CAMPAIGN FINANCE REPORT STATE OF WISCONSIN Is this report an Amendment? No COMMITTEE IDENTIFICATION Name of Committee Address 5410 North Pass OFFICE USE ONLY City, State, ZIP McFarland, WI 53558 GAB # ID NAME OF REPORT Jan 2011 Continuing Spring Fall Special (covers 7/1/2010-12/31/2010) Spring Fall Special SUMMARY OF RECEIPTS AND DISBURSEMENTS Column A Column B Audited Totals 1. RECEIPTS This Period YTD Office Use Only A. Contributions including Loans from Individuals $ 848.90 $ 6,581.76 B. Contributions from Committees (Transfers-In) $ - $ 700.00 C. Other Income and Commercial Loans $ 2.31 $ 6.75 TOTAL RECEIPTS (Add totals from 1A, 1B, and 1C) $ 851.21 $ 7,288.51 1. DISBURSEMENTS A. Gross Expenditures $ 686.88 $ 6,482.23 B. Contributions to Committees (Transfers-Out) $ 200.00 $ 200.00 TOTAL DISBURSEMENTS (Add totals from 2A and 2B) $ 886.88 $ 6,682.23 CASH SUMMARY Cash Balance at Beginning of Report $ 3,206.42 $ 2,564.47 Total Receipts $ 851.21 $ 7,288.51 Subtotal $ 4,057.63 $ 9,852.98 Total Disbursements $ 886.88 $ 6,682.23 CASH BALANCE AT END OF REPORT $ 3,170.75 $ 3,170.75 INCURRED OBLIGATIONS (at close of period) $ 692.20 LOANS (at close of period) $ 398.90 I certify that I have examined this report and to the best of my knowledge and belief it is true, correct and complete. Type or Print Name of Candidate or Treasurer Signature of Candidate or Treasurer Date Patrick Miles, Candidate Daytime Phone January 31, 2011 (608) 206-6462 NOTE: The information on this form is required by ss. 11.06, 11.20, Wis. Stats. Failure to provide this information may subject you to the penalties of ss.11.60, 11.62, Wisconsin Stats. GAB-2S (3/10)
IN- KIND SCHEDULE 1-A Perso CONDUIT nal _ID Loan Contributions Including Loans from Individuals EMPLOYE R ZIP CODE AMOUNT YTD COMMENTS OCCUPATION EMPLOYER EMPLOY EMPLOYE NUMBER DATE LAST NAME FIRST NAME ADDRESS CITY ST ZIP TITLE EMPLOYER NAME ADDRESS ER CITY R STATE 8/1/2010 Lobes Carol 5103 Autumn Ln McFarland WI 53558 50.00 50.00 Government Policy 14 W. Mifflin St., 8/1/2010 McIntosh Forbes 737 Seneca Pl Madison WI 53711-2950 President Solutions Ste. 206 Madison WI 53705 200.00 200.00 8/1/2010 Hutchinson Connie 5608 Chestnut Ln. McFarland WI 53558 100.00 100.00 8/1/2010 Flaherty Michael 5604 Chestnut Ln. McFarland WI 53558 50.00 50.00 0900187 8/1/2010 Kamperschroer George 2222 Chamberlain Ave. Madison WI 537263868 50.00 100.00 X 12/20/2010 Wills Marykay 5410 North Pass McFarland WI 53558 31.65 Patrick X 12/20/2010 Miles (Candidate) 5410 North Pass McFarland WI 53558 367.25 Paid bills, will be reimbursed Paid bills, will be reimbursed Page 2 of 85
SCHEDULE 1-B IN-KIND DATE COMMITTEE NAME Contributions from Committees GAB ID Number ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS Page 3 of 85
SCHEDULE 1-B IN-KIND DATE COMMITTEE NAME Contributions from Committees GAB ID Number ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS Page 4 of 85
SCHEDULE 1-B IN-KIND DATE COMMITTEE NAME Contributions from Committees GAB ID Number ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS Page 5 of 85
SCHEDULE 1-B IN-KIND DATE COMMITTEE NAME Contributions from Committees GAB ID Number ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS Page 6 of 85
SCHEDULE 1-B IN-KIND DATE COMMITTEE NAME Contributions from Committees GAB ID Number ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS Page 7 of 85
SCHEDULE 1-C Other Income and Commercial Loans LAST NAME/BUSINESS NAME FIRST NAME GAB ID ADDRESS CITY ST ZIP REASON FOR INCOME AMOUNT COMMENTS DATE 07/31/10 Summit CU Bank interest $ 0.49 08/31/10 Summit CU Bank interest $ 0.49 09/30/10 Summit CU Bank interest $ 0.47 10/31/10 Summit CU Bank interest $ 0.29 11/30/10 Summit CU Bank interest $ 0.28 12/31/10 Summit CU Bank interest $ 0.29 Page 8 of 85
IN- KIND SCHEDULE 2-A PERSO NAL LOAN PYMT DATE Gross Expenditures (NOT contributions to other committees) LAST NAME/BUSINESS NAME FIRST NAME GAB ID ADDRESS CITY ST ZIP EXPENSE PURPOSE CODE AMOUNT COMMENTS X 09/02/10 Miles Patrick (Candidate) 5410 North Pass McFarland WI 53558 287.98 12/20/10 Insty Prints 5401 Monona Drive Monona WI 53716 PCP $31.65 12/20/10 Premiere Political Communications LLC 4616 Fessenden St NW Washington DC 20016 MEDPH $94.05 12/20/10 Premiere Political Communications LLC 4616 Fessenden St NW Washington DC 20016 MEDPH $273.20 IND. EXP/RECOUN T Page 9 of 85
Expense_Purpose_Code Expense Description If an expense, does not match a code provided; please list that expense as ADMEX and enter additional detail in the comments section provided. ACT ADMEX BC BOOTH CC CD CEC CEG CEM CEMIL CPKG CETRV CGEN CMED CTC DCONV FA FE FF FFB FHR GIFT ICM ITHW ITMNT ITSW ITX LCPLS LFCA LFCF MDCH MDCO MDPOL MEDBB MEDGD MEDIA ActBlue Fees Administrative Expenses Bank Charges Event or Fair Booth Contribution to Committee Charitable Donation Candidate Expense - Clothing Candidate Expense - Gas Candidate Expense - Meals Candidate Expense - Mileage Candidate Expense - Parking Candidate Expense - Travel Consulting Fees - General Consulting Fees - Media Contribution to Charity Data Conversion Fundraiser - Auction Item Fundraiser - Entertainment Filing Fee Fundraiser - Food & Beverage Fundraiser - Hall Rental Gifts Internal Communication with Members IT - Campaign Computer Equipment IT - Campaign IT Maintenance IT- Campaign Software Income Tax (Interest Income) Plaintiff Libel Suits Legal Fees - Compliance/Administrative Legal Fees - Campaign Misinformation Membership Dues - Charitable Org Membership Dues - Community Org Membership Dues - Political Org Media - Billboards / Outdoor Advertising Media - Graphic Design Media - Issue Ads
MEDN MEDO MEDPH MEDR MEDTV MEET ML MPA MSERV OF OMNT OR OS PACT Media - Newspaper Media - Online Advertising Media - Phones / Robo calls Media - Radio Media - TV Meeting Expenses Mailing List Membership pins / awards Mailing Service Office Furniture Office - Campaign Office Maintenance Office Rent Office Supplies Professional - Accounting PAY Payroll Company Management Expense PB Printing - Brochures PCP Printing - Copies PEFC Parade Expenses - Fees, candy PEN Party Exp - Election Night PHB Phone Bank Printing Misc. (buttons, bumper stickers, t- PM shirts) POST Postage PYS Printing - Yard Signs RES Research - Survey RF Reimbursement - Food SE Solicitation Expenses SO Forfeitures ST Sales Tax STEB Staff - Employee Benefits Costs STG Staff - Gas STIN Staff - Insurance STL Staff - Lodging STM Staff - Mileage STPK Staff - Parking STRV Staff - Travel SVP Survey/Polls TE Tickets to Events UID Unitemized UTILE Utilities - Electrical UTILG Utilities - Gas
UTILI UTILP UTILW VM WCM WCS WET Utilities - Internet Access Utilities - Phone / Cell Phone Media - Website Development Volunteer Meals Wages - Campaign Manager Wages - Campaign Staff Wages - Employment Taxes
These codes are current as of 06- You may want to 04-10. New codes may be added print this list to have as needed. Please login to CFIS it easily accessible to view any additional codes that when you complete may have been added. the Schedule 2-A.
SCHEDULE 2-B Contributions to Committees IN-KIND DATE GAB ID NAME OF COMMITTEE ADDRESS CITY ST ZIP AMOUNT YTD COMMENTS 9/15/2010 Friends of Joe Parisi WI 100.00 100.00 PAC for Assembly 9/15/2010 Friends of Dianne Hesselbein WI 100.00 100.00 PAC for Assembly Page 16 of 85
SCHEDULE 3-A Incurred Obligations Excluding Loans NAME ADDRESS CITY ST ZIP PURPOSE Outstanding Balance Beg of Period New Obligations This Period Payment This Period Outstanding Bal Close of Period Insty Prints 5401 Monona Drive Monona WI 53716 PCP - Photocopies 31.65 $31.65 $ - Premiere Political Communications LLC 4616 Fessenden St NW Washington DC 20016 MEDPH - Robo calls 94.05 $94.05 $ - MEDPH - Live GOTV Premiere Political Communications LLC 4616 Fessenden St NW Washington DC 20016 calls 273.20 $273.20 $ - Citizens for Dane County's Future ML 42.20 $ 42.20 Alto Clef Productions 113 State Street Madison WI 53703 MEDGD - dispute with vendor over amount 150.00 $ 150.00 Ben Tobias 535 W. Johnson St. #803 Madison WI 53703 WCM $250.00 $ 250.00 849 E Washington Ave Opacolor LLC Suite #110 Madison WI 53703 MEDGD $250.00 $ 250.00 Page 17 of 85
SCHEDULE 3-B Loans: Individual, Committee or Commercial DATE NAME ADDRESS CITY ST ZIP Outstanding Balance Beg of Period New Loans This Period Cumulative Payments This Period Outstanding Balance End of Period Guarantor (if any) Name and Address Patrick Miles (Candidate) 5410 North Pass McFarland WI 53558 $ 287.98 $ 287.98 $ - Marykay Wills (Spouse of Candidate) 5410 North Pass McFarland WI 53558 $31.65 $ 31.65 Patrick Miles (Candidate) 5410 North Pass McFarland WI 53558 $367.25 $ 367.25 $ - $ - $ - $ - $ - $ - $ - $ - Page 18 of 85
SCHEDULE 4 TERMINATION REQUEST A committee may terminate its registration and reporting requirements if the committee will no longer receive contributions, make disbursements or incur obligations, and the obligations and cash balance have been reduced to zero. Candidates may not terminate prior to the election in which they are participating. Non-candidate committees registered with the state must pay the $100 filing fee if they have over $2,500 in total disbursements for the calendar year. Please read carefully and, if necessary, indicate how residual committee funds have been disposed of or if outstanding loans or obligations have been forgiven. Sign and date the termination request at the bottom of this page. Make sure the termination box on the cover page of this report is checked. Please note: An audit must be completed and all obligations with the Board, including settlement offers, fulfilled before termination can be granted. All records must be maintained until termination is granted. DISPOSAL OF RESIDUAL FUNDS THIS INFORMATION SHOULD ALSO BE INCLUDED ON SCHEDULE 2-A AND/OR 2-B. DATE RECIPIENT AMOUNT LOAN OR DEBT FORGIVENESS I hereby forgive all personal loans or have assumed responsibility for any and all debts of my campaign committee. DATE Endorser, Guarantor, or Creditor AMOUNT TERMINATION REQUEST. I hereby request that the committee registration be terminated. I declare that the committee has not incurred any obligations and does not anticipate incurring any. The committee does not anticipate receiving any further contributions or making any disbursements. I further state that the cash balance has been reduced to zero and that all remaining funds have been disposed of in the manner prescribed by law. Signature of Candidate or Treasurer Date