HomeMy WebLinkAboutCampaign Finance Records - Finance report - Committee to Elect Ian Hugh 2016 - 1/25/2016a
2.
POLITICAL COMMITTEE
CITY OF l Q
CAMPAIGN FINANCE REPORT
2015 November Special Election
wenn . —rJ L LZ L-,(- :E:AK�
Full Name of Committee
gI.) 0"
Atldress
Cfty ZIP Code County W� +/ .Ph A061 1
Sponsoring Orgami at or Candidate and office
Name of Candidate and Once Sought (if applicable) _
E -Mail Address
Fax #
4. REPORTING PERIOD (Please check appropriate box)
FOR OFFICE USE ONLY
CITY CLERK
CITY OF GLENDALE
2915 JAH 25 AM 10: 49
3A. ID#
DUE BETWEEN
January 31 Report - For Period of * thru December 31, 2014 ... ....... January 1, 2015 and January 31, 2015
❑ June 30 Report - For Period of January 1, 2015 thru May 31, 2015 ....... . ....... .... June 1, 2015 and June 30, 2015
❑ Pre -Election Report - For Period of June 1, 2D15 thru October 22, 2015 ....... October 23, 2015 and October 30, 2015
❑ Post -Election Report - For Period of October 23, 2015 thru November 23, 2015 . ...... November 24, 2015 and December 3, 2015
f�_January 31, Report - For Period of November 24, 2015 thru December 31, !t^o t`=� ......... January 1, " and January 31,
5. SUMMARY
Column A
Column B
Total This
Election Period
Reporting Period
Total To Date
5a Surplus from Previous Campaign (or at time Statement of
Organization was filed for the new committee)
Cj z LA t�
5b Cash on Hand at the Beginning of this Reporting Period
5c Total Receipts (from corresponding columns on Detailed
Summary Page, Line 8)
f
5d Subtotal [add Lines b and c for Column A and add lines
a and c for Column B]
6a Total Debts and Obligations from Previous Campaign Committee at
Beginning of this Election Period (or at time Statement of
Organization was filed for the new committee) [Do not add or
subtract this line from the other lines]
0
l
6b Total Disbursements (from corresponding columns on
Detailed Summary Page, Line 18)
`1
7. Cash on Hand at Close of Reporting Period [Subtract
Line 6b from Line 5d]�2
*Insert date which is 21 days after date of last election (A.R.S. §16-913).
**This will depend on the year next election is held. The "due between" year will be the year of an election and the date following
"December 31" will be the immediately prior year
Revised 9114
DETAILED SUMMARY PAGE
�
OF RECEIPTS AND DISBURSEMENTS 2. ID#
1. Committee Name: V� W W) .
3. Report covering period from D l
RECEIPTS
4. Contributions other than loans and in-kind:
(a) Individuals - more than $50 (Total from Schedule A)
(b) Individuals - aggregate $50 or less (Tota! from Schedule A-1)
(c) Political Committees (Total from Schedule B)
(d) Subtotal Contributions [add 4(a), 4(b), and 4(c)]
(e) Refund of contributions (Total from Schedule F-2)
(f) Total Contributions Other than Loans and In-kind [subtract 4(e) from 4(d)]
5. (a) Loans made or guaranteed by candidate (Total from Schedule C)
(b) All other loans (Total from Schedule C-1)
(c) Total Loans [add 5(a) and 5(b)]
6. In-kind contributions (Total from Schedule E)
7. Dividends, interest, and other forms of receipts (Total from Schedule F-1)
8. Total Receipts [add 4(f), 5(c), 6, and 7]
DISBURSEMENTS
2
COLUMN A COLUMN B
THIS PERIOD CAMPAIGN TO DATE
rol
. D®
t�_D
9. Expenditures for operating expenses (Total from Schedule D)
I e (^
1 (/
;D:;D
10. Independent Expenditures (Total from Schedule D-1)
11. Value of In-kind expenditures (Total from Schedule E)
J j 1 0
V
12. Loans made by reporting committee (Total from Schedule D-2)
13. (a) Repayment of loans made or guaranteed by candidate (Total from Schedule D-4)
(b) Repayment of all other loans (Total from Schedule 0-5)
(c) Totai Loan Repayments (add 13(a) and 13(b)]
l V
14. Transfers to other political committees (Total from Schedule D-6)
15. Any other disbursement (Total from Schedule D-7)
16. Subtotal disbursements [add lines 9, 10, 11, 12, 13(c), 14, and 151
O.�i
r l
J�ZI�.DoC
17. Rebates, refunds and other offsets to operating expenses (Total from Schedule D-3)
18. Total disbursements [subtract line 17 from line 16]
1 `!D
l
✓ L
19. Total Outstanding Debts owed by Reporting Candidate or Political Committee (Schedule F-3)
20. 1 certify, under penalty of perjury, that i have examined the contents of this campaign finance report and to the best of my knowledge and belief it is true and
complete.
Type or Wt Name of Treasurer
Signature of Treasurer or Candidate or Designatin ndividual Date
CONTRIBUTIONS more than $50 -from INDIVIDUALS* SCHEDULE A
2. ID#
1. Committee Name
3. Report covering period from _-t� thru i
4
CONTRIBUTIONS
DATE
RECEIVED
AMOUNT
RECEIVED
THIS
PERIOD
CUMULATIVE
TOTAL THIS
CAMPAIGN
TO DATE
NAME, ADDRESS, OCCUPATION AND EMPLOYER OR CONTRIBUTOR
4a.
LAST FIRST MI
'o
V L/l 0D
I
STREETADDRESS
CITY STAT ' j ZIP
OCCUPATION �
v `.,..v Y �` ^� ' 0
EMPLOYER
b.
LAST FIRST MI
STREET ADDRESS
CITY STATE ZIP
OCCUPATION
EMPLOYER
C.
LAST FIRST MI
STREET ADDRESS
CITY STATE ZIP
OCCUPATION
EMPLOYER
d.
LAST FIRST MI
STREET ADDRESS
CITY STATE ZIP
OCCUPATION
EMPLOYER
e.
LAST FIRST MI
I
STREET ADDRESS
CITY STATE ZIP
OCCUPATION
EMPLOYER
5.
1ENTER TOTAL ON''_Y IF LAST PAGE OF SCHEDULE A [If last page of Schedule A, transfer total to Detailed
Summary Page Line 4(z), Column A]
*if contributions of $50 or less are listed with contributor's name, address, occupation and employer on Schedule A, do not include Page 1 Of
them on Schedule A-1.
CONTRIBUTIONS of $50 or less - AGGREGATE TOTAL*
2. ID#
1. Committee Name
3. Report covering period from 1 � — —15
4. Aggregate Total of Contributions of $50 or less
SCHEDULE A-1
DESCRIPTION
AMOUW
RECEIVED THIS
PERIOD
CUMULATIVE
TOTAL THIS GAMPAIGN TO DATE
r
F
5. TOTAL THIS PERIOD [Transfer total to Detailed Summary Page, Line 4(b),
6. CUMMULATIVE TOTAL THIS
Column A]
CAMPAIGN TO DATE
[Transfer total to Detailed
Summary Page, Line 4(b),
Column B]
'If contributions of $50 or less are listed with contributor's name and address on Schedule A, do not include them on this schedule.
CONTRIBUTIONS FROM POLITICAL COMMITTEES SCHEDULE B
2. ID#
I
1. Committee Name
3. Report covering period from \ �� Is thru —1
4
CONTRIBUTIONS
AMOUNT
RECEIVED
THIS
PERIOD
CUMULATIVE
TOTAL THIS
CAMPAIGN TO
DATE
IDENTITY OF CONTRIBUTOR AND DATE RECEIVED
4a
ID #
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
b.
ID #
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
ID #
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
d.
ID #
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
e.
ID #
NAME, ADDRESS, CITY, STATE AN ZIP
DATE RECEIVED
,.
;D#
NAME, ADDRESS, C Y, STATE AND ZIP
DATE RECEIVED
g.
ID #
NAM ,ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
h.
ID #
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEI D
i.
;D#
NAME, ADDRESS, CITY, STATE AND ZIP
DATE RECEIVED
L
ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE B [If last page of Schedule B, transfer total to
Detailed Summary Page, Line 4(c), Column A]
Schedule B Pageof
CANDIDATE LOANS
SCHEDULE C
1.
Committee Name
Lk
2. ID # l
3.
Report covering period from y-- thru—
4.
LOANS MADE OR GUARANTEED BY CANDIDATE
DATE
RECEIVED
AMOUNT
RECEIVED t
CUMULATIVE
TOTALTHiS
CAMPAIGN
TO DATE
NAME AND ADDRESS FROM WHOM RECEIVED
4a,
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION
b.
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION
d.
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION
e.
NAME, ADDRESS, CITY, STA , AND ZIP
DESCRIPTI
f.
NA ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION
5.
ENTER TOTAL OF LOANS MADE OR GUARANTEED BY CANDIDATE ONLY IF LAST PAGE OF SCHEDULE C
[if last page of Schedule C, transfer total to Detailed Summary Page, Line 5(a), Column A]
Schedule C Pageof
OTHERLOANS
SCHEDULE C1
2. I D#
Committee Name
Report covering period from t �T �� thru
4
ALL OTHER LOANS
DATE
LOAN RECEIVED
AMOUNT
OF LOAN
CUMIULATIVE
TOTAL CAMPAIGN
CAMPAIGN
TO LATE
NAME AND ADDRESS OF EACH INDIVIDUAL!CR NAME, ID# AND ADDRESS OF
THE POLITICAL COMMITTEE OR LOAN, AND ANY ENCORSER OR GUARANTOR
�
CF LOAN.
4a
NAMEOF PERSON OR COMMITTEE MAKINGLOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
NAME OF ENDORSER OR GUARANTOR OF LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
DESCRIPTION
4b
NAME OF PERSON OR COMMITTEE MAKING LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
NAME OF ENDORSER OR GUARANTOR OF LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
DESCRIPTION
�
4C
F
NAME OF PERSON OR COMMITTEE MAKING LOAN, ADDRESS, CITY, S ,Af E ZIP, AND ID#
NAME OF ENDORSER OR GUARANTOR OF LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
DESCRIPTION
4d
NAME OF PERSON OR CON41VIITTEE MAKING LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
NAME OF ENDORSER OR GUARANTOR OF LOAN, ADDRESS, CITY, STATE, ZIP, AND ID#
DESCRIPTION
5.
ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE C-1 [If last page of Schedule C-1, transfer total to Detailed Summary
Page, Line 5(a), Column A]
Page_of
EXPENDITURES FOR OPERATING EXPENSES*
1. Committee Name
3 Renort coverina Deriod from
y —I—e'0—
I ` �iLV--1C77 thru t
SCHEDULE D
2. ID#
—15
4
EXPENDITURES
DATE
EXPENDITURE
MADE
AMOUNTOF
THE
EXPENDITURE
NAME AND ADDRESS TO WHOM EXPENDITURE (DISBURSEMENT) WAS MADE
4a.
NAME, ADDRESS CITY, STATE AND Z'P
Z
�[
az1
DESCRI
TION OF ITEMS ORERViCES PURCHASED
4b.
NAME, ADDRESS, CITY, STATE AND ZIP
DESCRIPTION OF ITEMS OR SERVICES PURCHASED
4c.
NAME, ADDRESS, CITY, STATE AND ZIP
DESCRIPTION OF ITEMS OR SERVICES PURCHASED
4d.
NAME, ADDRESS, CITY, STATE AND ZIP
DESCRIPTION OF ITEMS OR SERVICES PURCHASED
4e.
NAME, ADDRESS, CITY, STATE AND ZIP
DESCRIPTION OF ITEMS OR SERVICES PURCHASED
4f.
NAME, ADDRESS, CITY, STATE AND ZIP
DESCRIPTION OF ITEMS OR SERVICES PURCHASED
5
ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D [If last page of Schedule D, transfer total to Detail Summary Page Line
9, Column A]
v
(D . C
`Expenditures, other than a contract, promise or agreement to make an expenditure resulting in credit 1
Page of—A
INDEPENDENT EXPENDITURES* SCHEDULE D-1
2. ID#
1. Committee Name
3. Report covering period from thru
4
INDEPENDENT EXPENDITURES
DATE
AMOUNT OF
EXPENDITURE
THE
MADE
EXPENDITURE
IDENTIFY RECIPIENT OF EXPENDITURE AND CANDIDATE WHO IS BENEFITTED OR OPPOSED
4a.
NAME, ADDRESS, CITY, STATE AND ZIP
PURPOSE AND DESCRIPTION OF PURCHAS"enefittel--qpposed
CANDIDATE OFFICE SOUGHT YEAR C= ELECTION
4b.
NAME, ADDRESS, CITY, STATE AND ZIP
kpposed
PURPOSE AND DESCRIPTION OF PURCHAS
enefitte
CANDIDATE OFFICE SOUGHT YEAR OF ELECTI03rJ;
4c.
NAME, ADDRESS, CITY, STATE AND ZIP j
PURPOSE AND DESCRIPTION OF PURCHAS
enefitte
osed
CANDIDATE OFFICE SOUGHT YEAR OF ELECTION
5.
ENTER TOTAL ONLY IF LAST PAGE OF SCHEl [If last page of Schedule D-1, transfer total to Detailed Summary Page Line 10, Column A]
'SEE A.R.S. § 16-901(14).
I certify, under penalty of perjury, ty��the above stated independent expenditure(s) was not made in cooperation, consultation or concert with or at the
request or suggestion of any ca didate or any campaign committee or agent of that candidate.
Signature of
NAMES, OCCUPATIONS AND EMPLOYERS AND AMOUNT CONTRIBUTED BY EACH OF THE THREE TOP CONTRIBUTORS WITHIN THE LASTI AMOUNT
SIX MONTHS
Schedule D-1 Pageof
LOANS MADE BY REPORTING COMMITTEE SCHEDULE D-2
2. ID#
1. Committee Name Lr"N'r)'-k U��t�t�� +VL9
3. Report covering period from I 1 — :�'7 T —15 thru i ` L—:�' I — I
4
LOANS MADE BY THE REPORTING COMMITTEE
DATE
AMOUNT
LOAN MADE
OF THE LOAN
NAME, ADDRESS AND 1D# OF COMMITTEETO WHOM LOAN (DISBURSEMENT) WAS MADE
4a.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
4b.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
4c.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
4d.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
f
4e.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
4f.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID# ,.
r
4g.
NAME, ADDRESS, CITY, STATE, ZIR;°AND IDA
,r
4h.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
4i.
NAME, ADDRESS, CITY, STATE, ZIP, AND ID#
5.
ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D-2 [Transfer total to Detail Summary Page Line 12, Column A]
Page—of _...
4a.
45.
4c.
OFFSETS TO OPERATING EXPENSES * SCHEDULE D-3
z. !D#
?. Committee Name Yvl�� �� j� �A4 �rq
3. Report covering period from thru
REBATES, REFUNDS AND OTHER OFFSETS TO OPERATING EXPENSES
DATE
REFUND i
RECEIVED
AMOUNT
OF THE
REFUND
NAME AND ADDRESS FROM WHOM REFUND OR REBATE WAS RECEIVED
NAME, ADDRESS, CITY, STATE, AND ZIP
j
DESCRIPTION OF REFUND
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION OF REFUND
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION OF REFUND
NAME, ADDRESS, CITY, STATE, AND ZIP
f
DESCRIPTION OF REFUND
NAME, ADDRESS, CITY, STATE, AND ZIP
DESCRIPTION OF REFUND
NAME, ADDRESS, CITY, ATE, AND ZIP
DESCRIPTION OF REFUND
5. ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D-3 [If !ast page of Schedule D-3, [transfer total to Detailed Summary Page Line 17 Column A]
Includes return of contributions made by reporting committee
ScheduleD-3 Page—of—
4a.
4b.
4c.
4d.
4e.
4f.
Committee Name
REPAYMENT OF CANDIDATE LOANS
2. ID#
3. Report ccvering period from ^� thru
SCHEDULE D-4
REPAYMENT OF LOANS MADE OR GUARANTEED BY CANDIDATE
DATE
REPAYMENT
MADE
AMOUNTOF
THE
REPAYMENT
NAME AND ADDRESS TO WHOM REPAYMENT (DISBURSEMENT) WAS MADE
NAME, ADDRESS, CITY, STATE, AND ZIP
NAME, ADDRESS, CITY, STATE, AND ZIP
NAME, ADDRESS, CITY, STATE, AND ZIP
NAME, ADDRESS, CITY, STATE, AND ZIP
,
NAME, ADDRESS, CITY, STATE, AND IF
NAME, ADDRESS, 4C1TY. $1 ATE ArJD Z'P
5. ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D-4 [Transfer total to Detail Summary Page, Line 13(a), Column Al
Schedule D-4 Pageof
REPAYMENT OF ALL OTHER LOANS SCHEDULE D-5
2. ID#
I Ij1
l —D
`
1. Committee Name
i
3. Report covering period from thru
4
REPAYMENT OF ALL OTHER LOANS
DATE
AMOUNT OF
REPAYMENT
THE
MADE
REPAYMENT
NAME AND ADDRESS OFINDIVIDUA)- (OR NAME, ID# AND ADDRESS OF THE POL'TICAL COMMITTEE)
TO WHOM REPAYMENT (DISBURSEMENT) WAS MADE
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND iD#
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND ID# f
4e.
NAME. ADDRESS, CITY, STATE, ZIP AND ID#
4f.
11
NAME, ADDRESS,, CITY ZIP AND ID#
b.
ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D-5 [Transfer total to Detailed Summary Page, Line 13(b), Column A]
Pageof
TRANSFERS TO OTHER POLITICAL COMMITTEES SCHEDULE D-6
2. !D#
II DI
Committee Name
q�� y r
Report covering period fromT—thru —1—LS
4
TRANSFERS MADE BY THE REPORTING COMMITTEE
DATE TRANSFER
MADE
AMOUNT OF THE
TRANSFER
NAME AND ADDRESS OF INDIVIDUAL (CR NAME, ID# AND ADDRESS OF THE POLITICAL
COMMITTEE)
TO WHOM REPAYMENT (DISBURSEMENT) WAS MADE
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
4e.
NAME, ADDRESS, CITY, STATE, ZIP AND
All
NAME, ADDRE ,CITY STATE, ZIP AND!D#
5. ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE D-6 [Transfer total to Detailed Summary Page, Line 14, Column A]
Page -Q,
ANY OTHER DISBURSEMENT
SCHEDULE D-7
2. ID#
�AAeee p� t�-n�
1. Committee Name C D V 14V'Ji ' 4
3. Resort covering period from l \ —1 thru
5. ENTER TOTAL ONLY iF LAST PAGE OF SCHEDULE D-7 [Transfer total to Detailed Summary Page Line 15 Column A]
Pageof _
ANY OTHER DISBURSEMENTS
DATE
AMOUNT OF THE
4.
DISBURSEMENT
DISBURSEMENT
MADE
NAME. ADDRESS AND ID# OF COMMITTEE TO WHOM
DISBURSEMENT WAS MADE; DESCRIPTION
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND; ON
DESCRIPTION
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND,d
DESCRIPTION
s�
4e.
NAME, ADDREV6, CII Y, STATE, ZIP AND ID#
DESCRIPTION
5. ENTER TOTAL ONLY iF LAST PAGE OF SCHEDULE D-7 [Transfer total to Detailed Summary Page Line 15 Column A]
Pageof _
IN-KIND CONTRIBUTIONS and EXPENDITURES
1. Committee Name
3. Report coverng period from
11-'_� -ll
2. 1D#
thru
SCHEDULE E
I t _v 1
4
IN-KIND CONTRIBUTIONS and EXPENDITURES
DATE
FAIR
MARKET VALUE
NAME AND ADDRESS OF INDIVIDUAL (OR NAME, ADDRESS AND ID# OF THE
POLITICAL COMMITTEE) FROM WHOM RECEIVED OR TO WHOM GIVEN
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND ;D#
CONTRIBUTION
EXPENDITURE
DESCRIPTION
OCCUPATION
EMPLOYER
a
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
�.✓'�
CONTRIBUTION d
EXPENDITURE
DESCRIPTION
rf
A`
OCCUPATION
EMPLOYER
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
'
/-°
CONTRIBUTION
EXPENDITURE
r
DESCRIPTION
sfr,,
OCCUPATION �'�
EMPLOYER
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
CONTRIBUTION
f
j`
EXPENDITURE
DESCRIPTION
OCCUPATION
EMPLOYER
5.
ENTER TOTAL IN-KIND CONTRIBUTIONS ONLY IF LAST PAGE OF SCHEDULE E [If last page of Schedule E, transfer total to Detailed Summary Page
Line 6, Column Ai
6,
ENTER TOTAL IN-KIND CONTRIBUTIONS ONLY IF LAST PAGE OF SCHEDULE E [If last page of Schedule E, transfer total to Detailed Summary Page
Line 11, Column A)
Page_of
DIVIDENDS, INTEREST. AND OTHER RECEIPTS SCHEDULE F-1
z. ID#
11 i
1. Committee Name "4. 1E-�vx --LA4� -4u� l
3. Report covering period'rom U — 1- thru (a'`1 — — l
4
DIVIDENDS, INTEREST AND OTHER FORMS OF RECEIPTS
DATE
AMOUNT
RECEIVED
AMOUNT
OF THE
RECEIPT
NAME AND ADCRESS FROM INDiViDUAL (OR NAME, ADDRESS AND ID# OF THE POLITICAL
COMMITTEE) FROM WHOM RECEIPT WAS RECEIVED
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF RECEIPT
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF RECEIPT
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND iD#
DESCRIPTION OF RECEIPT
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF RECEIPT
4e.
NAME, ADDRESS, CITY, STATE, ZIP A ID#
DESCRIPTION OF RE IPT
4f.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF RECEIPT
5. ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE F-1 [If last page of Schedule F-1, transfer total 'o Detailed Summary Page Line 7 Column A
I
Page—of
OFFSETS TO CONTRIBUTIONS RECEIVED* SCHEDULE F-2
, Committee Name
2. ID#
H-1)(
3. Report covering period from -y�T=� thru
4
REFUNDS AND OTHER OFFSETS TO CONTRIBUTIONS RECEIVED
DATE
REFUND I
MADE
AMOUNT
OF THE
REFUND
NAME AND ADDRESS OF INDIVIDUAL (OR NAME, ADDRESS AND ID# OF THE POLITICAL COMMITTEE)
TO WHOM REFUND WAS MADE
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF REFUND
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF REFUND
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID# f
DESCRIPTION OF REFUND
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF REFUND
4e.
NAME, ADDRESS, CITY, STATE, ZIP AN D#
DESCRIPTION OF REFU
4f.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF REFUND
5. ENTER TOTAL ONLY IF LAST PAGE OF SCHEDULE F-2 [If last page of Schedule F-2, transfer total to Detailed Summary Page, Line 4(E), Column A] I
` Includes return of contributions received by reporting committee
Page_of
DEBTS AND OBLIGATIONS (Excluding Loans)
SCHEDULE F-3
2. ID#
I
Committee Name
3. Report coverinq period from t1 t5; thru l L:;2-
4
4
DEBTS AND OBLIGATIONS
OUTSTANDING
OUTSTANDING
BALANCE
AMOUNT INCURRED
PAYMENT THIS
BALANCE AT CLOSE
NAME AND ADDRESS OF INDiVIDUAL (OR NAME,
BEGINNING
THIS PERIOD
PERIOD
OF THIS PERIOD
ADDRESS AND ID# OF THE POLITICAL
THIS PERIOD
COMMITTEE) TO WHOM DEBT IS OWED
4a.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF DEBT
4b.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
7z
DESCRIPTION OF DEBT
to
i
4c.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#�
DESCRIPTION OF DEBT
d
4d.
NAME, ADDRESS, CITY, STATE, ZIP AND I
DESCRIPTION OF DEBT
4e.
NAME, ADDRESS, CITY, STATE, ZIP AND ID#
DESCRIPTION OF DEBT
5.
ENTER TOTAL OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD ONLY IF LAST PAGE OF SCHEDULE
F-3 [Transfertotal to Detail Summary Page Line 19, Column A