 Cardinal Lake Circle Duluth, GA 30096 01/05/ Graphic Design $300.00 Rorke, Robert 01/05/ Printing Cost $225.00 Rorke, Robert 03/30/ Campaign expenses $318.78 Rorke, Robert 02/02/ Campaign Signs, Magnets & office supplies $571.27 Rorke, Robert 02/14/ Fundraiser Supplies $250.58 Sign Rocket 340 Broadway Ave St. Paul Park, MN 55071 02/18/ Campaign Signs $739.25 Sign Rocket 340 Broadway Ave St. Paul Park, MN 55071 03/19/ Campaign Signs $739.25 Staples 2355 Market Place Blvd 02/26/ Campaign Supplies $136.09 Vista Print 95 Hayden Ave Lexington, MA 02421 02/23/ Campaign Car Door Magnets $298.96 Summary of Itemized s Made Paid s Total for this period: $18,571.57 for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883
Investments Statement Investment Name Institution/Person Holding Account Address Address City, State, Zip Investment Transactions There are No Investments this reporting period There are No Investments this reporting period Account Number Value at beginning of reporting period Value at end of reporting period Cash Dividends Interest Paid Out for March 31st - Election Year - Original Campaign Finance Commission on: 4/3/ 8:20:52PM -- Confirmation #C201100573655883