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Home My WebLink AboutAndrea Ortiz for City Council PC 1 Summary Statement of Contributions and Expenditures Please Bfpe or print legibly m black mk Page 1 of 2 Candidate or Polmcal Committee Name (use full name) Andrea Ortiz for City Council Mailing Address as it Appears on Statement of Organization (street, route or box nmnber, city, state, zip code) 189 Foch Street Eugene, OR 97402 Treasurer's Name' [ Telephone Number (day). Tamara M~ller I 541-52%5855 Cornrmttee iD Number Committee Type, Measure Number or Office N/A Eugene C~ty Courted, Ward 7 [] Original [] Primary. 20 04 [] General 20 [] Other [] Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20 September Supplemental A-TOTALS FOR THIS B-CUMUL&TIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1~ Cash Contributions (Accounting Period Total from PC 2) 2,700.00 2,700.00 2 Loans Received (Non-Exempt) + 0.00 + 0.00 (AccounUng Period Total from PC 2) 3 Total Cash Contributions = 2,700.00 = 2,700.00 (lines 1-2) 4 In-Kind + 454.90 + 454.90 (Accounting Period Total from PC 2) 5 TOTAL CONTRIBUTIONS = 3,154.90 = 3,154 90 (lines 3 + 4) EXPENDITURES 6 CashExpendltures 291 75 291.75 (Accounting Period Total from PC 3) 7~ Loan Pa;qnents (Non-Exempt) + 0 00 + 0.00 (Accounting Period Total from PC 3) 8 Total Cash Expenchtures = 291 75 = 291 75 (lines 6 + 7) 9 In-Kind + 454.90 + 454~90 (Accounting Period Total fi'om PC 2) 10 TOTAL EXPENDITURES = 746.65 = 746.65 (lines 8 + 9) CASH BALANCE l I Beginning Cash Balance 0.00 FOR OFFICE USE ONLY (line 20 of pre~lous report) 12 Total Contributions + 3,154.90 (line 5) 13 Other Receipts + 0.01 (Accounting Period Total fi'om PC 4A) 14. Loans Received (Exempt) + 0.00 (Accounting Period Total from PC 4A) 15 CONTRIBUTION SUBTOTAL = 3,154.91 (hnes 11 + 12 + 13 -v 14) 16 Total Expenditures 746.65 (line 10) (Accounting Period Total i¥om PC 4B) ~ ~. ~i ~ V ~., ~.~ 18. Loan Payments 0~xempt) + 0.00 (Accounting Per, od Total from PC 4B) ~¢)R'; ~ i ;~ 19 EYd>ENDITURE SUBTOTAL = 746.65 (hnes 16 * 17 + 18) 20 ENDING CASH BALANCE CiTY RECORDER (hue 15 minus line 19) = 2,408.26 PC 1 Summary Statement of Contributions and Expenditures Please type or pnnt legibly ~n black mk Page 2 of 2 Can&date or Pohtical Comrmtree Name Cormrmttee ID Number Andrea Orbz for C~ty Councd N/A [] Original [] Pr ma y 20 04 [] General [] Other [] Amendment [] 1st Pre-elecnon [] 2nd Pre-elecnon [] Post-elecuon [] 20 September Supplemental LOAN SUMMARY FOR OFFICE USE ONLY 21 Beginning Outstanding Loans 0.00 (hne 29 of previous report) 22 Loans Recmved (Non-Exempt) + 0.00 (line 2) 23 LoansRecmved (Exempt) + 0.00 (line 14) 24 LOANS RECEIVED SUBTOTAL = 0.00 0roes 21 4- 22 + 23) 25. Loan Payments (Non-Exempt) 0.00 (line 7) 26. Loan Payments (Exempt) + 0.00 (line I8) 27 Forgzven Loans + 0.00 (Total loans forgiven during thzs accounting period) 28 LOAN' PAYMENT SUBTOTAL = 0.00 (lines 25 + 26 +27) 29, TOTAL OUTSTANDING LOANS = 0.00 (hne 24 minus line 28) PERSONAL EXPENDITURE SUMMARY 30 Beginning O utstan&ng Personal Expen&tures 0,00 (line 36 of previous report) 31. Personal Expen&tures + 879.00 (Accounting Period Total from PC 3A) 32. PERSONAL EXPENDITURE SUBTOTAL = 879.00 (hnes 30 + 31) 33 Personal Expenditure Rmmbursements 0.00 (.Total expenditures on PC 3 with purpose code R) 34. Forgwen Personal Expenchtures + 0.00 (Total personal cxpen&tares tbrgtven this acctg period) 35 REIMBURSEMENT SUBTOTAL = 0.00 (lines 33 ~ 34) 36. OUTSTanDING PERSONAL EXPENDITURES = 879.00 (hne 32 minus line 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 Ending Cash Balance 2,408.26 (line 20) 38 Accounts Recmvable + 0,00 (Accounting Period Total from PC 5) 39 SUBTOTAL = 2,408.26 (lines 37 + 38) 40 Total Outstanding Loans 0.00 (hne 29) RECEi~JED 41 Outstanding Personal Expen&tures + 879.00 (line 36) 42 Accounts Payable + 0.00 l*;~;~ 7~ ~ (Accounting Period Total from PC 6) SUBTOTAL = 879.00 (hnes40 +41 +42) OlTY RECORDER 44 BALANCE~EFiCIT = 1,529.26 (line 39 minus line 43 indicate + or - balance) I, Tamara Miller (name of can&date or treasurer), hereby cert~ that the above statement and the attached suppomng reports are true and correct, S~gnature of candidate or treasurer Date s~gned pc 2 Cash Contributions, Loans Received and In-Kind Candidate or Polit,cal Co~rs:nittee Name' Comrmttee ID Number Andrea Ortiz for City Council N/A Page 1 of ~ Elect, on [] Pr,mat3, 20 [] General 20 [] Other Report [] 1 st Pre-elect,on [] 2nd Pre-electron [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE ;2: Contribution Type B Business Entib' CA Cash C Polnical Corem,tree (includes bus,ness and union PACs) CO Cos,grief Obhgatmn F Candlchtte's irrm~ediate Famdy (includes cand,date) IK tn-Kind I Inchwdual LR Loan Recmved L Labor Orgamzat,on O Other P Poht,cal Party Comrmttee Amount of In-Kind Purpose b'ne # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information or Contributor Code ~ I Code 2 Date Received Contributing Committee's ID# Aggregate Friends of Arammta Hawkins I 5157 Astove Street $ 100.00 Eugene, OR 97402 Oregon PAC No. 004348 $ 100.00 P I 2/6/2004 CA Andrea Ortiz L 2 189 Foch Street $ 41.90 Eugene, OR 97402 3/9/2004 Hospital Ward Clerk $ 41.90 F IK Franclsca E, Johnson 3 25474 Milo Road $ 100.00 Veneta, OR 97487 City Human Rights Commission Staff $ 100.00 I I CA O/2OO4 Andrea Orbz O 4 189 Foch Street $ 300.00 Eugene, OR 97402 3/11/2004 Hospital Ward Clerk $ 341.90 F IK Andrea Ortiz L 5. 189 Foch Street $ 55.00 Eugene, OR 97402 Hospital Ward Clerk $ 396.90 F I IK 5/2O04 See Page Totals (Add all amounts with the same Accounting Period Totals (Complete mtly for last page and Instructions contribution type Do not include aggregates ) transfer these amounts to the Summary Statement. PC 1 ) on Back and 200.00 m Campmgn Cash (CA) $ Cash (CA) $ Enter on Summary Statement, Column A. L~ne 1 Fznance Manual In~Kind (IK) $ 396.90 In-K,nd (IK) $ Enter on Summary Statement, Column A Lines 4 and 9 PC 2 Loans Rece,ved (LR) $ 0.00 Loans Recmved (LR) $ Enter on Summao Statement. Column A. Line 2 PC 2 Cash Contributions, Loans Received and in-Kind ,,v Candidate or Pohtical Committee Name Comm}ttee ID NtLrnbe~ Andrea Ortiz for City Counci~ N/A Page .~_~ of 4 Elechon [] Primary 20 04 E~ General 20 [] Other Report' [] 1st Pre-electzon [] 2nd Pre-elechon [] Post-electron [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Buszness Entity CA Cash C Pohtzcal Cormmttee 0ncludes business and umon PACs) CO Coszgner Obhgatmn F Candzdate's Immedzate Family (includes candzdate) IK In-Kind I Indn,zdual LR Loan Recmved L Labor Orgamzahon O Other P Politzcal Par~, Cornmzttee Amount of In-Kind Purpose Line # Name and Address of Contributor Contnbut¢on (see manual for suggested purpose codes) Occupational Information or Conb'ibutor Code 1 I Code 2 Date Received Contributing Committee's IDI¢ Aggregate Andrea Ortiz 1. 189 Foch Street $ 500,00 Eugene, OR 97402 Hospital Ward Clerk $ 896.90 F I CA 3/15/2004 David R. P~ercy 2 1371 West 4th $ 200 00 Eugene, OR 97402 Retired $ 200.00 I I CA 311 6t2004 Andrea Ortlz L 3 189 Foch Street $ 41,84 Eugene, OR 97402 Hospital Ward Clerk $ 938 74 F I IK 3/1 8/2004 Carmen Urbina 4, 788 Blackfoot Avenue $ 100,00 Eugene, OR 97404 Director El Centre Latmo $ t00.00 I I CA 3/1 9/2004 Ray G, Wolfe 5. 1473 Luella Street $ 100.00 Eugene, OR 97401 3/24/2004 Retired $ 100.00 I CA See Page Totals (Add all amounts xvzth the same Accounting Period Totals (Complete only for last page and Instructions contribution type Do not ~nclude aggregates.) transfer these amotmts to the Summary Statement, PC 1 ) on Back and 900 00 in Campmgn Cash (CA) $ Cash rCA) $ ' Enter on Summary Statement. Colunm A_ Linc 1 Finance Manual In-K~nd (IK) $ 41,84 In-Kind (IK) $ Enter on Summa~' Statement. Column A~ Lines 4 and 9 PC 2 Loans Received (LR) $ 0.00 Loans Recmved (LR) $ Enter on Stm~mary Statement. Column A. Line 2 Pc Cash Contributions, Loans Received and in-Kind Can&date or Polmcal Cormmttee Name' Comnmttee ID Number: Andrea Ortiz for City Council N/A Page 3~ of Electron [] Primary 20 04 [] General 20 [] Other Report [] 1 st Pre-elechon [] 2nd Pre-elecUon [] Post-elechon [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Bus~ness Entzty CA Cash C Poht~cal Committee 0ncludes business and umon PACs) CO Cosigner Obhgatmn F Can&date's lmmedmte Family 0ncludes candzdate) IK ln-K~nd [ Indzv~dual LR Loan Recmved L Labor Orgamzatlon O Other P Polmcal Party Corem/tree Amount of In-K/nd Purpose Line # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information Oontributor or Code ~ I Code 2 Date Received Contributing Committee's ID# Aggregate Andrea Orbz L 1. 189 Foch Street $ 16,16 Eugene, OR 97402 3t2312004 Hospital Ward Clerk $ 954,90 F IK Bonny Bettman 2. 2191 Friendly Street $ 75,00 Eugene, OR 97405 3/23/2004 Retired R.N. $ 75.00 I CA Carol Van Houten 3 768 West 10th Avenue $ 75,00 Eugene, OR 97402 3/29/2004 Retired $ 75.00 I CA Jan Vandertuin 4. 455 West 1st Avenue, Apt. B $ 200.00 Eugene, OR 97401 3/29/2004 Bike builder $ 200,00 I CA Gary Halvorson 5 2875 Adme Way $ 100 00 Eugene, OR 97403 Physician $ 100.00 t [ CA 3f29/2004 See Page Totals (Add all amounts w~ the same Accounting Period Totals (Complete only for last page and InstrucUons contribution .type Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1 ) on Back and 450.00 m Campmgn Cash (CA) $. Cash (,CA) $ Finance Enter on Summary Statemenk Column A Line 1 Manual In-K~nd (IK) $ 16.16 In-K~nd (IK) $ Enter on S/re]mary Statement. Column PC 2 Loans Recmved (LR) $ 0.00 Loans Recmved (LR) $ Enter on sun, m~ry statement, Column A, Lrae 2 PC Cash Contributions, Loans Received and n-Kind Candidate or Political Committee Name' Com,'rnttee ID Number' Andrea Ortiz for C,ty Council N/A Page 4 of 4 lec ,on [] Primary 20 04 [] General :0 [] Other Report [] 1st Pre-electron [] 2nd Pre-elect~on [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Political Cormmttee (includes buszness and umon PACs) CO Cosigner Obhgatzon F Can&date's lnm'~edlate Fannly (includes can&date iK In-Kind i Indn,ldual LR l.oan Received L Labor Organizatmn O Other P Political Party Comrmttee Amount of ln-K~nd Purpose Line # Name and Address of Contnbutor Contnbutton (see manual for suggested purpose codes) Occupational Information or Oontributor Code ~ I Code 2 Date Received Contributing Committee's ID# Aggregate Lola Fritz I 3774 Pine Canyon Drive $ 250.00 Eugene, OR 97405 Hospital Operations Director $ 250 00 I 3/29/2004 CA Wilham C. Robertson 2 97t Fayette $ 100.00 Eugene, OR 97404 Retired $ 100.00 i t CA 3/29/2OO4 R~chard Kozak 3 2684 City View Street $ 100,00 Eugene, OR 97405 3/29/2004 Physician $ 100.00 I CA Constance Monch 4 2986 Flintlock Street $ 100.00 Eugene. OR 97408 3/31/2004 Retired $ 100 00 I CA Miscellaneous Cash Contnbutlons $50 and Under 5 $ 600.00 2/6/04-4/1/04 $ 600.00 I CA See Page Totals (.Add all amounts with the same Accounting Period Totals (Complete only for last page and Instructions contnbutlon type Do not mclude aggregates ) transfer these amounts to the Summary Statement. PC 1.) on Back and in Campaign Cash (CA) $ 1,150 00 Cash (CA) $ _ 2,700.00 Finance Enter on Sumrnary StatemenL Column A, Line 1 Manual in-K~nd (IK) $ 0,00 in-Kind (IK) $ 454.90 Enter on Summary Statement. Column A Lines 4 and 9 PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ 0 00 Enter on Su.mmar5 SmtemenL Column A, Line 2 PC 3 Cash Expenditures and Loan Payments Candidate or Political Committee Name. Comrmttee ID Number: Andrea Ortiz for City Council N/A Page 1 of 1 Election: [] Pr/mary 20 04 [] General 20~ [] Other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20~ September Supplemental PUP, POSE CODES (see back of tk~rm for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advemsmg (yard mgns, buttons, otc,) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Reunbursement for Personal Expenditures F Ftmdraismg Event Expenses S Surveys and Polls G General Operational Expenses (describe if over $50) 2 Travel Expenses l describe if over $50) I Imerest Payment U Utilmes L Literatttre, Brochttres, Pnnting W Wages, Salaries, Benefits M Management Services Y Petition Circulators N Newspaper and Other Periodical Advertising Z Preparanon and Product/on of Advertising Payee's Name and Payee's Committee ID#, Exp. Amount of bne # Date Check # if applicable Purpose Type Expenditure Paid (as ~t appears on invoice, receipt or check) to G 1. 2/2512004 Deb~t Pacific Cascade Federal Credit Union CA $ 13.75 3119/2004 100t Senior News N 2. CA $ 174.00 F 3/3012004 Debit River Road Parks & Recreation CA $ 100,00 3 G 313112004 Deb~t Pacific Cascade Federal Credit Union CA $ 4.00 4. * 9 $ [51 10 $ See Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and Instructions expenditure type.) transfer these amounts to the Summary Statement, PC 1,) on Back and 291.75 291.75 in Campaign Cash (CA) $ Cash (CA) $ Enter on Summary Statement, Coluzm~ A, Line 6 Fnmnce Manual Loan Payment {LP) $ 0.00 Loan Payment {LP) $ 0~00 Enter on StmmTn~ Statement, Coh~rm A, Line 7 PC 3 PC 3A Personal Expenditures for Reimbursement Candidate or Political Committee Name Comn~attee ID Number Andrea Ortiz for City Council N/A Page _....,~__ of. _ ! .... Election' [] Primary 20 04 [] General 20 [] Other Report [] 1 st Pre-electron [] 2nd Pre-election [] Post-electron [] 20__ September Supplemental PURPOSE CODES (see back of form ~br instructions and code definitions) A Agent O Other Advertmmg (yard signs, bLWrons, crc ) B Broadcast Advemsmg (Radio, TV) P Postage C Cash Contributions S Surveys and Polls F Ftmdrmsmg Event Expenses T Travel Expenses (describe if over $50) G General Operational Expenses {describe if over $50) U Utdltxes I Interest Payment W Wages, Salaries, Benefits L Lltmature, Brochures, Printing Y Petition Circulators M Management Services Z Preparatmn and Productmn of Advemsmg N Newspaper and Other Penochcal Advertising Amount of bne # Date Payee's Name Purpose Expenditure 3/19/2004 United States Postal Service P 1 $ 37.00 3/19/2004 United States Postal Service P 2 $ 111,00 3/23/2004 Oregon T's O 3 $ 600 00 3/29/2004 Off~ceMax L 4 $ 35.00 3/30/2004 Square Deal Lumber & Hardware O 5. $ 96,00 6 $ 7 $ 8 9 $ 10. $ See Page Total Accounting Period Total (Complete only for last page and Instructions 879.00 transfer this amount to the Sunmxary Statement. PC 1 ) on Back and Personal Expenditures $ in Campaign Personal Expenditures $ 879.00 Enter on Summary StatemenL Line 31 Fmance Manual PC 3A PC 4A Receipts Other Candidate or Poht~cal Con~rfittee Name. Cormmttee iD Number Andrea Ortiz for C~ty Council N/A Page .___1. __ of,._ !__ Election: [] Primary 20 04 [] Oenera120~ [] Other. Report [] 1st Pre-elect~on [] 2nd Pre-elect~on [] Post-elecbon [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS Other Receipt Transaction Type Codes EL Exempt Loan Proceeds FM items Sold at Fmr Market Value InteresEInvesnnent Income OM Mzscellaneous (prowde a descnptmn) RF Refunds~ Rebates and Retuxns Date Name Other Receipt Line # Received (required for codes EL, OM and RF ; Transaction Type Other Rece¢pf Amount optional for codes FM and IN) Code 3131/2004 Pacific Cascade Federal Credit Union IN 1 $ 0,01 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ 8 $ 9 $ 10 $ See Page Totals (Add all Other Recmpt Transaction Account~g Period Totals (Complete only for last page and Instructmns Type Codes specified ) transfer these amounts to the Summary Statement, PC 1 ) on Back and 0.01 zn Campmgn Codes FM, IN. OM, RF $ 0,01 Codes FM~ IN, OM. RF $ Finance Enter on Summary Statement, Column A, Line 13 Manual Code EL $ 0.00 Code EL $ 0,00 Enter on Summary Statement, Colmnn A, Line 14 PC 4A PC 2 Amendment Amendments-Cash Contributions, Loans Received and In-Kind Can&date or Pohncal Cormmttee Name. Comn'uttee ID Nmnber Andrea Ortiz for City Council N/A Page ~ of 1 Elect,on ~ Prm~av 20 04 ~ General 20 ~ Olher Report ~ let Pre-eleet~on ~ 2nd Pre-elect~on ~ Post-elect~on ~ 20~ September Supplemental SEE BACK FOR INSTRUCTIONS A~ CODE DEF~ITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Ent~ CA Cash C Pohncal Co~zttee Oncludes business and umon PACe) CO Coszgner Obhgabon F Can&&te's I~'zedmm Parody (includes can&&te) IK h~-Kznd I in&v~dual LR Loan Recmved L Labor ~gamzanon O O~er P Polkmal Par~ Con~ttee Amending Page g Name and Address of Contributor Amount of In-Kind Pu¢ose and Line ~ Confrib~ion (see manual for suggested purpose codes) Occupational Information or Contfib~or Code ~ ~ Code 2 Date Received Conf~buting Commi~ee ~ I D~ Aggregate Pag~ I dne 1 Fdends of Araminta Hawkins ~ New Entw 5157 Astove Street $ 100,00 ~ Correcbng Eugene, OR 97402 ~ Delebng 2~6~2OO4 Oregon PAC No 004348 $ 100.00 C CA Page Line D New EnW $ ~ Correcbng ~ Delettng Page L}ne ~ New Entre ~ Correcting ~ Deleting Page Ltne D New Entw ~ Correcbng ~ Ddebng $ Page.__ une ~ New Entry' ~ Gorrecbng ~ Deleting See FOR OFFICE USE ONLY ,nstmcno~s ¢'~_ RECEIVED onBack and ~x,~ ¢ ¢ F~nance S~gnature of can&date o[4~easurer ~ ,~ ~ :i CiTY RECORDER ~nendment Date signed PC 1 Summary Statement of Contributions and Expenditures Please type or print legibly m black ink Page 1 of 2 Candidate or Polmcal Committee Name (use full namet. Andrea Ortiz for City Council Mailing Address as tt Appears on Statement of Organization (street, route or box number, city, state, zip code). 189 Foch Street Eugene, OR 97402 Treasurer's Name' Telephone Ntamber (day) Tamara Miller (541) 521-5855 Comrmttee D Number. Committee Type~ Measure Number or Office N/A Eugene City Council, Ward 7 [] Original [] Pr=aw 20 04 [] General 20~ [] Other [] Amendment [] l st Pre-election [] 2nd Pre-election ~ Post-election [] 20 September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1 Cash Contributions 4,510.99 7,210.99 (Accounting Period Total from PC 2~ 2 Loans Received (Non-Exempt) + 745.00 + 745.00 (Accounting Period Total from PC 2) 3 Total Cash Contributions = 5,255~99 = 7,955.99 (lines 1+ 2) 4. In-Kind + 271.13 + 726.03 (Accounting Period Total from PC 2) 5 TOTAL CONTRIBUTIONS = 5,527.12 = 8,682.02 (hnes 3 + 4) EXPENDITURES 6 Cash Expenditures 5,387.98 5,679.73 (Accounting Period Total from PC 3) 7 Loan Payments (Non-Exempt) + 0.00 + 0.00 (Accounting Period Total fi'om PC 3) 8 Total CashExpendffmes = 5,387.98 = 5,679.73 (lines 6 ~- 7) 9. In-Kind + 271.13 + 726.03 (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 5,659.11 = 6,405.76 (hnes 8 + 9) CASH BALANCE 11 Beginning Cash Balance 2,408.26 FOR OFFICE USE ONLY (line 20 of previous report) 12. Total Contributions + 5,527.12 (line 5) 13. Other Receipts + 0.01 (Accounting Period Total from PC 4Al 14 Loans Received (Exempt) + 0.00 (.Accounting Penod Total from PC 4Al 15. CONTRIBLFI'ION SUBTOTAL = 7,935.39 (hnesll+12+13+14) 16 Total Expendltmes 5,659.tl RECEIVED (lille 10) 17 Other Disbursements + 0.00 (Accounting Period Total from PC 4B) ~¥' 0 5 ~0~. 18 Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) CiTY RECORDER = 5,659.11 (lines 16 + 17 + 18) 20. ENDING CASH BALANCE = 2,276.28 (hne 15 minus hne 19) PC Summary Statement of Contributions and Expenditures Rev Please type or print leg,bly m black ink Page 2 of 2 Candidate or Pohtical Committee Name' Committee ID Numben Andrea Ort~z for City Council N/A Ong,nal ~ Pr,mary 20 04 [] General 20 [] Other Amendment [] 1st Pre-election ]~ 2nd Pre-election [] Post-elect,on [] 20 September Supplemental LOAN SUMMARY 21. Beginmng Outstanding Loans FOR OFFICE USE ONLY (line 29 of pre¥1ous report) 0.00 22 Loans Received ('Non-Exempt) + 745.00 (hne 2) 23. Loans Received (Exempt) + 0 00 (hne 14) 24 LOANS RECEIVED SUBTOTAL (lines 21 + 22 + 23) = 745.00 25. Loan Payments (Non-Exempt) (line 7) 0.00 26 Loan Payments (Exempt) + 0.00 (line 18) 27 Forg,ven Loans + 0.00 (Total loans lbrgiven dunng this accounting period) 28 LOAN PAYMENT SUBTOTAL = 0.00 (lines 25 + 26 +27) 29. TOTAL OUTSTANDING LOANS = 745.00 (line 24 minus line 28) PERSONAL EXPENDITURE SUMMARY 30. Beg~nmng Outstanding Personal Expenditures 879.00 (line 36 of previous report) 31 Personal Expenchtures + 0.00 (Accounting Period Total from PC 3A) 32 PERSONAL EXPENDITURE SUq3TOTAL = 879.00 (lines 30 + 31) 33 Personal Expenditure Rmmbursements 87~.00 (Total expenditures on PC 3 w~th purpose code R) 34 Forgiven Personal Expenchtures + 0.00 (Total personal expenditures tbrgiven th~s acctg period) 35. REJMB~SE~ SUBTOTAL = 879.00 (lines 33 + 34) 36 OUTSTANDING PERSON.kL EXPENDITURES = 0.00 (hne 32 minus line 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 Endmg Cash Balance 2,276.28 (hne 20) 38 Accounts Receivable + 500.00 (Accounting Period Total from PC 5) 39 SUBTOTAL = 2,77~.28 (lines 37 + 38) 40 Total Outstanding Loans 745.00 RECEIVED (hne 29) 41 Outstanding Personal Expenditures + 0.00 ~{IJ¥'{' 0 ~ 200~} (line 36) 42 Accounts Payable + 0.00 (Accommng Period Total from PC 6) 01TY 43 SUBTOTAL = 745.00 (lines 40 + 41 + 42) 44 BALANCE/DEFICIT = 2,031.28 (line 39 minus hne 43 in&cate + or - balance) I, Tamara Miller (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports are true and correct ~' ' Date signed S,gnature of can&date or ~easurer ~' ~ ~ ~ PC 2 Cash Contributions, Loans Received and In-Kind Candidate or Pohtical Comrmttee Name. CozTnrnttee ~D Nttmber' Andrea Ortiz for City Council NtA Page __!,___ of 6 Electron. [] Prnmary 20 04 [] general 20 [] O~:her Report' [] 1st Pre~electxon [] 2nd Pre-elect2on [] Post-electron [] 20, September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Ent~tv CA Cash C Polmcal Cormmttee (includes business and umon PACs) CO Cosigner Obhgat~on F Candidate's Immediate Famdy (~ncludes can&date) IK In-Kind I Ind~wdual LR Loan Received L Labor Orgamzafion O Other P Poht~cal Party Committee Amount of In-Kind Purpose Une Ct Name and Address of Contnbutor Contnbution (see manual for suggested purpose codes) Occupational Information or Contributor Code 1 I Code Date Received Contributing Commi~ee's IDCt Aggregate 2 Gary P. Young, M.D. 1. 741 E. 20th Avenue $ 100 00 Eugene, OR 97405 Physlcmn $ 100.00 I 4/2/2004 CA G. Geoffrey Gordon 2 2609 Fairmount Blvd $ 100.00 Eugene, OR 97403 Physician $ 100,00 I I CA 4/2/2OO4 Lee Boutell 3. 926 Calwn Street $ 100.00 Eugene, OR 97401 4/5/2004 Maintenance Technician $ 100.00 I CA Anita Johnson 4. 2288 Birch Lane $ 100.00 Eugene, OR 97403 Journalist $ 100 00 I I CA 4/5/2004 Michael A, Barkrnan 5 85542 Winding Way $ 100.00 Pleasant Hill, OR 97455 4/6/2004 Physician $ 100.00 I CA See Page Totals (Add all amounts with the same Accounting Per~od Totals (Complete gray for last page and Instructions contribution type. Do not xnclude aggregates ) transfer these amounts to the Summary StatemenL PC 1 ) on Back and 500,00 m Campmgn Cash (CA) $ Cash (CA) $ Finance Enter on Summary Statement Column A. L~ne Manual In-Kind (IK) $ 0 00 In-Kxnd (IK) $ Enter on Summary. Statement. Column .z% Lines 4 and 9 PC 2 Loans Recmved (LR) $ 0 00 Loans Received (LR) $ Enter on Summary Statement. Coltm~n A. Line 2 PC 2 Cash Contributions, Loans Received and In-Kind Candidate or Political Committee Name Committee ID Number Andrea Ortiz for City Council N/A Page 2 of 6 Elect~on. [] Primary 20 04 [~1 General 20 E] Other Report [] 1st Pre-elecuon [] 2nd Pre~electron [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Pohtzcal Committee (includes business and umon PACs) CO Cosigner Obhgatzon F Candzdare's Immediate Famdy (includes candidate) IK In-Kind I Individual LR Loan Received L Labor Organizatmn O Other P Pohttcal Party Committee Am~>unf of In-Kind Purpose Uno # Name and Address of Contributor Contributlon (see manual for suggested purpose codes) Occupational tnformatton Contr~butor Code 1 ] Code 2 or Dale Received Contributing Committee's ID# Aggregafe John V. AIIcott 1, 2650 Cresta De Ruta $ 100,00 Eugene, OR 97403 4/7/2004 Physician $ 100.00 I CA Lmda Fuller 2 2401 W. 22nd Avenue $ 100.00 Eugene, OR 97405 Professor $ 100 00 I I CA 4/7/2OO4 Cary Thompson 3 966 Jackson Street $ 500.00 Eugene, OR 97402 4/8/2004 Retired $ 500.00 I CA Teresa Damron 4~ 605 Howard Avenue $ 200,00 Eugene, OR 97404 Teacher/Farmer, etc, $ 200,00 I 4/9/2004 CA John Jordan-Cascade 5. 1575 Larkspur Loop $ 20,00 Eugene, OR 97401 4/10/2004 Web Content Coordinator $ 70 00 I CA See Page Totals (Add all amomlts with the same Accounting Period Totals (Complete only for last page and Instmcuons contrlb-utmn type Do not include aggregates ) transfer these amounts to the Smxm2ary Statement, PC 1 on Back and 920.00 m Campaign Cash (CA) $ Cash (CA) $ Finance Enter on Summary Statemcnt~ Column A, Line 1 Manual In-Kind (IK) $ 0.00 In-Kind (IK) $ Enter on Summary Statement. Column A, L~neb 4 and 9 PC 2 Loans Received (LR) $ 0.00 Loans Recmved (LR) $ Enter on Summary Statement. Column A, Line 2 PC2 Cash Contributions, Loans Received and In-Kind Rev Candidate or Political Committee Name Comrmttee ID Number. Andrea Ortiz for City Council N/A Page 3 of 6 Election. [] Prn~nary 20 04 [] General 20 [] Other Report' [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] 20 September SupplememaI SEE BACK FOR INSTRUCTIONS AN[_) CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Busmess Entl~' CA Cash C Pohtlcal Committee (includes busmess and union PACs) CO Cosigner Obligation F Candidate's Immediate Family (includes candidate) iK In-Kind I Individual LR Loan Recmved L Labor Organization O Other P Political Percy Committee Amount of In-Kind Purpose Line # Name and Address of Contributor Contnbution (see manual for suggested purpose codes) Occupafional Infon~ation or Contributor Code I I Code 2 Date Received Contributtng Commrttee's ID# Aggregate John Jordan Cascade L 1. 1575 Larkspur Loop $ 29,56 Eugene, OR 97401 Web Content Coordinator $ 99.56 I [ IK 4/1 0~20O4 Andrew Peara 2 410 E. 34th Avenue $ 75,00 Eugene, OR 97405 D~rector of non-profit/Educator $ 75.00 I t CA 411 0~2OO4 Alison Cantrd 3~ 410 E. 34th Avenue $ 75.00 Eugene, OR 97405 Volunteer Educator $ 75.00 t I CA 411 0/2004 James Baker 4. 51013 McKenzie H~ghway $ 75.00 Finn Rock, OR 97488 4tl 112004 Retired $ 75 00 I CA Paul Nicholson 5 1855 E, 28th Avenue $ 100.00 Eugene, OR 97403 4112~2004 Bicycle Retailer $ 100.00 I CA See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and Instructions contnbuhon type Do not include aggregates transfer these amounts to the Summary Statement, PC I ) on Back and 325.00 in Campaign Cash (CA) $ Cash (CA) $ Enter on Summary Statement. Cohmm A. Line 1 Finance Manual In-Kind (IL) $ 29.56 In-Kind (IL) $ Enter on Summary Statement. Column A, Lines 4 and PC 2 Loans Received (LR) $ 0.00 Loans Recmved (LR) $ Enter on Star, mary Statement. Column .~, Line 2 Pc 2 Cash Contributions, Loans Received and in-Kind *e,, Candidate or Political Corramttee Name Comrmttee ID Number. Andrea Ortiz for City Council N/A Page 4 of Election [] Primary 20 04 [] General 20 [] Other Report [] 1st Pre-election [] 2nd Pre-elect~on [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Bus~ness Enbty CA Cash C Political Cormmttee (includes business and union PACs) CO Cosigner Obhgatmn F CandMate's Irnmediate Fannly (includes candidate) IK In-Kind I Individual LR Loan Received L Labor Orgamzanon O Other P Pohtlcal Party Committee Amount of In-Kind Purpose Line # Name and Address of Contributor Contribution (see manual for suggested purpose cedes) Occupational Information or Contr~butor Code 1 I Code 2 Date Received Contributing Committee's ID# Aggregate Tamara Mdler G 1 293 E. Anchor Avenue $ 17,58 Eugene, OR 97404 Attorney/Property Administrator $ 67.58 4/1 2/20O4 IK Steven Neubauer 2 3047 Grand Cayman Drive $ 100,00 Eugene, OR 97408 4/14/2004 Physician $ 100.00 I CA Tamara Miller G 3. 293 E Anchor Avenue $ 9,99 Eugene, OR 97404 Attorney/Property Administrator $ 77.57 I I IK 4/1 7/20O4 Phhhp Johnson 4 2866 Lydick Way $ 100.00 Eugene, OR 97401 4/17/2004 Physician $ 100.00 I CA Steve Tarver 5, 1455 Wilson Court $ 100.00 Eugene, OR 97402 Forestry Technician $ 100.00 I 4/1 7/2O04 CA See Page Totals (Add all amom~ts w~th the same Accounting Period Totals [Complete only for last page and Instructions contribution type Do not include aggregates ) transfer these amounts to the Summary Staternent PC 1 ) on Back and 300.00 m Campmgn Cash (CA) $ Cash (CA) $ Enter on SummaD Statement. ColumnA, Line Fmance Manual In-Kind (IK) $ 27.57 In-Kind (IK) $ Enter on Summary StatemenL Column A, I_me~ 4 and 9 PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ Enter on Summar) Statement, Column A. Line 2 PC 2 Cash Contributions, Loans Received and In-Kind Candidate or Political Comnmtee Name Comnnttee ID Number Andrea Ortiz for City Council N/A Page ~ _of 6 Electron [] PrLmary 20 04 E~ General 20 [] Olher Report [] 1st Pre-election [] 2nd Pre-election [] Post-elect~on [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Political Committee (includes business and union PACs) CO Cosigner Obhgatmn F Candidate's Immediate Famdy (includes candidate) IK In-Kind I IndJvldual LR Loan Received L Labor Orgamzatmn O Other P Political Party Con-mnktee Amount of tn-Kind Purpose Line # Name and Address of Contributor Contnbutton (see manual hr suggested purpose codes) Occupational Information or Contributor Code I I Code 2 Date Received Contributing CommiYree's ID# Aggregate Richard Cunnlngham 1 1699 North Terry Street, SP 293 $ 75.00 Eugene, OR 97402 Insurance Consultant $ 75.00 I 4/1 8/2O04 CA Mehnda Glore 2 2587 Stratford Street $ 75.00 Eugene, OR 97404 4/18/2004 Postal Worker $ 75.00 I CA Laurie McCla~n 3 245 North Polk $ 100.00 Eugene, OR 97402 Financml Adwsor (self-employed) $ 100.00 I ] CA 4/20/2004 David Caress 4~ 6509 99th Street, Apt. IQ $ 100.00 Rego Park, NY 11374 4/21/2004 Counselor $ 100.00 I CA Deborah Barker Noble 5~ 4990 West Hillside Dnve $ 745.00 Eugene, OR 97405 Business Manager (timber sales) $ 745.00 I I LR 4/22/2004 See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only ~'or last page and Instructions contribution type Do not include aggregates ) transfer these amounts to the Summary Statement, PC 1 ) on Back and 350.00 m Campaign Cash (CA) $ Cash (CA) $ Enter on Summary Statement, Column A, Line Flrmnce Manual In-Kind (IK) $ _ 0.00 In-Kind (FK) $ Emer on Summary Statement. Column & Lines 4 and 9 PC 2 Loans Received (LR) $ 745.00 Loans Received (LR) $ Enter on Summary StatemenL Column A. Line 2 PC 2 Cash Contributions, Loans Received and In-Kind e,r Candidate o~ Pohtmal Committee Name: Comn~ttee ID Number Andrea Ortiz for City Council NIA Page 6 of 6 Election [] Prrmary 20 04 [] General 20., [] E~her Report' [] 1st Pre-electron [] 2nd Pre-electron [] Post-elect~on [] 20 __ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA_ Cash C Pohtmal Committee 0ncludes business and umon PACs) CO Coszgner Obhgatmn F Candidate's Immediate Famdy 0ncludes candidate) IK in-Kind I indzwdual LR Loan Received L Labor Orgamzation O Other P Pohucal Party Committee Amount of In-Kind Purpose Line # Name and Address of Contnbutor Confnbuf¢on (see manual for suggested purpose codes) Occupational Information or Contnbutor Code ~ [ Code 2 Date Received Contributing Committee's ID# Aggregate Mary O'Bnen 1 3525 Gilham Road $ 100.00 Eugene, OR 97408 4/24/2004 Professor $ 100.00 I CA Dawd Witkin, M.D. 2. 1755 Coburg Road, Ste 6 $ 100.00 Eugene, OR 97401 Physician $ 100.00 I I CA 4/26/2004 Pat Hadley P 3 2611 Edison $ 214,00 Eugene, OR 97402 Political Consultant $ 214.00 I I IK 4/3O/20O4 M~scellaneous Cash Contnbutlons $50 and Under 4. $ 1,915.99 4/2/04-5/2/04 $ I CA 5. $ See Page Totals (Add all amotmts weh the same Accounting Period Totals (.Complete only for last page and Instructmns contribution type Do not include aggregates,) transfer these amounts to the Surrmmry Statement, PC 1 ) on Back and 2,115.99 4,5I 0 99 in Campmgn Cash (CA) $ ~ Cash (CA) $ Enter on Summary Statement. Column .~ Line 1 Fmance Manual In-K~nd (IL/ $ 214,00 . In-Kind (III) $ 271,13 Enter on Summar) Statement. Column A. Lines 4 and 9 PC 2 Loans Received (LR) $ 0,00 Loans Received (LR) $ 745,00 Enter on Summary Statement. Coltumn A, Line 2 PC 3 Cash Expenditures and Loan Payments Candidate or Political Committee Nmne: Cornrmttee ID Number: Andrea Ort~z for City Council N/A Page 1 of 2 Election: [] Pr/mary 20 04 [] General 20 [] Other Report: [] 1st Pre-electzon [] 2nd Pre-election [] Post-election [] 20 .......... September Supplemental PURPOSE CODES (see bask of form for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advertising (yard signs, buttons, otc } CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Rehnbursement for Personal Expenditures F Fundraising Event Expenses S Surveys and Polls G General Operational Expenses (describe if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilitzes L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Y Petitzon Czrculators N Newspaper and Other Periodical Advertising Z Preparation and Production of Advertzsmg Payee's Name and Payee's Committee ID#, Exp, Amount of Line # Date Check # if applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to AlP 41212004 1003 Andrea Orbz R 1. CA $ 844.00 41912004 1004 Michael Carrigan L 2. (Expense reimbursement for lit. expenses) CA $ 57.98 4~912004 1005 Brooke Robertshaw L 3. (Expense reimbursement for bt. expenses) CA $ 77.51 411612004 1006 Andrea Ort~z R 4. CA $ 35.00 4/20/04 1007 Accessible Data Serwces, Inc P 5. CA $ 1,096.34 4/24/2004 1008 Senior News N 6. CA $ 198.00 4/27/2004 1009 Eugene Weekly N 7. CA $ 718.00 4/26/2004 Debit U.S. Postal Service P 8. CA $ 74 00 P 4/29/2004 1010 Accessible Data Services 9. CA $ 823.17 4/29/2004 1011 The Register Guard N 10. CA $ 848,64 E~ See Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and Instructions expenditure type.) transfer these amounts to the Summary Statement, PC 1 on Back and in Campaign Cash (CA) $ 4,772.64 Cash (CA) $ Finance Enter on Summary Statement, Cotumn A. Line 6 Mannal Loan Payment (LP) $ 0.00 Loan Payment (LP) $ E~ter on Stannmry Statement~ Colmxm A, Lm~ 7 PC 3 PC 3 Cash Expenditures and Loan Payments :,03 Candidate or Pohtical Committee Name: Committee ID Number: Andrea Ortiz for City Council N/A Page 2 of 2 Election' [] Primary 20 04 [] General 20~ [] Other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-elect/on [] 20 September Supplememal PURPOSE CODES (see back of fl~rm for instructions and code definitions) EXPENDITURE TYPES A Agent O Ottier Advertising (yard signs, buttons, etc.) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Reimbursement for Personal Expenditures F Fundraislng Event Expenses S Surveys and Polls G General Operatio~M Expenses (describe if over $50) T Travel Expenses (describe if over $50) I interest Payment U Utihties L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Y Petition Circulators N Newspaper and Other Periodical Advertising Z Preparation mid Production of Advertising Payee's Name and Payee's Committee ID#, Exp. Amount of [] IJne# Date Check # if applicable Purpose Type Expenditure Paid (as it appears on invoice, recdpt or check) to AlP 4~29/2004 1012 Peace Rose Graphics L 1. CA $ 448.00 E~ 5/1/2004 t013 Brooke Robertshaw L 2. (Expense reimbursement for hr. expenses) CA $ 68 83 ~ 511/2004 1014 M~chael Carrigan P 3. (Expense reimbursement for postage) CA $ 50,60 E~ 5/112004 1015 Pat Hadley L CA $ 47.91 ~ 4. (Expense reimbursement for lit, expenses) 5. $ 9 10. $ See Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and Instructions expenditure type ) transfer these amounts to the Summary Statement, PC 1 on Back and m Campaign Cash (CA) $ 615.34 Cash (CA) $ 5,387.98 Finance Ente~ on Sm~mr2 Statement, Colm~m A, Lm~ 6 Manual Loan Payment/.LP) $ 0.00 Loan Payment (LP) $ 0.00 Enter on Stanmary Statement, Colurrm A L~ne 7 PC 3 PC 4A Receipts :Jo3 Other Candidate or Poht~cal Conm~lttee Name. Co~maittee ID Nm~ber Andrea Orbz for City Council N/A Page 1 of 1 Election [] Prm~ary 20 04 [] General 20 [] Other Report' [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20 .... September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS O~her Receipt Transaction Type Code~ EL Exempt Loan Proceeds FM Items Sold at Fair Market Value Interest/investment Income OM Miscellaneous (provide a descr~ptmn5 t@ RefUnds, Rebates and Retuins Date Name Other Receipt (required for codes EL, OM and RF: Transaction Type Other Receipt Amount IJne # Received optional for codes FM and IN) Code 4/30/2004 Pacific Cascade Federal Credit Un~on IN I $ 0,01 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ 8 $ $ 10 $ See Page Totals (Add all Other Recmpt Transaction Aeeotmting Period Totals (Complete only/or last page and Instructions Type Codes spemfied ) transfer lhese amotmts to the Summary Statement, PC 1 ) on Back and 0,01 m Campmgn Codes FM, iN, OM, RI;' $ 0~01 Codes FM, IN, OM,. R~ $ Finance Emer on Summary Statement. Column A, Line i3 Manual Code EL $ 0.00 Code EL $ 0.00 Enter on Summary Statement. Column A. Line 14 PC 4A Pc 5 Accounts Receivable Candidate or Pohtical Cornrmttee Name Corrm~ttee ID Number Andrea Ortiz for City Council N/A Page Elect,on [] Prrrnary 20 04 [] General 20 [~1 Other Report [] 1st Pre-elecnon [] 2nd Pre-elect,on [] Post-electron [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Account Receivable Type B Bus~ness Ent,ty OR Other Account Rece, vable C Polit, cal Con2mttee (mcludes busmess and umon PACs) PC Pledge of Cash F Can&date's Immechate Family 0ncludes can&date) PI Pledge of [n-Kmd I In&v~dual PL Pledge of Loan L Labor Orgamzation O Other P Pohtmal Party Comm,ttee Amount of in-Kind Purpose Line # Name and Address of Contributor Account Receivable (see manual for suggested purpose codes) Occupational Information or Contributor Code I I Code 2 Date Contributing Committee's ID~ Aggregate Oregon AFSCME PAC 1 (American Federation of State, County & $ 500 00 Municipal Employees) Local #1724 4~27/2004 Local PAC #1724 $ 500.00 C PC 2. $ 3 $ 4. $ 5 $ See Page Total (Add all amounts for the Accounts Accounting Period Total (Complete only for last page and Instructions Recmvable Type Codes spec,fled Do not transfer these amounts to the Sun-n:nary Statement, PC 1 .) on Back and mclude PI or aggregate ) m Campaign Fmance Codes OR, PC, PL $ 500.00 Codes OR, PC, PL $ 500.00 Manual Enter on Summary Statemenk Column A. L~ne 38 PC 5 Supplement to Second Pre/Post-Election - Contributions Candidate or Pohhcal Conm~mee Name Comn~ttee ID Number Andrea Orbz for City Council N/A Page 1 of 1 Electron [] Prm~ary 20 04 [] Oeneral 20 [] Other Report [] 1st Suppl to the 2nd Pre-elect~on [] 2nd Suppl to the 2nd Pre-electron [] SuppI to Post-election SEE BACK FOR INSTRUCTIONS Arq) CODE DEFINITIONS CODE '1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Pohhcal Cormmttee (includes business and umon PACs) CO Cosigner Obhgahon F Candidate's lmmedmte Family Oncludes can&date) IK In-K~nd I In&v~dual LR Loan Received L Labor Orgamzatmn PC Pledge of Cash O Other PI Pledge of [n-Kind P Pohhcal Party Committee PL Pledge of Loan Amount of Line # Name and Address of Contributor Contribution In-t<ind Purpose Occupational Information or Code ~ I Code 2 (see manual ~or suggested purpose codes) Date Received Contributing Committee's tD# Oregon AFSCME, Local #1724 - Political I (American Federabon of State, County & $ 500 00 Municipal Employees) 5/412004 Local PAC #1724 C CA 2. $ 3 $ 4 $ 5 $ See FOR OFFICE USE ONLY Instructions I, Tamara M,iler , (name of cand,date or RECEIVED on Back and .trza~t~mz.~ereby certify that the above statement is true and correct m Campmgn F~nance Mantel , CiTY RECORDER PC 8A ~gnature of can&date or~easurer , Dar4 signed Pc Summary Statement of Contributions and Expenditures Please ~pe or print legibly m black n4: Page 1 of Can&date or Pohtmal Committee Name (use full name) Andrea Ortiz for City Council Mmhng Address as ,t Appears on Statement of Orgamzanon (street, route or box number, c~; state, z,p code) 189 Foch Street Eugene, OR 97402 %easurer's Name Telephone Number (day) Tamara Mdler (541) 521-5855 Conumttee ID Ntm~ber I Committee Type, Measure Number or Ofhce' N/A [ Eugene City Council, Ward 7 [] Original [] Pr,mary 20 04 [] G enend 20 [] Other [] Amendment [] 1st Pre-elccnon [] 2nd Pre-elect,on [] Post-elecnon [] 20 September Supplememal X-TOTALS I?OR 'rills B-CUMUL^TIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS i Cash Contributions 1,185.00 8,395.99 (Accounting Period Total 1rom PC 2) 2 Loans Recmved (Non-Exempt) + 200 00 + 945.00 (Accounting Period Total trom PC 23 3. Total Cash Contributions = 1,385.00 = 9,340 99 (hnes 1+ 2) 4 In-Kind + 53 99 + 780.02 (Accounnng Period Total fi'om PC 2) 5 TOTAL CONTRIBUTIONS = 1,438 99 = 10,121 01 (hnes 3 + 4/ EXPENBffURES 6 Cash Expenditures 2,744.42 8,424.15 (Accounting Period Total from PC 3) 7 Loan Payments (Non-Exempt) + 200.00 + 200.00 (Accounhng Period Total lycra PC 3) 8 Total Cash Expen&tures = 2,944 42 = 8,624.15 (hne~ 6 + 7) 9 lin-Kind + 53.99 + 780.02 (Accounting Period Total from PC 2) 10 TOTAL EXPENDITURES = 2,998.41 = 9,404 17 (hnes 8 + 9) CASH BALANCE 11 Beginning Cash Balance 2,276.28 F (hne 20 ot'pre,,ous repo, t) 12 Total Contribut,ons + 1,438 99 (hne 5) ~ ,~. 13 Other Receipts + 90.01 (Accouimng Period Total from PC 4A) 14 Loans Received (Exempt) + 0.00 CiW (Accommng Period Total from PC 4A) 15 CONTRIBUTION SUBTOTAL = 3,80528 (lines 11 ~- 12 * 13 -~- i4) 16 TotalExpen&turcs 2,998.41 (hn~ 10) 17 Other Disbursements + 0.00 (Accounting Period Total from PC 4B) 18 Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) 19 EXPENDITURE SUBTOTAL = 2,998.41 (hnes 16 -: 17 * 18) 20 ENDING CASH BALANCE = 806.87 (hne 15 minus hne 19) pc 1 Summary Statement of Contributions and Expenditures ,:/03 Please b'pe or print legibly ,n black i~24 Page 2 of 2 Can&date or Potmcal Committee Name Co,rLrmttee ID Number Andrea Orbz for C~ty Council N/A ~ Ong,nal [ ~Pnmary 2004 [] General 20 [] Other [] Amendment LJ 1st Pre-elect,on [] 2nd Pre-elect,on ~ Post-elect,on [] 20__ September Supplemental LOAN SUMMARY 21 Begznnmg Outstanding Loans FOR OFFICE USE ONLY (hne 29 o£ previous report) 745 00 22 Loans Received (Non-Exemp0 (hne 2) + 200,00 23 Loans Recmved (Exempt) (line 141 + 0.00 24 LOANS RECEIVED SUBTOTAL (lines 21 + 22 + 23) = 945.00 25 Loan Payments (Non-Exempt) (line 7) 200 00 26 Loan Payments (Exempt) (hne 18) + 0.00 27 Forgiven Loans (Total loans tbrgl~ en during this acconnt~ng period) + 0.00 28 LOAN PAYMENT SUBTOTAL = 200 00 (hnes 25 + 26 +27) 29 TOTAL OUTSTANDING LOANS = 745.00 (line 24 minus line 28) PERSONAL EXPENDITURE SUMfvIARY 30 Beginning Outstan&ng Personal Expen&tures 0 00 (hne 36 of prewous report) 31 PersonalExpen&mres + 0.00 (Accounting Period Total from PC 3A) 32 PERSONAL EXPENDITURE SUBTOTAi~ = 0.00 (lines 30 + 31) 33 PersonalExpen&ture Rmmbmsements (Total expenditures on PC 3 wdh purpose code R) 0.00 34 Forgn'en Personal Expert&rares + 0.00 (Total personal expen&tures tbrg~ven this acctg period) 35 REIMBURSEMENT SUBTOTAL = 0.00 (hnes 33 + 34) 36 OlYlPSTANDING PERSONAL EXPENq)ITURES = 0.00 (line 32 nunus line 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 Endmg Cash Balance (line 20) 806 87 38 Accounts Recmvable + 0.00 (Accounting Period Total from PC 5) 39 SUBTOTAL = 806.87 (hnes 37 + 38) 40 Total Outstandmg Loans (line 29) 745.00 41 Omstan&ng Personal Expend,rares + 0 00 dine 36) 42 Accounts Payable + 0.00 (Accounting Period Total from PC 6) 43 SUBTOTAL = 745.00 (hnes 40 +41 +42) 44 BALANCE/DEFICIT = 61 87 (hne 39 m~nus hne 43 ~n&cate + or - balance) I, Tamara Miller (name of can&dateflr t~easurer)~¢hereby cernfy that thc abex e statement and the attached suppomng reports are true and correct ............. ~' Szgnature of c~&date or treasurer Date szgned PC 2 Cash Contributions, Loans Received and in-Kind Can&date or Poht,cal Comrmttee Name Cmrkrmttec ID Ntkmber Andrea Ort~zfor Qty Council N/A Page 1, of 2 Elect,on' ~ Prunao 2(UF'{~ [] General 20 [] Other Report LJ t st Pre-elect, on [] 2nd P,e-elect,on [] Pt~st-elect,on [] 20. September Supplemental SEE BACK FOR iNSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entl~~ CA Cash C Pohtmal Con-umttee (includes business and union PACs) CO Cosigner Obhgat~on F Candidate's Inm~cdxate Famdv (includes can&dare) IK In-Kind i IndB',dual LR Loan Received L Labor ©rgamzation © Other P Polmcal Parb~ Committee Amount of ln4(~nd Purpose Line # Name and Address of Contnbutor Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contubutor Code ~ Code 2 Contributing Committee's ID# Aggregate Oregon AFSCME, Local #1724 - Political 1 (American Federation of State, County & $ 500,00 Municipal Employees) 5~4~2004 Local PAC #1724 $ 500,00 C CA John V, AIIcott 2 2650 Cresta De Ruta $ 250,00 Eugene, OR 97403 5/6/2004 Physician $ 350,00 I CA Martin Jones 3. 2300 Parkside Lane $ 100.00 Eugene, OR 97403 51612004 Physician $ 100 00 I CA Thomas Pugh 4 3295 Inspiration Point Drive $ 75 00 Eugene, OR 97405 5tl 112004 Physical Therapist $ 75 00 I CA Carol Van Houten 5 768 West 10th Avenue $ 100 00 Eugene, OR 97402 5113~2004 Retired $ 175 00 I CA See Page Totals (Add all amounts xv,th the same Accounting Period Totals (Complete only for last page and Instructions contnbut,on tF.?e Do not include aggregates ) transfer these amounts to the Summary Statement. PC 1 ) on Back and ,n Campaign Cash (CA) $ 1,025 00 Cash (CA) $ Finance Enter on bummary %ttemcnL Column A L~ne l Manual In-K,nd (IK) $ 0 00 In-Kznd (IK) $ Enter on Summdr~ Statcmcnk Column A L~nco 4 and PC 2 Loans Received (LR) $ 0 00 Loans ReceB'ed (LR) $ Enter on Scunmary Statement, Column A, Line 2 PC 2 Cash Contributions, Loans Received and In-Kind ,e, t:,u Candidate or Political Conmmtce Name Cormmttee ID Number. Andrea Ortiz for City Council N/A Page 2 of 2 Eleonon ~ Primal' 20 ~, 4' [] General 20~ [] Other Report ~iJ 1st Pre-election [] 2nd Pre-election [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Busmess Entity CA Cash C Pohucal Cvnmmtee (includes business and umon PACs) CO Cosigner Obligation F Candidate's Immediate Family 0ncludes candlck~te) IK In-Kmd 1 Individual LR Loan Received L Labor Organization O Other P Political Party Con-Lrmttee Amount of ln~g~nd Purpose bne # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information or Contributor Code ? I Code 2 Date Received ContnbuOng Committee's ID# Aggregate Tamara Miller I 293 E. Anchor Avenue $ 49,00 Eugene, OR 97404 Attorney/Property Administrator $ 126.57 I I CA 5/13/2004 Tamara Miller 2 293 E Anchor Avenue $ 4 99 Eugene, OR 97404 5/20~2004 Attorney/Property Admmistrator $ 131 56 I CA Michael Carngan 3 1439 W. 4th Avenue $ 200.00 Eugene, OR 97402 Community Organizer $ 225.00 I I 5/12/2004 LR Miscellaneous Cash Contributions $50 and Under 4 $ 160,00 5/3/04 - 6/7/04 $ I CA 5 $ See Page Totals (Add all amounts xvlth the same Accounting Period Totals I.Cumplcte only for last page and Instructmns contribution type Do not include aggregates.) transfer these amounts to the Surmna~y StatemenL PC 1 on Back and 160.00 1,185 00 in Campaign Cash (CA) $ Cash (CA) knter on Summary Statement. Column A. Line 1 Flnallce Manual In-Kmd (IK) $ 53.99 in-Kmd tlK) $ 53 99 Enter on Smnmary Statement Column A Lmes 4 and 9 PC 2 Loans Recetxed (LR) $ 200,00 Loans Received tLR} $ 200,00 Enter on Summary Statement, Coluran .\, Line 2 PC Cash Expenditures and Loan Payments Can&date or Polmcal Commmee Name' Cormxmtce ID Nmnber' Andrea Ortiz for City Council N/A Page 1 of 1 Election: ~, Prnnary 20~ [] General 20 [] Other Report: L_J 1st Pre-elecuon [] 2nd Pre-elecnon [] Post-electron [] 20 .....September Supplemental PURPOSE CODES (see back offi~rm for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advernsmg (yard signs, buttons, etc ) CA Cash B Broadcast Advertising (Radio, I'V) P Postage LP Loan Payment C Cash Comnbuuons R Re/mbursement for Persoral Expen&tures F Ftmdralsing Event Expenses S Surveys and Polls G General Operational Expenses (describe if over $50) T 1ravel Expenses (describe ~f over $50) I Interest Payment U Utihties L Literature, Brochures, Printing W Wages, Salaries, Benefits M Management Services Y Petmon Circulators N Newspaper and Other Periodical Advertising Z iS:eparanon m~d Production of Adverusmg Payee's Name and Payee's Committee ID#, Exp. Amount of b'ne # Date Check # if apphcable Purpose Type Expenditure Pa~d (as it appears on invoice, rec6~pt or check) to P 1. 51412004 1016 Accessible Data Services CA $ 798.84 5~5~2004 1017 Peace Rose Graphics L 2. CA $ 350 00 5/10/2004 1018 Eugene Weekly N 3 CA $ 359 00 E~] P 5/10/2004 1019 Accessible Data Services CA E~] 4. $ 895.43 5/10/2004 1020 Peace Rose Graphics L 5 CA $ 187 00 5/10/2004 1021 Lane Events Center G 6, (table for Election Central) CA $ 100 00 5/21/2004 1022 Michael Carngan P 7 LP $ 2O0 00 5/28~2004 Debit Pacific Cascade Federal Credit Union G 8. CA $ 4 00 O 6/612004 1023 Michael Carrigan (expense reimbursement CA E~ 9. for T-shirts, postage, Lane Co. Elections) $ 50 15 10. $ See Page Totals (Add all expendm~res with the same Accounting Period Totals (Complete only for last page and Instructions expenditure type.) transfer these amounts to the Summary Statement, PC 1 ) on Back and m Campaign Cash (CA) $ 2,744 42 Cash (CA) $ 2,744 42 Finance Enter on Summ=r5 Staterncnt, Colurrm A, Linc Manual Loan Payment (LP) $ 200 00 Loan Payment (LP) S 200 00 Enter on Smmmary Statement, Cohmm A [ mc 7 PC 3 pi' 4A Other Receipts ,:,¢ Candidate or Pohtzcal Comnnttce Name Comtmttee ID Number Andrea Ort~z for Qty Councd N/A Page q of q Elect~on ~ Pr~aqv 20 04 ~ General 20 ~ Other Report ~ 1st Pre-electron ~ 2nd Pre-clect~on ~ Post-elect~on ~ 20 September Supplemental SEE BACK FOR INSTRUCTIONS A~ CODE DEFINITIONS Other Receipt Transaction Type Codes EL Exempt Loan Proceeds FM Items Sold at Fmr Market Value [nteresfflnvestment income OM M~scell~eous (provide a description) Refunds, Rebates and Returns Date Name Other Receipt bne # Recewed (required for codes EL, OM and RF, Transactzon Type Other Receipt Amount optional for codes FM and IN) Code 5/1012004 R~ver Road Parks & Recreation RF 1 $ 90 00 5/28/2004 Pacific Cascade Federal Credit Union IN 2 $ 0 01 $ $ 5 $ $ 7 $ 8 $ 9 $ lO $ See Page Totals (Add all Other Receipt Transaction Accounting Period TotaLs (Complete onl.~ for last page and ~nsrructions Type Codes specified ) transfer these amounts to thc Surmma~' Statement. PC 1 ) on Back and ~n Campaign Codes FM. iN, OM, RI;' $ 90 01 Codes FM, IN, OM, RF $ 90 01 Finance Enter on Summdry Statement Loltm~nA Linc I3 Manual Code EL $ 0 00 Code EL $ 0 00 Enter on Summary Statement, Column A Linc 14 PC 4A Pc Summary Statement of Contributions and Expenditures Please type or pnnt lcg,bly in black ink Page i of 2 Cand,date or Polmcal Commxttee Name (use full name) Andrea Ort~z for City Council Marling Address as ~t Appears on Statement of Organization (street. route or box number, c~ty, state, zip code) 189 Foch Street Eugene, OR 97404 Treasurer's Name Telephone Number (day) Tamara Mdler (541) 521-5855 Cornm~ttee ID Number I Committee Type. Meastrre Nmnber or Office N/A [ Eugene City Council, Ward 7 [] Original ~ Pr,mary 2(I 04 [] General 20 [] Other [] Amendment [] 1st Pre-election [] :nd Pre-electron [] Post-election [] 20__ September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRiBUTiONS 1 Cash Contributions (Accounting Period Total from PC 2) 4,510.99 7,210 99 2 Loans Recmved (Non-Exempt) (Accounting Period Total trom PC 2) + 745.00 + 745.00 3 Total Cash Contnbutmns (hnes 1+ 2) = 5,255.99 = 7,955 99 4. In-Kind (Accounting Period Total from PC 2) + 271.13 + 726.03 5 TOTAL CONTRIBUTIONS (lines 3 + 4) = 5,527 12 = 8,682.02 EXPENDITURES 6. Cash Expenditures (Accounting Period Total from PC 3) 6,108.98 6,400.73 7 Loan Payments (Non-Exempt) (Accounting Penod Total from PC 3) + 0 00 + 0.00 8 Total Cash Expen&tures (hnes 6 + 7) = 6,108 98 = 6,400 73 9 In-Kind (Accounting Period Total t¥om PC 2) + 271.1 3 + 726.03 10 TOTAL EXPENDITURES (hnes 8 + 9) = 6,380.11 = 7,126.76 CASH BALANCE 11 Beglnmng Cash Balance (hne 20 ofpre~ious report) 2,408.26 FOR OFFICE USE ONLY 12 Total Contnbutmns (line 5) + 5,527 12 13. Other Recmpts (Accounting Period Total from PC 4A) + 0.01 14. Loans Received (Exempt) (Accounting Period Total from PC aA) + 0.00 ~..~.~ ~ *~,:,~, 15. CONTRIBLFFION SUBTOTA% (hnes 11 + 12 + 13 + 14) = 7,935.39 16 Total Expenditures .~ ";=~ ; : (line 10) 6,380.11 17 Other Disbursements ~,, (Accountlna Period Total flora PC 4B) + 0.00 i t., ,~. ~ 18 Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) 19 EXPENDITURE SL~TOTAL (lines 16 + 17 + 18) = 6,380.11 20 ENDING CASH BALANCE (tine 15 minus line 19) = 1,555 28 PC 1 Summary Statement of Contributions and Expenditures ,:J03 Please type or print legibly in black ink Page 2 of 2 Candidate or Polmcal Committee Name I Committee ID Number Andrea Ortiz for City Council [ N/A D O lgma } Prim<,, 20 D 20 [] Other J~Amendment{ bJ let Pre-elecaon ~1 2nd Pre-elect~on [] Post-election [~ 20 September Supplemental LOAN SUMMARY FOR OFFICE USE ONLY 21 Beginning Outstan&ng Loans (line 29 of previous report) 0.00 22 Loans Received kNon-Exempt) (hne 2) + 745.00 23 Loans Received (Exempt) (line 14) + 0.00 24. LOANS RE~CEIVED SUBTOTAL (lines 21 + 22 + 23) = 745.00 25. Loan Payments (Non-Exempt) (line 7) 0.00 26 Loan Payments (Exempt) (tine 18) + 0.00 27 Forgiven Loans (Total loans forgiven during this accounting period) + 0 00 28 LOAN PAYMENT SUBTOTAL (lines 25 +26 +275 = 0 00 29 TOTAL OUTSTANDING LOANS (line 24 minus hne 28) = 745.00 PERSONAL EXPENDITURE SU[VlMARY 30. Beginning Outstanding Personal Expen&tures 879.00 (line 36 of previous report) 31 Personal Expen&tures + 0.00 (Accounting Period Total from PC 3A) 32 PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) = 879.00 33 Personal Expenditure Reimbursements (Total expenditures on PC 3 with purpose code R) 879.00 34 Forgiven Personal Expenditures + 0.00 (Total personal expenditures forgiven this acctg period) 35 REIMBURSEMENT SUBTOTAL = 879.00 (lines 33 + 34) 36 OUTSTANDkNGPERSONAL EXPENDFFURES (line 32 minus line 35) = 0.00 FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 Ending Cash Balance (line 20) '1,555 28 38 Accounts Receivable + 500.00 (Accounting Period Total from PC 5~ 39 SUBTOTAL = 2,055.28 (lines 37 + 38) 40 Total Outstanding Loans (hne 29) 745 00 41 Outstanding Personal Expenditures + 0.00 (line 36) 42. Accounts Payable + 0.00 (Accounting Period Total from PC 6) 43 SUBTOTAL = 745.00 (lines 40 ~- 41 + 42) 44 BALANCE/DEFICIT = 1,310.28 (line 39 minus line 43 indicate -1- or - balance) ~* 4~-- . V'* ~ ~f.~ ~ '~i!~- !~ - ~, ~ (name of candidate o~ ....... tma.s~Eer), hereby cerhfy th,it the above statement and the attached supporting reports are true and correct of candidate o(t~ie_as~gr- Date Signature signed PC Summary Statement of Contributions and Expenditures Please t.¥pe or print leg~bty m black mk Page i or' 2 Candidate or Political Comnnttee Name (use full name) Andrea Orbz for City Council Mailing Address as tt Appears on Statement of OrgamzaUon (street, route or box number, c~, state, mp code) 189 Foch Street Eugene, OR 97402 Treasurer's Name Telephone Number (day)' Tamara Miller (541) 521-5855 Corrm~t~ee iD Number Committee Type, Measure Nmnber or Office N/A Eugene C~ty Council, Ward 7 [] Ongmal ~ Prnnmy 20 04 [] General 20 E] Other [] )2-nendment [] 1st Pre-elecnon [] 2nd Pre-election [] Post-elecuon [] 20 September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions (Accounting Period Total froin PC 2) 1,185 00 8,395.99 2 Loans Received (Non-Exempt) (Accounting Period Total from PC 2) + 200.00 + 945.00 3. Total Cash Contnbutzons (lines 1+ 2) = 1,385.00 = 9,340.99 4 In-K~nd + 115.82 + 841~85 (Accounting Period Total from PC 2) 5 TOTAL CONTRIBUTIONS (hnes 3 + 4) = 1,500.82 = 10,182.84 EXPENDITURES 6 Cash Expenditures (Accounting Period Total from PC 3) 2,744.42 8,424.15 7. Loan Payments (Non-Exempt) (Accommng Period Total from PC 3) + 200.00 + 200.00 8 Total Cash Expen&tures (hncs o ~- 7) = 2,944.42 = 8,624.15 9 In-Lhnd + 115.82 + 841.85 (Accounting Period Total from PC 2) 10 TOTAL EXPENDITURES (lines 8 ~ 9) = 3,060.24 = 9,466.00 CASH BALANCE 11 Begumlng Cash Balance (line 20 of previous report) 2,276.28 FOR OFFICE USE ONLY 12 Total Comnbutmns (line 5) + 1,500 82 13 Other Recmpts (Accommng Period Total from PC 4A) + 90 01 14. Loans Received (Exempt) (Accounting Period Total from PC 4A) + 0.00 15 CONTRIBUTION SLrBTOTAL = 3,867.11 (hnes ti + 12 + 13 + 14) 16 Total Expen&mres (hne I0) 3,060.24 RECE!Vc.¢ 17. Other Dtsbursements (Accounting Period Total trom PC 4B) ~ ;~)~ ~ ~, ~ ~ 18 Loan Payments (Exempt) + 0 00 (Accounting Period Total from PC 4B) 19 EXPENDITURE SUBTOTAL U,T' (lines 16 + 17 + 18) = 3,060.24 20 ENDING CASH BALANCE = 806.87 (line 15 minus line 19) Summary Statement of Contributions and Expenditures Please type or prim leg,bly m black mk Page 2 of 2 Candidate or PohUcal Corm:mt,ce Name I C°rm~mttee ID Number Andrea Orbz for C~ty Councd I N/A E~ Original [] Pr,mary 20 04 [] General 20~ [] Other []Amendment [] 1st Pre-elechon [] 2nd Pre-elechon ]~ Post-elect,on [] 20__ September Supplemental LOAN SUMr~IARY 21 Begmmng Outstan&ng Loans FOR OFFICE USE ONLY (hne 29 ofprevmus report) 745.00 22 Loans Recmved (Non-Exempt) (line 2) + 200.00 23 Loans Recmved (Exempt) (hne 14) + 0.00 24 LOANS RECEIVED SUBTOTAL (hnes 21 + 22 + 23) = 948.00 25 Loan Payments (NomExempt) (hne 7) 200.00 26. Loan Payments (ExempU (line 18) + 0.00 27 Forg,ven Loans (Total loans forgtven dunng fins accounnng period) + 28 LOAN PAYMENT SUBTOTAL (hnes 25 + 26 +27) = 200.00 29 TOTAL OUTSTANDING LOANS (hne 24 minus hne 28) = 745.00 PERSONAL EXPENDITURE SUmmARY 30 Beg~nmng Outstan&ng Personal Expen&tt~e~ (hne 36 of prevmus report) 0.00 31 Personal Expen&tures (Accommng Period Total from PC 3A) + 0 00 32 PERSONAL EXPENDITURE SUBTOTAL (hnes 30 +31) = 0 00 33 Personal Expen&ture Rmmbursements (Total expen&tures on PC 3 w~th purpose code R) 0.00 34 Forg,ven Personal Expen&tures (Total personal expendttures forgiven th~s acctg period) + 0.00 35 RJClMBURSEMENT SUBTOTAL (lines 33 + 34) = 0 00 36 OVrSTAND~'G PERSON.4A, EXPENDITURES (hne 32 m~nus hne 35) = 0.00 FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD ST En&ng Cash Balance (hne 20) 806 87 38 Accounts Recmvable + 0.00 (Accounting Period Total from PC 5) 39. SUBTOTAL (hnes 37 + 38) = 806.87 40 Total Outstan&ng Loans (hne 29) 745 00 41 Outstan&ng Personal Expen&mres (hne 36) + 0.00 42 Accounts Payable + (Accounting Period Total from PC 6) 43 SUBTOTAL (hnes 40 + 41 ,- 42) = 745.00 44 BALANCE/DEFICIT = 61.87 (hne 39 m~nus hne 43 re&cate + or - balm~c¢ I, ', ; t,b' ', ~¢{'~& 'U ,' t.[% ~/'* (name of cand,date or treasurer/, herebv cerhfy that the above statement and the attached supporting reports are true and correct Szgnature of can&date 9rtreasurer Date szgned ' I'~C 2 Amendment Amendments-Cash Contributions, Loans Received and In-Kind Candidate or Pohucal Commztree Name Comrmttee ID Nurnber Andrea Ortiz for Qty Council NIA Page 1 of 1 Eleohon ~] Primary 20 04 [] General 20~ [] Other Report [] 1st Pre-electzon [] 2nd Pre-elechon [] Post-elecuon [] 20 September Supplemental SEE BACK FOP, INSTI~JUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Enhty CA Cash C Pohhcal Cormrnttee (includes buszness and umon PACe) CO Cosigner Obhgahon F Candzdate's [mmedzate Family 0ncludes candzdate) iK In-Kznd I Indzvzdual LR Loan Recezved L Labor OrgamzaUon O Other P Pohheal Party Conwm~tee Amending Page Ct Name and Address of Contnbutor Amount of In-Kind Purpose and Line Ct Contnbutlon (see manual for suggested purpose codes) Occupational Information or Contnbutor Code 1' I Code 2 Date Received Contnbuting Commtttee's IDCt Aggregate Page 2 Line 1 Tamara Miller G (food for Election night) [] New Entry 293 E. Anchor Avenue $ 49~00 [] Correcting Eugene, OR 97404 [] Deleting ! 5/13/2004 Attorney/Property Administrator $ 126.57 I I IK Page 2 Line 2 Tamara Miller G (note cards) E] New Entry 293 E. Anchor Avenue $ 4.99 [] Correcting Eugene, OR 97404 [] Delebng 1 5/2O/2004 Attorney/Property Administrator $ 131 56 I I IK Page. Line Oregon League of Conservation Voters PAC S (telephone bank) [] New Entry 320 SW Stark #415 $ 61.83 [] Correcting Portland, OR 97204 [] Deleting 5/3/04 - 5/19/04 PAC ¢2352 $ 61.83 C Page_ Line [] New Entry $ [] Correchn9 [] Deleting Page L~ne~ [] New Entry $ [] Correcbn9 [] Deleting $ Instructions ,, .... Finance S~gnature of can&date or'treasurer ' ~: ~ ' ;' *: ~ ~ Manual Amendment Date szgned PC ~ Summary Statement of Contributions and Expenditures Please type or print legibly m black mk Page 1 of 2 Candidate or Polmcal Comrmttee Name (use fall name). Andrea Ortiz for City Council Marling Address as ~t Appears on Statement of Organization (street. route or box mumber, mty~ state, z~p code). 189 Foch Street Eugene, OR 97402 Treasurer's Name Telephone Numbe~ (da>,)~ Tamara Miller (541) 521-5855 Committee ID Number' I Committee Type, Measure Number or Oftlce NIA I Eugene City Councd, Ward 7 [] Orig, nal [] Primary' 20 04 [] General 20 E~ Other [] Amendment [] 1st Pre-elecnon [] 2nd Pre-election ~] Post-¢lectzon [] 20 September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions (Accounting Penod Total from PC 2) 1,310 00 8,520.99 2 Loans Recmved (Non-Exempt) + 200.00 + 945.00 (Accounting Period Total from PC 2) 3. Total Cash Contribuhons = 1,51 0 00 = 9,465.99 (hnes 1 + 2) 4. In-Kind + 115.82 + 841.85 (Accounting Period Total from PC 2) 5 TOTAL CONTRIBUTIONS = 1,625.82 = 10,307.84 (hnes 3 ~- 4) EXPEND)TURES 6. Cash Expen&tures 2,744.42 9,145.15 (Accounting Period Total t¥om PC 3) 7 Loan PaTyments (Non-Exempt) + 200.00 + 200.00 (Accounbng Period Total from PC 3) 8 Total Cash Expen&tures = 2,944 42 = 9,345.15 (hnes 6 + 7) 9. In-Kind + t15.82 + 841.85 [Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 3,060 24 = 10,187.00 (hnes 8 + 9) CASH BALANCE 11 Beginning Cash Balance 1,555.28 FOR OFFICE USE ONLY (hne 20 of prevmus report) 12 Total Contributions + 1,625.82 (hne 5) 13 OtherRecmpts + 90 01 (Accounting Pcnod Total from PC 4A) 14. Loans Recmved (.Exempt) + 0.00 b; {? ~" (Accounting Penod Total ~om PC 4A) ........ ' ' 15. CONTRIBUTION SUBTOTAL = 3,271.11 , ~ , (hnesll+12+13+14) '-~ i 16 Total Expen&mres 3,060.24 17 Other Dmbursements + 0.00 ;J ~ ~ ~' ' (Accounting Period Total from PC 4B) 18 Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) 19 EXPENDITURE SL~TOTAL = 3,060.24 (hnes 16 + 17 + 18) 20. ENDING CASH BALANCE = 210.87 (hne 15 m~nus line 19) PC Summary Statement of Contributions and Expenditures Please type or pnnt legibly in black mk Page 2 of 2 Can&date or Polmcal Corrmnttee Name Comnmtee ID Numbe~ Andrea Orbz for City Council NIA [] Original ~ Pr,mary 20 04 [] Oenera! 20 [] Other ~ Amendment [] 1st Pre-elect,on [] 2nd Pre-election ~ Post-election [] 20 September Supplemental LOAN SUMMARY 21 Beginning Outstanding Loans FOR OFFICE USE ONLY (line 29 of previous report) 745.00 22. Loans Rece,ved (Non-Exempt) (line 2) + 200.00 23. Loans Received (Exempt) (line 14) + 0.00 24 LOANS RECEIVED SUBTOTAL (lines 21 + 22 + 23) = 945 00 25 Loan Payments (.Non-Exempt) (line 7) 200.00 26 Loan Payments ~xempt) (line 18) + 0.00 27 Forg,ven Loans (Total loans forgiven during this accounting period) + 0.00 28 LOAN PAYMENT SUBTOTAL (lines 25 + 26 +27) = 200.00 29. TOTAL OUTSTANDING LOANS (line 24 minus hne 28) = 745.00 PERSONAL EXPENDITURE SUMMARY 30 Beg,nmng Outstan&ng Personal Expen&mres (line 36 of previous repoil) 0.00 31 Personal Expenditures (Accounting Period Total from PC 3A) + 0.00 32 PERSONAL EXPENDITLPfd~ SLFBTOTAL (lines 30 + 31) = 0.00 33. Personal Expen&ture Rmmbursements (.Total expenditures on PC 3 with purpose code R) 0.00 34 Forgiven Personal Expert&rares + 0.00 (Total personal expendCures forgiven this acctg, period) 35 RE[lvlBURSEMENT SUBTOTAL (lines 33 + 34) = 0.00 36. OUTSTANDING PERSONAL EXPENDITURES (,line 32 minus line 35) = 0.00 FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 En&ngCash Balance (line 20) 21 0 87 38 Accounts Recmvable (Accounting Penod Total ,rom PC 5) + 0.00 39 SUBTOTAL (lines 37 ~- 38) = 210.87 40. Total Outstan&ng Loans (line 29 ) 745.00 41 Outstan&ng Personal Expen&tures (hne 36) + 0.00 42 Accounts PavaNe (Accounting Period Total from PC 6) + 0.00 43 SUBTOTAL (lines 40 + 41 + 42) = 745.00 44 BALANCE/DEFICIT = -534.13 (.line 39 ncnnus line 43 in&cate -~ or - balance) l, Vi;;¢, ., .,, ~i, -¥,~,.~' ~'~ _ ,~.; ~ ~ ~ ~,.I ' ~* (name of candidate o? treas~r~)~ hereb-~ cemfy that the above statement and the attached supporfmg repons are true and correct S,gnature of' can&date 9f-tr'~asur-er Date s,~ned PC 2 A_mendment 1~, Amendments-Cash Contributions, Loans Received and In-Kind Candzdate or Pohtmal Committee Name Comrmtte¢ 1D Number Andrea Ortiz for City Council N/A Page 1 of Elechon [] Prnna~ 20 04 ~ Oen~nfl 20__ ~ OILer Report ~ 1st Pre-electron ~ 2nd Prc-elecnon ~ Post-elcct~on ~ 20~ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Ent~V5 CA Cash C Polmca~ Co~ttee {md-udes business and umon PACe) CO Cosigner ObhgaUon F Can&date's I~nedzatc Fa~uly (includes candzdate) IK in-Kind ~ [n&vzdual LR Loan Rec~n'ed L Labor OrgamzaUon O Oflxer P Polmcal Pa~ Co~mttee Amending Page ~ Name and Address of Contnbutor Amount of tn-Kind Purpose and Line ~ Contnb~on (see manual for suggested purpose codes) Date Received Occupattonal Informat/on or Contnbutor Code 1 [ Code 2 Contfibuffng Commiffee ' s ID~ Aggregate Page_,2 L~ne 4 Miscellaneous Cash Contnbufions $50 and Under ~ New Ent~, $ 285 00 ~ Correcting D Delebng 5/3/04 - 6/7/04 $ I CA Page~ hne ~ New Ent~ $ ~ Correcting ~ Deleting Page~ L~ne ~ New Ent~ ~ Correcbn9 ~ Delebn9 Page ~ New E~W $ ~ Correct,n9 ~ Deter,p9 $ Line ~ New EnW ~ CorrecbnO ~ Delerm9 Instruchons on Back ~d . ~..j~ .~ / ~'"- .... . m Campmgn ~ ~~~J4/ Finance Szgnaturc of can&date ~r~r~. ~ :' " k~nual 2 ?5- CITY RECORDER ~nendment Date szgned PC 3 Amcndmcm Amendments-Cash Expenditures and Loan Payments Candidate or Political Committee N:xne: Committee ID Nttmber Andrea Ortiz for City Council N/A Page 1 of 1 Election' [] Primary 20 04 [] General 20 [] Other Report. [] 1 st Pre-election [] 2nd Pre-election [] Past-electron [] 20 September Supplemental PURPOSE CODES (see back of form fl}r instructi~ms and code definitions) EXPENDITURE A Agent O Other Advemsmg (yard signs, buttons, etc.) CA (;ash B Broadcast Advertising (Radio. TV) P Postage LP Loan Payment C Cash Contributions R Re/mbursement for Personal Expendkures F Fundraising Event Expenses S Surveys and Polls G General Operational Expenses (describe if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Unlmes L Llterature, Brochures, Printing W Wages, Salaries, Benefits M Management Sermces Y Petition Circulators N Newspaper and Other Periodical Advert~slng Z Preparation and Production of Advemsmg Amending Page # Payee's Name and Payee's Commtltee tO#, Exp. Amount of [] and Dna # Check # ~f ap¢cabte Purpose Date (as ~t appears on invoice, receipt or check) Type Expenditure Paid to A/P Page--~l--- Line--6-- Serllor News N ~ New Entry 1008 [] Correcbng [] Deleting CA $ 174.00 4/24/2004 Page____ Line .... Peace Rose Graphics L [] New Entry N/A (Bill paid directly by Deborah Noble and [] Correcting reflected as a loan) [~ F-I Oelebng CA $ 745 00 4/22/2004 Page .... Ltne___ [] New Entry [] Correcting [] Deleting Page ...... [] New Entry [] Correcbng [] Deleting $ E~ Page ...... Line [] New Entry [] Correcting [] Deleting Instructions on Back and Finance Signat~e of candidate Manual ' C TY RECORDER PC 3 ~lell~ent Date s~gned PC Summary Statement of Contributions and Expenditures Please type or pnnt legibly in black znk Page 1 of 2 Can&date or PohtmaI Comrmttee Name (use full name) Andrea Ort~z for C~ty Councd Marling Address as ~t Appears on Statement of Orgamzatlon (street. route or box number, c~ty, state, z~p code) 189 Foch Street Eugene, OR 97402 Treasurer's Name I Telephone Number (da}') Tamara Miller [ (54 I) 521-5855 Con~rmttee ID Nttrnber I Committee Type. Measure Number or Office NtA I Eugene C~ty Councd, Ward 7 [] Grig, hal ~ Pr,mary. 20 [] General 2004 [~ Other [] Amendment [] 1st Pre-elecnon [] 2nd Pre-elect,on [] Post-elect~on [] 20__ September Supplemental A-TOTALS FOR THIS B-CUMULATiVE TOTALS ACCOUNTING PERIOD FOR TH~S EL£CTION CONTRIBUTIONS 1 Cash Contnbutmns (Accounting Period Total from PC 2) 520 00 520.00 2. Loans R~cmved (.Non-Exempt) (Accounting Period Total from PC 2) + 0.00 + 0.00 3 Total Cash Contnbutmns (hnes I ~- 2) = 520.00 = 520.00 4 In-Kind + 0 00 + 0.00 (Accounttng Period Total from PC 2) 5 TOTAL CONTRIBUTIONS = 520 00 = 520.00 (hnes 3 4- 4) EXPENDITURES 6 Cash Expen&tures (Accommng Period Total from PC 3) 4.00 4.00 7. Loan Payments (Non-Exempt) (Accounting Period Total fi'om PC 3) + 0.00 + 0.00 8 Total Cash Expen&tures (hnes 6 + 7) = 4.00 = 4.00 9. In-K~nd + 0.00 + 0.00 (Accommng Period Total l¥om PC 2) 10 TOTAL EXPENDITURES = 4.00 = 4 00 (hnes 8 ,- 9) CASH BALANCE t 1 Beg,nmng Cash Balance (hne 20 of pre~ous report) 210.87 FOR OFFICE USE ONLY 12. Total Contnbutzons (hne 5) + 520.00 13 Other Recmpts (Accounting Period Total from PC 4A') + 0 03 14. Loans Recmved (Exempt) (Accounting Period Total t'rom PC 4A} + 0.00 15 CONTRIBUTION SUBTOTAL RECEIVED (hnes 11 ,- 12 + 13 + 14) = 730.90 16 Total Expen&tures 4 00 (hne 10) .' *'~ ~. 17 Other Dzsbursements + 0.00 (Accounting Period Total from PC 4B) la Loan Payments (Exempt) OlTY RECORDER (Accommng Period Total from PC 4B) + 0 00 19 EXPENDITURE SUBTOTAL = 4 00 (lines 16 + 17 + 18) 20 ENDING CASH BALANCE = 726.90 (hne 15 mmus hne 19) PC Summary Statement of Contributions and Expenditures Please type or print legibly ~n black mk Page 2 of 2 Candidate or Pohtmal CmrLrmttee Name' ] Cormmttee ID NumbeL Andrea Ort~z for City Council I N/A [~ Original [] Primary 20 [~ General 20 04 [] Other []/5m*lendment [~ 1st Pre-~lectlon [] 2nd Pre-election [] Post-election [] 20__ September Supplemental LOAN SUMMARY 21 Beglnmng Outstanding Loans FOR OFFICE USE ONLY (hne 29 of previous report) 745 00 2Z Loans Recezved (Non-Exempt} (hne 2) + 0.00 23 Loans Recmved (Exempt) (hne 14) + 0,00 24 LOANS RECEIVED SUBTOTAl, (hnes 21 + 22 + 23) = 745.00 25 Loan Payments (Non-Exempt) (hne 7) 0.00 26 Loan Payments (Exempt) (hne 18) + 0,00 27 Forgzven Loans (Total loans forgzven during th~s accounting period) + 745.00 28, LOAN PAYMENT SUBTOTAL (hnes 25 + 26 +27) = 745.00 29 TOTAL OUTSTANDING LOANS (hne 24 minus linc 28) = 0.00 PERSONAL EXPENDITURE SUMMARY 30, Beg~nmng Outstanding Personal Expenditures (hne 36 of prewous report) 0.00 31 Personal Expenditures (Accounting Period Total from PC 3A) + 0.00 32 PERSONAL EXPENDITURE SUBTOTAL (hnes 30 + 31) = 0.00 33 Personal Expen&ture Rmmbursements (Total expen&mres on PC 3 xvzth purpose code R) 0.00 34 Forgzven Personal Expenditures (Total personal expen&mres forgiven thru acctg period) + 0.00 35 REIMBURSEMENT SUBTOIAL (hnes 33 ~ 34) = 0.00 36. OlYl;STANDING PERSONAL EXPENDITURES (hne 32 m~nus hne 35) = 0.00 FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 Ending Cash Balance (hne 20) 726.90 38 Accounts Recmvable + 0.00 (Accounting Period Total from PC 5) 39. SUBTOTAL (hnes 37 + 38) = 726 90 40 Total Outstanding Loans (hne 29) 0.00 41 Outstanding Personal Expenditures (hne 36) + 0 00 42 Accom~ts Payable (Accounting Period Total from PC 6) + 0.00 43 SLPBTOTAL (hnes JO -: 41 + 42) = 0.00 44, BALANCE/DEFICIT = 726.90 (hne 39 minus hne 43' ~n&cate ~ m - balance) I, {~(/i,A/~ {,)t~ ,~ ]~i '~ ~ ~ ( ~ (name of candlda(t~ or treasurer), hereby ceru~\~ that the above statement and the attached suppomng reports are true and correct Szgnature of can&date or treasurer Date sl~ned PC 2 Cash Contributions, Loans Received and In-Kind ,:,o3 Candidate or Pohtlcal Cormmttee Name Cormrnttec ID Number Andrea Ortizfor City Councd N/A Page 1 of 1 Election [] Prlmap¢ 20~ [] General 20 04 [] Other Report [] 1st Pie-election [] 2nd Pre-election [] Post-elecuon [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Busmess Entity CA Cash C Political Committee (includes business and union PACs) CO Cosigner Obhgahon F Candidate's Irrmtedmte Family (includes candidate) IK In-Kind I individual LR Loan Received L Labor Organization O Other P Political Part5' Committee Line # Name and Address of Contributor Amount of In-Kind Purpose Contributlon (see manual for suggested purpose codes) Date Received Occupational Information or Contributor Code ~ Code 2 Contributing Committee's ID# Aggregate Eugene Firefighters Fire PAC #60 1 2300 Oakmont Way, Suite #201 $ 500 00 Eugene, OR 97401 611112004 PAC #60 $ 500.00 C CA Miscellaneous Cash Contributions $50 and Under 2 $ 2O 00 6~8~04 - 9/16104 $ 2O 00 I CA 3 $ $ 5. $ $ See Page Totals (Add all amounts w~th the same Accounting Period Totals (Complete only for last page and Instructions contribution type Do not include aggregates ) transfer these amounts to the SurmzaaU~ Statement, PC 1 ) on Back and in Campaign Cash (CA) $ 520 00 Cash (CA) $ 520 00 Finance Enter on Summary Statement, Column A, Line ! Manual In-Kind (IK) $ 0,00 In-Kind (IK) $ 0 00 l:nter on Summary StatemenL Column A, Linc~ 4 and 9 PC 2 Loans Received (LR) $ 0 00 Loans Received (LR) $ 0,00 Enter on Stm~mary Statement, Colmnn A Line 2 PC Cash Expenditures and Loan Payments Candidate or Political Committee Name: Committee ID Number' Andrea Ortizfor Qty Council N/A Page. 1 of 1 Election [] Primary 20 ~] General 20 04 [] Other Report' [] 1 st Pre-election [] 2nd Pre-election [] Post-election [~] 20__ September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advertising (yard s~grm, burtons, etc.) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Rewnbursement for Personal Expenditures F Fundraislng Event Expenses S Surveys and Polls G General Operational Ex'penses (describe if over $50) T Travel Expenses (describe ~f over $50) I Interest Payment U Utflrtles L Literature, Brochures, Pnnting W Wages~ Salaries, Benefits M Management Services Y Petition C~rculators N Newspaper and Other Periodical Advertising Z Preparauon and Production of Advertmmg Payee's Name and Payee's Committee ID#, Exp. Amount of bne # Date Check # ff applicable Purpose Type Expenditure Pa~d (as it appears on invoice, receipt or check) to AlP 6/3012004 Deb~t Pacific Cascade Federal Credit Umon G 1, CA $ 4 00 E~ 3 $ 4. $ See Page Totals (Add all expenditures with the same Accounting Period T~tals (Complete only for last page and Instructions expenditure type.) transfer these amounts to thc Sunmlary Statement, PC 1 .) on Back and ~ Campaign Cash (CA) S 4.00 Cash (CA) $ 4 00 F~n~ce ~=t~ on Smranar5 StatemertL Cot~,n A, Lm~ 6 Mamml Loan Payment (LP) $ 0 00 Loan Payment (LP) $ 0.00 Enter on S~ux~ Statement, Coh~ A, Line 7 PC 3 PC 4A Other Receipts Can&&~te or Political Corrmmtee Name Committee ID Number Andrea Odiz for City Council N/A Page I of 1 Elechon ~ Primary 20_ ~ Genezal 20 04 ~ Other Report ~ 1st Pre-electron ~ 2nd Pre-elect,on ~ Post-electron ~ 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFI~TIONS Other Receipt Tr~sacfion Type Codes EL Exempt Loan Proceeds FM Items Sold at Fmr Market Value Interest~nvestment ~ncome OM ~scellaneous ~row& a descnprmn) Re~nds~ Rebates and Returns Date Name Other Receipt Line # Received (required for codes EL, OM and RF; Transaction Type Other Receipt Amount optional for codes FM and IN) Code 6/30/04 Pacific Cascade Federal Credit Union IN I $ 0.01 7/31/2004 Pacific Cascade Federal Credit Union IN 2 $ 0.01 8/31/2004 Pacific Cascade Federal Credit Union IN 3. $ 0 01 4 $ 5. $ 6 $ 7 $ 8 $ 9 $ 10. $ See Page Totals (Add all Other Recmp~ Transaction Accounting Period Totals (Complete only for last page and Instructions Type Codes specified ) transfer these amounts to the Sunmxarv Statement, PC 1 ) on Back and m Campa,gn Codes FM, ~N, OM, RF $ 0.03 Codes FM~ IN, OM~ RF $ 0.03 Finance Enter on Summary. Statement. C~,lumn A, Line 13 Manual Code EL $ 0 00 Code EL $ 0 00 Enter on Summary Statement Column A, Linc 14 PC 4A PC 1 Summary Statement of Contributions and Expenditures Please type or print legibly in black ink Page 1 of 2 Candidate or Polmc,d Conmnttee Name (use full name). Andrea Ortiz for City Council Marling Address as it Appears on Statement of Orgamzahon (street, route or box number, city, state, zip code) 189 Foch Street Eugene, OR 97402 Treasurer's Name' I Telephone Nmnber (day) Tamara MSer I (541) 521-5855 Committee II) Number' Committee Type, Measure 'Number or Office NIA Eugene C~ty Council, Ward 7 [] Original ~ Prmmry 20 [] General 2004 [] Other [] Amendment [] 1st Pre-election ~ 2nd Pre-election [] Post-elccuon [] 20 September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1 Cash Contributions 0 00 520.00 (Accounting Period Total from PC 2) 2 Loans Received (Non-Exempt3 + 0 00 + 0.00 (Accounting Period Total from PC 2) 3. Total Cash Contnbuhons = 0 00 = 520.00 (lines 1-~ 2) 4 In-Kind + 0.00 + 0.00 (Accounting Penod Total from PC 2) 5 TOTAL CONTRIBUTIONS = 0,00 = 520 00 (lines 3 + 4) EXPENDITURES 6. Cash Expenditures 2.00 6.00 (Accounting Period Total from PC 3) 7 Loan Payments (Non-Exempt) + 0,00 + 0 (Accounting Period Total from PC 3) 8 Total Cash Expenditures = 2 00 = 6.00 (hnes 6 + 7) 9, In-K~nd + 0.00 + 0.00 (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 2,00 = 6.00 dines 8 + 9) CASH BALANCE l L Beginning Cash Balance 726.90 FOR OFFICE USE ONLY (tine 20 of previous report) 12 Total Contributions + 0,00 (line 5) 13 OtherRecmpts + 0 01 (Accounting Period Total from PC 4A) 14. Loans Received (Exempt) + 0,00 (Accounting Period Total from PC 4A) 15 CONTRIBUTION SUBTOTAL : RECEIVED (lines 11 + 12+ 13 + 14) t6 Total Expenditures 2.00 ~,,~ ,~ ,.~ 17 Other Disbursements + 0 00 (Accoantmg Period Total from PC 4B'~ C~}'Y 18 Loan Payments (ExempO + 0.00 (Accounting Period Total trom PC 4B) 19 EXPENDITURE SUBTOTAL = 2 00 (lines 16 + 17 + 18) 20, ENDING CASH BALANCE = 724.91 (line 15 minus line 19) PC 1 Summary Statement of Contributions and Expenditures Please type or prmt tegzbly m black n4: Page 2 of 2 Can&date or Poht,cal Comm,ttec Name Cormmttee ID Number Andrea Ort~z for C~ty Council N/A Igl Or,gmal [] Pr,ma~, 20~ [] Oeneral 2004 [] Other_ [] Amendment [] 1st Pre-elect,on [~l 2nd Pre-elect,on [] Post-elect,on [] 20 September Supplemental LOAN SUMMARY 21 Begmmng Outstanding Loans FOR OFFICE USE ONLY (line 29 of' previous report) 0.00 22 Loans Recetved (Non-Exempt) (hne 2) + 0.00 23 Loans Recmved (Exempt) (hne 14) + 0 O0 24~ LOgANS RECEIVED SUBTOTAl.. (hnes 21 ,-22 + 23) = 0 00 25. Loan Payments (Non-Exempt) (hne 7) 0 00 26. Loan Payments (Exempt) (hne 18) + 0.00 27 Forgiven Loans + 0.00 (Total loans forgiven dunng th~s accounting period) 28 LOAN PAYMENT SUBTOTAL (hnes 25 + 26 +27) = 0.00 29 TOTAL OUTSTANDING LOANS (hne 24 m~nus hne 28) = 0.00 PERSONAL EXPENDITURE SUMMARY 30 Beginning Outstand,ng Personal Expen&tures (hne 36 ofprewous report) 0.00 31 Personal Expen&tures (Accounting Period Total from PC 3A) + 0.00 32 PERSONAL EXPENDITURE SUBTOTAL (hnes 30 + 31) = 0.00 33 Personal Expen&ture Rmmbursements (.Total expen&tares on PC 3 w~th purpose code R) 0.00 34 Forgiven Personal Expen&tures + 0.00 (Total personal expen&tures ~org~en th~s acctg period) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) = 0.00 36 OL~STM~DDIG PERSONAL EXPENT~ITURES (hne 32 nnnus hne 353 = 0.00 FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37 En&ng Cash Balance (hne 20) 724 91 38 Accounts Recmvable + 0.00 (Accounting Period Total from PC 5~ 39 SUBTOTAL (hnes 37 - 38') = 724 91 40 Total Outstan&ng Loans (hne 29) 0 00 41. Outstan&ng Personal Expend,tm es (hne 36') + 0.00 42 Accounts Payable (Accounting Period Total from PC 6) + 0.00 43 SUBTOTAL (hnes 40 + 41 + 42) = 0.00 44 BALANCE/DEFICIT = 724.91 (hne 39 minus hne 43' ~ndmate + or - baldnce) I. Tamara Miller (name of can&date o~treasurcr~/herebv certify that the above statement and the attached supporting reports are true and correct ............. · " .::- ....... ~O.'.~-~c~ / '--.' ........ i C.~ '~-~ i Signature of can&date or treasurer Date s,gned Cash Expenditures and Loan Payments Candidate or Politmal Contrmttee Nm-ne' Conm-nttee ID Number' Andrea Ortiz for Qty Councd N/A Page 1 of 1 ElecUon: [] Primary 20. [] General 20 04 [] Other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-elecuon ~ 20_ September Supplemental PIJRPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advertising (yard sLans, buttons, etc.) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Ren-nbnrsement for Personal Expendm~es F Fundraising Event Expenses S Surveys and Polls G General Operational E~enses (describe ffover $51)) T Travel Expenses (describe i1' over $50) I interest Payment U Utflmes L L~terature, Brochttres, Printing W Wages, Salaries, Benefits M Management Services Y Petition C~rculators N Newspaper and Other Periodical Advertising Z Preparation and Producnon of Advertising Payee's Name and Payee's Committee ID#, Exp, Amount of [] Line # Date Check # if applicable Purpose Type Expenditure Pa~d fas it appears on invoice, receipt or check) to AlP 9~27~2004 Debit Eugene Weekly G 1, CA $ 2 00 ~ 2, s 3 $ 4. $ 9, $ [~ 10, $ Se~ Page Totals (Add all expendit~u:es with the same Accounting Period Totals (Complete only for last page and Instructions expenditure l)~e.) transfer these amounts to the Summary Statement, PC 1.) on Back and m Campaign Cash (CA) $ 2 00 Cash (CA) $ 2 00 Finance Ent¢~ on Sdnar~ar5 $~a~ement, Coknzqn A, Line 6 Manual Loan Payment (LP) $ 0.00 Loan Payment (LP) $ 0 00 Enter oil SUIIIlIIdI~ Statement, Colurp, zx A, LtBc 7 PC 3 Pr2 4A Other Receipts kev Can&date or Pohtlcal Conxmttee Name Comrm[tce iD N~maber Andrea Or~iz for City Council N/A Page 1 of 1 Eteotmn E~ Prmxary 20 [] General 2() 04 [] Odxer Repm't [] I st Pre-e]ectzon [] 2nd Pre-electron [] Post-electzon [] 20 .... September Supplemental SEE BACK FOR INSTRUCTION'S AND CODE DEFINITIONS Other Receipt T ransactio~ Type Codes EL Exempt Loan Proceeds FM Items Sold at Fair Market Value Interest~nvestment income OM M~scellaneous (proxade a descnptmn) RF Refunds, Rebates and Returns Date Name Other Recett Uno # Received (required for codes EL, OM and RF; Transaction Type Other Receipt Amount o¢ional for codes FM and IN) Code 9~30/04 Pacific Cascade Federal Credit Union IN 1 $ 0,01 $ 3 $ 4 $ 5 $ 7 8 $ 9 $ 10 $ See Page Totals (Add all Other Receipt Transaction Accounting Period Totals (Complete only for last page and [nstructmns Type Codes spemfied ) transfer these amomats to the Summary Statement> PC 1 ) on Back and m Campmgn Codes FM~ IN, OM. RF $ 0.0~ Codes FM. IN, OM, Ri"' $ 0 0~ Finance Enter an Samma~ ~ta~emem, Co~cmm A. Line 13 Manual Code EL $ 0 00 Code EL $ 0 00 Enter on Summa~, Statcmeat, Column A Line t 4 PC 4A PC 1 Summary Statement of Contributions and Expenditures Rev Please type or print legibly in black ink. Page 1 of 2 Candidate or Political Committee Name (use full name): Andrea Ortlz for City Council Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code): 189 Foch Street Eugene, OR 97402 Treasurer's Name: Telephone Number (day): Tamara Mdler (541) 521-5855 Committee ID Number' I Committee Type, Measure Number or Office. N,A IEugene C~ty Council, Ward 7 [] Original [] Primary 20 [] General 2004 [] Other [] Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20 September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions 0.00 520.00 (Accounting Period Total from PC 2 2. Loans Received (Non-Exempt) + 0 00 + 0 00 (Accounting Period Total from PC 2) 3. Total Cash Contributions = 0.00 = 520.00 (lines 1+ 2) 4. In-Kind + 0.00 + 0.00 (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS = 0.00 = 520.00 (lines 3 + 4) EXPENDITURES 6. Cash Expenditures 407.00 413 00 (Accounting Period Total from PC 3) 7. Loan Payments (Non-Exempt) + 0.00 + 0.00 (Accounting Period Total from PC 3) 8. Total Cash Expenditures = 407.00 = 413.00 (lines 6 + 7) 9. In-Kind + 0.00 + 0.00 (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 407.00 = 413.00 (hnes 8 + 9) CASH BALANCE l l. Beginning Cash Balance 724.91 FOR OFFICE USE ONLY (line 20 of previous report) 12. Total Contributions + 0 00 (line 5) 13. Other Receipts + 0 01 (Accounting Period Total from PC 4A) 14. Loans Received (Exempt) + 0.00 (Accounting Period Total from PC 4A) 15. CONTRIBUTION SUBTOTAL = 724 92 (hnes 11 + 12 + 13 + 14) 16. Total Expenditures 407.00 (hne 10) RECEIVED 17. Other Disbursements + 0.00 (Accounting Period Total from PC 4B) DE~C 0 2004 18. Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) 19. EXPENDITURE SUBTOTAL CITY RECORDER (lines 16 + 17 + 18) = 407.00 20. ENDING CASH BALANCE = 317.92 (line 15 minus line 19) PC 1 Summary Statement of Contributions and Expenditures kev Please type or print legibly in black ink. Page 2 of 2 Candidate or Political Committee Name: I Committee ID Number: Andrea Ort~z for City Council I N/A [] Original I [] Primary 20 [] General 2004 [] Other [] AmendmentI []1st Pre-election [] 2nd Pre-election ~] Post-election [] 20 September Supplemental LOAN SUMMARY 21. Beginning Outstanding Loans FOR OFFICE USE ONLY (line 29 of previous report) 0.00 22. Loans Received (Non-Exempt) (hne 2) + 0.00 23. Loans Received (Exempt) (hne 14) + 0.00 24. LOANS RECEIVED SUBTOTAL = 0.00 (lines 21 + 22 + 23) 25. Loan Payments (Non-Exempt) (line 7) 0.00 26. Loan Payments (Exempt) (line 18) + 0.00 27. Forgiven Loans + 0.00 (Total loans forgiven during this accounting period) 28. LOAN PAYMENT SUBTOTAL (lines 25 + 26 +27) = 0.00 29. TOTAL OUTSTANDING LOANS = 0.00 (hne 24 minus hne 28) PERSONAL EXPENDITURE SUMMARY 30. Beginning Outstanding Personal Expenditures 0.00 (hne 36 of previous report) 31. Personal Expenditures + 0.00 (Accounting Period Total from PC 3A) 32. PERSONAL EXPENDITURE SUBTOTAL (lines 30 + 31) = 0.00 33. Personal Expenditure Reimbursements 0.00 (Total expenditures on PC 3 with purpose code R) 34. Forgiven Personal Expenditures + 0.00 (Total personal expenditures forgiven this acctg period) 35. REIMBURSEMENT SUBTOTAL (lines 33 + 34) = 0 00 36. OUTSTANDING PERSONAL EXPENDITURES = 0.00 (line 32 minus line 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37. Ending Cash Balance (line 20) 317.92 38. Accounts Receivable + 0 00 (Accounting Period Total from PC 5) 39. SUBTOTAL (lines 37 + 38) = 317 92 40. Total Outstanding Loans 0.00 (line 29) 41. Outstanding Personal Expenditures + 0.00 RECEIVED (line 36) 42. Accounts Payable (Accounting Period Total from PC 6) + 0.00 ~EC 0 ~ 2004 43. SUBTOTAL (lines 40 + 41 + 42) = 0.00 44. BALANCE/DEFICIT CITY R EC 0 R D ER = 317 92 (line 39 minus line 43: indicate + or - balance) I, ~'~(ff~- ~ (name of candidate asurer)cJnereby certify that the above statement and the attached supporting reports are true and correct ~--~-~-~' Signatur,~5t' candidate or treasurer Date PC 3 Cash Expenditures and Loan Payments Rev ,21o3 Candidate or Poht~cal Committee Name: Committee ID Number: Andrea Ortiz for City Council N/A Page 1 of 1 Election. [] Primary 20 [] General 20 04 [] Other Report: [] 1st Pre-elect~on [] 2nd Pre-election [] Post-election [] 20 September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Adveras]ng (yard signs, buttons, etc.) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Reimbursement for Personal Expenditures F Fundrals~ng Event Expenses S Surveys and Polls G General Operational Expenses (describe If over $50) T Travel Expenses (describe ~f over $50) I Interest Payment U Utilities L L~terature, Brochures, Pnntmg W Wages, Salaries, Benefits M Management Serwces Y Petition C~rculators N Newspaper and Other Periodical Advems]ng Z Preparation and Production of Advertls~ng Payee's Name and Payee's Committee IDg, [] Ltne# Date Check # tf applicable Purpose Exp Amount of (as it appears on tnvoice, receipt or check) Type Expenditure Paid to A/P 10/20/04 1024 Keep Hampton Our Commissioner C 1. CA $ 100 00 I--I 10/27/04 1025 Eugene Weekly N 2. CA $ 277.00 ~l 10/27/04 1026 Peace Rose Graphics L 3 CA $ 30 00 FI 4 I-I 5. $ 6. $ [-I 7. $ ~ 8 $ I-I I-I 10. $ O See Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and Instructions expenditure type.) transfer these amounts to the Summary Statement, PC 1.) on Back and in Campmgn Cash (CA) $ 407.00 Cash (CA) $ 407 00 Finance Enter on Summary Statement, Colunm A, L~ne 6 Manual Loan Payment (LP) $ 0 00 Loan Payment (LP) $ 0 00 Enter on Summary Statement, Column A, L~ne 7 PC 3 PC 4A Other Receipts Rev ,2 o3 Candidate or Political Committee Name. Committee ID Number Andrea Ortiz for C~ty Council N/A Page 1 of 1 Election: [] Primary 20__ [] General 20 04 [] Other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20 September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS Other Receipt Transaction Type Codes EL Exempt Loan Proceeds FM Items Sold at Fair Market Value IN Interest/Investment Income OM Miscellaneous (provide a description) RF Refunds, Rebates and Returns Date Name Other Receipt Line # Received (required for codes EL, OM and RF; Transaction Type Other Receipt Amount opttonal for codes FM and IN) Code 10/29/04 Pacific Cascade Federal Credit Umon IN 1 $ eel 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ 8 $ 9 $ 10 $ See Page Totals (Add all Other Receipt Transaction Accounting Period Totals (Complete only for last page and Instructions Type Codes specified.) transfer these amounts to the Summary Statement, PC 1 .) on Back and in Campaign Codes FM, IN, OM, RF $ 0 01 Codes FM, IN, OM, RF $ 0.01 Finance Enter on Summary Statement, Column A, Line 13 Manual Code EL $ 0 00 Code EL $ 0 00 Enter on Summary Statement, Column A, Line 14 PC 4A