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Please Wpe or print legibly in black ink Page I of 2
C~d~date or Political Comm~ee N~me (~;name~ %
M~l~ng Address as ~t Appe~s oa Smtemeat of Org~zafioa (s~et, route or box n-~ber, c~kv, sta~e, z~p code):
Tmas~fs Name: [ Tdephone~nmber (day):
Cormi~ee ID Nmber: ] Co~i~ee T~pe, Me,urn Number or Offloe:
riginal D Prima. 20 ~ General 20 P Z D Other
mendment ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election ~ 20 ~eptember Supplemental
A2[OTALS FOR THIS ~U~ATFVE TOTALS
ACCOUNT~G PE~O~ FOR THIS ELECTION
CONT~gUT~ONS
Cash Contributions
tAccmmting Period Total from PC 2}
2. Loans ReceNed (Non-Exempt) +
+
(Accounting Period Total from PC
3 Total Cash Contributions
0,00
thnes 1+ 2)
4. In-Kind +
+
(AccountNg Period Total from PC 2
5. TOTALdines 3 + 4}CONTRIBUTIONS = ~ 0.00 =
C~h Expendkures
Lkccouafing Period Total from PC 3)
7. Loan Payments (Non-Exempt) +
+
tAccount~g Period Total from PC 3~
8 TotaL(lines 6Cash* 7} Expendim res = ~ 0.00 =
9. In-Kind + ~ 0.00 +
(Accounting Period Total from PC 2~
10. TOTAL EXPENDITURES = ~ 0.00 =
dines 8 + 9)
CASH BALANC~
11. Beg~,ng Cash Balance
FOR
OF[lC[
HS[
O~kY
{l~e 20 of previous re~) .
12. Total Contributions + ~ 0.00
(l~e 5)
13. Other Receipts +
tAccounting Period Total kom PC 4A)
~4 Lo~s Received (Exempt) +
(Accounting Period Total kom PC 4A~
15. CONTRIBUTION SUBTOTAL =2q03 ~So.oo
(lines 11 + 12 + 13 + 14)
16. Total Expenditures
17. ~her D~sbursements +
(Accounting Period Total from PC 4B)
18. Loan Payments (Exempt') +
{Accounting Period Total from PC 4B)
{hnes l~+ 17+ 18)
20. ENDING CASH BALANCE =
{l~e 15 minus lh~e 19)
Please type or print legibly ~n black ~ Page 2 of 2
Candidate~~~or Political Co~r~i~ee~.~ ~e: ~~ ~~ [ Com~fi~ee ID N~ber:
~riginal 1 ~Pr,ma~ 20 ~ General 20 ~ ~ ~ Other
mendment ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election ~ 20 ~eptember Supplemental
LOAN
21. Begin(rig Outstanding Lo~s FOR OFFICE USE ONLY
(line 29 ofpre~ious repo~)
22. Lo~s Received (Non-Exempt)
dhe 2~ + ~ 0.00
23. Lo~s Received (Exempt)
(line t4~ + ~ 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)
(INe 18) + ~ 0.00
27. Forgiven Loans
{Total loa~ forgiven during this accountNg p~riod} +
28. LOAN PAYMENT SUBTOTAL
(lNes 25 + 26 +27)
29. TOT~ OUTSTANDING LOANS
(line 24 minus hne 28} = / 0.00
P~SONAL ~XPEND~T~E $~A~Y
30. Beginning Omst~ding Personal Expenditures
(line 36 ofpre~,~ous repo~)
3 L Personal Expenditures +
{AccoumNg Period Total ~om PC 3A}
32. PERSONAL EXPENDITURE SUBTOTAL
dines 30' 31) = ~ 0~00
33. Personal Expenditure Reimbursements
(Total expendkures on PC 3 ~ith pu~ose code R}
34. Forgiven Personal Ex~nditures +
(Total personal expenditures lbrgi~en this acctg, period)
35. ~[~URSE~NT SgBTOT~ = ~ 0.00
{lines 33 + 34)
36. OUTST~D~'G PERSON~
=
CNe 32 ~ns 1Ne 35)
RNANC~AL STAT~S AT CLOSE OF ACCO~NT}NG
37. dineEnding Cash Balance20)
38. Accounts Receivable
+
(Accounting Period Total Nora PC 5)
39. SUBTOTAL
(1Nes 37 + 38)
40 Total Outstanding Loans
(line 2%
41. Outstanding Personal Expenditures +
42. Accounts Payable +
(Accounting Period Total ~Oln PC 6)
(l~es 40 + 41 + 42) =
44. BALANCE/DEFICIT = 2% 5 ~$ 0.00
(hne 39 minus line 43' indicate + or - balance)
statement ~d the a~ched sup~i~ repo~s are true and co~ect.
8 ~lre c~d'd~,o trea~ Date signed
PCI
Please ~pe or print legibly ~ black ir&. Page [ of 2
C~didate or Political Cow~i~ee Nme (use ~1 n~ne):
MaiIing Address as it Appe~$ on S~temem of Org~ization (s~t, route or box number, ci~, st, re, zip code):
~reas~er's N~e: ~ Telephone N~ber (d~y):
Co~ffn~ee ID Number: ~ Commi~ee Type, Me~ure N~ber or O~ce:
~ Original ~ Primm* 20 ~Gener~ 20 ~ W ~ Other
~mendment ~ 1st Pre-el~tion D 2nd Pre-ekction ~ Post-elation ~ 20~eptember Supplemental
A-TOTALS ~OR THIS ~UMULAT~; TOTALS
ACCOUNTENG PE~OD FOR T~IS ELECTION
CO~TR~BHTIO~$
1~ C~h Contributions
{Accouath~g Period Total from PC 2}
2. Loans Received {Non-Exempt) + ~ +
{Accounting Period Total from PC
3. To~I Cash Con~ibutions
0.00
(lines 1+ 2}
4. In-Kind + ~ +
{AcconntNg Period Total ~om PC
5. TOT.~ll~es 3 ~ 4}CONT~BUTIONS = ~ 0.00 =
EXPE~D~T~gES
6. Cash Expenditures
{Acco~mfing Period Final f~sm PC 3~
7. Loan Payments ~Non-ExempO +
(Accounting Period Total ~om PC 3)
8. To~I Cash Expendi~es = /~ 0.00 =
{lines 6 + 7)
9. In-Kind +
0~00
+
{Accotmtkqg Period Total ~om PC
t0. TOTAL EXPENDITU~S
= ~ 0~00 =
{tin~s 8 + 9}
1 t. Begi~ing Cash Bal~ce
(line 20 of previous ~e[~n~ ~ ~~ ~ FOR OFFICE USE ONLY
12. Total Comribmions + ~ 0.00
[~ine 5)
13. Other Receipts +
{Accounting Period Total fi'om PC 4A}
14~ ko~s Received tExempt) +
(Account~g Period To~ ~om PC
15~ CONT~BUTION SUBTOTAL
16. Total Expenditures
{line
17. Other Disbursements +
{Accounting Period Total ~om P(
~Acconnt~g Peri,~ Total ~rn PC
19. EXPENDITL~ SUBTOTAL
= ~ 0.00
{lines 16+ 17' 18}
~line 15 mhms line 1%
PC 1
Please type or print legibly h~ black i~ Page 2 of 2
CaMidae or Polkical Commi~ee Name: ~ Cormmi~ee ID Number:
I
~ Original [ ~ Prima. 20 ~General 20 O <~' D Other
~Amendmenti ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election ~0,,¢~September Supplemental
kOg~ $~ARY
2J. ~¢~i~ Outst~dh~ Loa~s FOR OFFICE USE ONLY
(line 29 of previous repo~}
22. Loans Received (Non-Exempt}
23. Lo~s Received (Exempt)
24. LOANS ~CEIVED SUBTOTAL
(lines 21 + 22 + 23) = */' 0.00
25 Loan Payments tNon-Exempt)
(line 7) ~ 0.00
26. Loan Payments (Exempt)
(hne 18} + */ 0.00
27, Forgiven Loans
( Total 1o~ forgiven during ~is accounting period ~ +
28, LOAN PAYMENT SUBTOTAL
d~es 25 + 26 +27) = ~- 0,00
29. TOT~ OUTSTANDING LOANS = / 0,00
dine 24 minus line 28)
PERSO~AL EIPEN~iT~RE SUmmARY
30. Begi~fing Ontstanding Personal Expenditures
(line 36 ofpr¢~ ious repo~)
31, Personal Expenditures
(Accmmting Period Total ~om PC 3A) +
32. PERSON~ EXPENDIT~ SUBTOTAL
(lines 30 + 31) =
33. Personal Expenditure Reimbursements
(Total expenditures on PC 3 ~fl~ purpose code R)
34. Forgiven Personal Ex~nditures +
l Total pemonal expert&tares forgiven ~s acctg.
35. REIMB~SEN~NT SUBTOTAL
(l~es 33 + 34) = ~"~ 0.00
36. OUTST~7~G PERSON_~ E~ENDITU~S
dine 32 m~us line 35) = ~ 0.00
Fi~A~CIAL STATUS AT CLOSE OF ACCOUnTInG PERIO~
37. Ending Cash Balance
(line 20}
38. Accounts Receivable
(Accounting Period Total from PC 5 ) +
39. SUBTOTAL
(l~es 37 + 38) =
40. Total Outst~ding Loans
(hne 29;
41. Outstand~g Personal Expenditures
42. Accounts Payable
tAccouming Period Total ~om PC 6} +
43. SUBTOTAL
: ~- 0.00
(lines 40 + 41 + 42)
44. BALANCE/DEFICIT = ,'; ,L.~;., .,' :-i ]~- 0.00
(line 39 m~us line 43' indicate + or - bal~ce)
s~tement ~d the a~ached suppling repo~s ~e ~e ~d co~ect.
sBmure ofcand~te o~ t~rer Date stgn~d
PC 4A
Candidate or Political Committee Name: Committee ID Nmnber:
Elecnon: ~ Primary 20~ ~Oenera1200 ~ ~ Other
Repom ~ 1st Pre-election ~ 2nd Pre-election ~ Post-election ~ 20~~September Supplemental
SEE gACK FOR [NSTRUCTIONS AND CODE DEFINITIONS
Other Receipt Transaction Type Co~es
EL Exemp~ Loan Proceeds
F M Items Sold ~ Fair ~rke~ Valse
~ InteresV~nves~ent income
OM ~scell~eous (provMe a description)
~ Refunds~ Rebates and R~s
Na~ Other Receipt
Line # Date (required ~or codes EL, OM and RF; Transaction Type ~her R~pl Ar~unt
Re~ived
opfionat for ~des FM a~d IN)
?
2 ' ~ ' ' - '4
,t
~o !/ /" ~ ;,:,'; $
See Page Totals (Add all Other Receipt Transaciion AccemlCag Periea Totals (Complete only for l~t page
Instruaio~s Type Codes specifie&) tr~fer these amounts m ~e Su~n~ Statement PC 1. )
on Back and ~j (
in Campaign Codes FM~ IN~ OM, RF $ Codes FM~ ~ OM, ~ $
F~a~ce ~r on Surf St~mt, Col~m & Lm~ 13
Mmmal Code EL $ Code EL $
Er~t~ oa Sure--D, Stae~lL Cot~ A_ Line 14
PC 4A
PC 4K
Other Receipts
Candidate or Pohtical Commtttee Name: Commtttee ID Number:
r.., ~ ~ tx: ~2 :'~ ~,~ ~ ; ;' ~ ,'~ kf 4 ( '~ ~"~'~ ~ ~ .... Page ~ of ~-
Election: ~ Primaw 20 ~ General 20 ''~ ~- ~ Other
Report' ~ 1st Pre-elect~on ~ 2nd Pre-election ~ Post-elect~on ~.20 Septe~nber Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
Other Receipt Transaction type Codes ~ ~ ~ ~t m
EL Exempt Loan Proceeds ~- ~-~ ~ ~ ~ ~-'~
FM Items Sold at Fmr Market Value : ~:
IN Interest/Investment Income
OM Miscellaneous (provide a description) k~"~-~T¥: ~ ~(~ 1~5 ~ ~ (~ ~' '~ ' ~ ~ ~'~ ~
RF Re~nds, Rebates and Returns
Date Name Other Receipt
bne # Recewed (required for codes EL, OM and RF; Transaction Type Other Receipt Amount
optional for codes FM and IN) Code
3 $
4 $
5 $
$
7 $
8 $
9 $
10. $
See Page Totals (Add all Other Receipt Transaction Accounting Period Totals (Complete only for last page and
instructions Type Codes spectfied.) transfer these amounts to thc Summary Statement, PC
on Back and
in Campaign Codes FM, IN, OM, RF $ ~/; Codes FM, l%L OM, RF $ , '~i ?~
E~ter on Sunnnary Statement Column A Line 13
Finance
Manual Code EL $ Code EL
E~ter on Surmrtary Statement, Column A, Line 14
PC 4A