HomeMy WebLinkAboutMill Street Bridge Committee PC 1
Summary St, ment of Contributions an Expenditures
Please type or print legibly in black ink. Page 1 of 2
Candidate or Political Committee Name (use full name):
Malhng Address. as ~t Appears on Statement of Organization (street, route or box number, city, state, zip code):
Treasurer's Name' Telephone Number (day):
Committee ID Number: Committee T~e, Measure Number or Office'
~ Original [] Primary 20 [] General 20~ [] Other
[] Amendment [] 1st Pre-electron [] 2nd Pre-election [] Post-el¢ct~on ~, 20 O q September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
1. Cash Contributions 2.'/0. OO ~1,70 , O O
(Accounting Period Total from PC 2)
2 Loans Received (Non-Exempt) + -- O -- + ~
(Accounting Period Total from PC 2)
3. Total Cash Contributions = 2. ~' O, 190 = ~ "~ t9
(hnes 1+ 2)
4. In-Kmd + --- O '"' + '" 0
(AccounUng Period Total from PC 2)
5. TOTAL CONTRIBUTIONS = ,2.'7Oo OO = fi,~'~ 0 o OO
(hnes 3 + 4)
EXPENDITURES
6. Cash Expenditures / 8 ~/ o O O / ~q. OO
(Accounting Period Total from PC 3)
7 Loan Payments (Non-Exempt) + ~ 0 -- + ~ O --
(Accounting Period Total from PC 3)
8. Total Cash Expenditures = / ~ {/· O O = tr ~q?.
(hnes 6 + 7)
9 In-Kind + ~ O ~ + ~ O
(Accounting Period Total from PC 2)
10 TOTAL EXPENDITURES = / 8 9. O0 : /
(hnes 8 + 9)
CASH BALANCE
11 Beginning Cash Balance ~ · ~ ~ FOR OFFICE USE ONLY
(hne 20 of prewous report)
12. Total Contributions + ;k70, OO
(line 5)
13 Other Recmpts + ·
(Accounting Period Total from PC 4A)
14 Loans Received (Exempt) + -o - RECEIVED
(Accounting Period Total from PC 4A)
15 CONTRIBUTION SUBTOTAL = -77,2_3 SEP 1 0 2004
(lines 11 + 12 + 13 + 14)
16. Total Expenditures ] ~ C~ O O
(hne 10) ' CITY RECORDER
17. Other Disbursements + ~ O -
(Accountmg Period Total from PC 4B)
18. Loan Payments (Exempt) + -- O -
(Accounting Period Total from PC 4B)
19. EXPENDITURE SUBTOTAL = / ~ ~, O O
(lines 16 + 17 + 18)
20. ENDING CASH BALANCE : 8 9,23
(line 15 m~nus hne 19)
PC
Summary St. ement of Contributions ar, Expenditures Rev,2,03
Please type or print leg]Ny in black ink. Page 2 of 2
Candidate or Pohtlcal Committee Name: Committee ID Number:
]~Origmal [] Pr,mary 20 [] General 20 [] Other
[] Amendment [] 1 st Pre-elect~on [] 2nd Pre-elect~on [] Post-election [] 20 O~ September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans FOR OFFICE USE ONLY
(line 29 of previous report) -- O --
22. Loans Recmved (Non-Exempt)
(line 2) + ~ O --
23. Loans Recmved (Exempt)
(hne 14) + -
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23)
25. Loan Payments (Non-Exempt)
(line 7) --
26. Loan Payments (Exempt)
(hne 18) +
27 Forgiven Loans
(Total loans forgiven during this accounting period)
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginmng Outstanding Personal Expenditures
(line 36 of previous report) '" O --
31. Personal Expenditures
(Accounting Period Total from PC 3A) +
32 PERSONAL EXPENDITURE SUBTOTAL
(lines 30 + 31)
33. Personal Expenditure Reimbursements
(Total expenditures on PC 3 w~th purpose code R)
34 Forgiven Personal Expenditures
(Total personal expenditures forgiven this acctg period) + -"
35 REIMBURSEMENT SUBTOTAL
(lines 33 + 34)
36. OUTSTANDING PERSONAL
EXPENDITURES = --
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
37. Ending Cash Balance
(line 20)
38. Accounts Recmvable
(Accounting Period Total from PC 5) +
39. SUBTOTAL
(lines 37 + 38)
40. Total Outstan&ng Loans
(hne 29)
41. Outstanding Personal Expenditures + .~/5} _
(line 36) SEP 1 0 2004
42. Accounts Payable + '-- O
(Accounting Period Total from PC 6)
43. SUBTOTAL CITY RECORDER
(hnes 40 + 41 + 42) =
44. BALANCE/DEFICIT
(line 39 minus line 43 indicate + or - balance)
I, '~ oma $ Z e$"Per~ (name of candidate or treasurer), hereby cert,fy that the above
statement and the attached supporting reports are true and correct.
Signature of candidate or treasurer Date
PC 2
Cash Coh.cibutions, Loans Receivecl ..nd In-Kind Rev 12/03
Can&date or Political Committee Name: Committee 1D Number:
Election: ~ Pnmaw 20~ ~ General 20 ~ Other
Repom ~ 1 st Pre-election ~ 2nd Pre-election ~ Post-election ~ 20 O~ September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
CODE ~: Contributor Type CODE 2: Contribution Type
B Business Enti~ CA Cash
C Political Co~l~ee (includes business and union PACs) CO Cosigner Obligation
F Candidate's I~edlate Family (includes candidate) IK In-K~nd
I Individual LR Loan Received
L Labor Organization
O Other
P Political Pa~ Committee
Amount of In-K/nd Purpose
L/ne ~ Name and Address of Contributor
Contribution (see manual for suggested purpose codes)
Occupational Information or Contributor Code 1 I Code 2
Date Received Contributing Comm~ee's I~ Aggregate
0?/o,/o3 ~r;+e~ $ / Zo. oo ~ I
Eva. Li~le
4. $
5 $
See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and
Instructions contribution type. Do not ~nclude aggregates.) transfer these amounts to the Summary Statement, PC 1.)
onBackand Z. 70 O0 .2.70 O0
~n Campmgn Cash (CA) $ - Cash (CA) $ °
Finance Enter on Summary Statement, Column A, Line 1
Manual In-K~nd (IK) $ '"' 0 ~ In-Kind (IK) $ "- O --
Enter on Summary Statement. Column A. Lines 4 and 9
PC 2 Loans Received (LR) $ ~ 0 ~ Loans Received (LR) $ ~O ~
Enter on Summary Statement, Column A. Line 2
PC 3
Cas . Expenditures and Loan Payments Rev
Candidate or Political Committee Name: Committee ID Number'
'The Mil/ JcreeP gr;dse do,,, rn;-N-ee Page / of ~
Elect~on' ~ Prima~ 20 ~ General 20 ~ Other
Report: ~ I st Pre-elect~on ~ 2nd Pre-elect~on ~ Post-election ~ 20 O~ September Supplemental
PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES
A Agent O O~er Adve~sing (y~d Sl~S, bu~ons, etc.) CA Cash
B Broadcast Adve~s~ng (Radio, TV) P Postage LP Loan Payment
C Cash Contributions R Rmmb~sement for Personal Expend~es
F Fundrals~ng Event Expenses S Su~eys and Polls
G General ~era~onal Expenses (describe ~fover $50) T Travel Expenses (describe if over $50)
I Interest Payment U Utdities
L Literature, Brochures, Pnnt~ng W Wages, Salaries, Benefits
M Management Seduces Y Petition C~rculators
N Newspaper and Other Perlod~cal Adve~smg Z Preparation and Production of Adve~is~ng
Payee's Name and Payee's Commt~ee I~, Exp Amount of
Dne ~ Date Check ~ if apphcable Purpose Type Expenditure Pard
(as tt appears on invoice, recetpt or check) to NP
See Page Totals (Add all expenditures w~th the same Accounting Period Totals (Complete only for last page and
Instructions expenditure Wpe.) transfer these amounts to the Summa~ Statement, PC 1 .)
on Back and
m Campaign Cash (CA) $ / 3 ~ · O O Cash (CA) $
Enter on Summa~ Statement, Column A, Line 6
Finance
Manual Loan Payment (LP) $ ~ ~ -- Loan Payment (LP) $
Enter on Su~a~ Statement, Column A, Line 7
PC 3
PC 3
Cas,, Expenditures and Loan Payments ,2,03
Candidate or Political Committee Name: Committee ID Number.
Etecnon. ~ Pnmaw 20 ~ General 20 ~ Other
Repo~. ~ 1 st Pre-elecuon ~ 2nd Pre-elecnon ~ Post-election ~ 20 0 ~ September Supplemental
PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES
A Agent O O~er Advemsmg (y~d si~s, buaons, em) CA Cash
B Broadcast Adve~ising (Radio, TV) P Postage LP Loan Payment
C Cash Contributions R Re~mb~sement tbr Personal Expendi~es
F Fundrms~ng Event Expenses S Sumeys and Polls
G General ~eranonal Expenses (describe ~fover $50) T Travel Expenses (describe if over $50)
I Interest Payment U Utilities
L L~teramre, Brochures, Pnnnng W Wages, Salaries, Benefits
M Management Semices Y Pention C~rculators
N Newspaper and Other Periodical Advemang Z Preparation and Production of Advemang
Payee's Name and Payee's Commi~ee I~, ~
Exp Amount of
Line ~ Date Check ~ tf apphcable Purpose Type Expenditure Paid
(as tt appears on invoice, recetpt or check) to NP
4
8. $ [-]
9 $ ~]
10 $ [--]
See Page Totals (Add all expenditures with the same Accounting Period Totals (Complete only for last page and
InstrucUons expenditure type.) transfer these amounts to the Summary Statement, PC 1 .)
on Back and ~'4/o OO /
~n Campmgn Cash (CA) $ Cash (CA) $
Finance Enter on Summary Statement, Column A, L~ne 6
Manual Loan Payment (LP) $ -- O -- Loan Payment (LP) $ "- O "-
Enter on Summary Statement, Column A, Line 7
PC 3
PC 4A
Other Receipts ~ev 12/03
Candidate or Poht~cal Committee Name: Committee ID Number'
Election' [] Primary 20 [] General 20 [] Other
Report. [] 1 st Pre-election [] 2nd Pre-election [] Post-election ~' 20 O~/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 M~scellaneous (provide a description)
RF Refunds, Rebates and Returns
Date Name Other Recetpt
Ltne# Received (required for codes EL, OM and RF; Transactton Type Other Recetpt Amount
opttonal for codes FM and IN) Code
See Page Totals (Add all Other Receipt Transaction Accounting Period Totals (Complete only for last page and
Instructions Type Codes specffied.) transfer these amounts to the Summary Statement, PC 1.)
on Back and 2.3
in Campaign Codes FM, IN, OM, RF $ · Codes FM, IN, OM, RF $
Enter on Summary Statement~ Column A, L~ne 13
Finance
Manual Code EL $ "- O '" Code EL $
Enter on Summary Statement. Column A, Line 14
PC 4A
PC 4A
Other Receipts
Candidate or Pohtical Committee Name' Committee ID Number:
Election: [] Primary 20 [] General 20 [] Other
Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-election ,~ 20 0 g 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 Recetpt
Ltne# Received (requtred for codes EL, OM and RF; Transaction Type Other Receipt Amount
optional for codes FM and IN) Code
1 07//30/05f Il"/ $ .0.2..
2 0~/31/0~ .7.~,3,] $ ,0~.._
g--
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
InstrucUons Type Codes specified.) transfer these amounts to the Summary Statement, PC 1 .)
on Back and
in Campaign Codes FM, IN, OM, RF $ , O ~ Codes FM, IN, OM, RF $
Finance Enter on Summary Statement, Column A, Line l 3
Manual Code EL $ -- t~ ~ Code EL $
Enter on Summary Statement, Column A, Line 14
PC 4A
PC 7
Certificate oT Limited Contributions ano ,-'xpenditures
Candidate or Political Committee Name: Conumttee ID Number:
Treasurer's Name 0f different than candidate) Telephone Number'
Mailing Address as ~t Appears on Statement of Organization (street, route or box number, c~ty, state, zip code):
Office:
Opp s;ar?o gal/o'//V]eas tr¢ 2o- 8
Election' I [] Primary 20__ [~],General 20 O q [] Other
I, '~OI'YI~5 ~3~ (name ofcand,date or treasurer), hereby certlfyI expect nmther
the aggregate contributions recmved nor the aggregate expen&tures made by or on behalf of my can&dacy or committee for this
election to exceed $2,000 I understand that if the committee exceeds $2,000 tn total contributions or expenditures dunng the
electron, subsequent detailed reports must be filed
Signature of can&date or treasurer / Date signed
· Ifa candidate or political committee EXPECTS to neither receive a total of more than $2,000 nor spend a total of more than
$2,000 for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Committees may file this
certificate when they originally file their Statement of Organization or during the first pre-election reporting period. A committee
may not file this certificate for a second pre-election, post-election or any supplemental reporting period.
· A separate certificate must be filed for each election.
· Th~s form cannot be used by chef petitioners of an initiative, referendum or recall petition.
· When e~ther the total contributions or total expenditures for the election exceed $2,000, detailed contribution and expenditure
reports must be filed The first detailed report must be filed for the accounting period in which the committee exceeds $2,000 ~n
rather contributions or expenditures and must reflect all contributions and expenditures to date Refer to the Campaign Finance
Manual for further mformatmn
· Deadline dates for filing a Cemficate of Limited Contnbunons and Expenditures or detailed contribution and expenditure reports
MUST BE strictly observed. Under ORS 260.232, the Secretary of State may impose a mvd penalty against a candidate or
treasurer for filing a late or ~nsufficlent detailed contribution and expenditure report or Certificate of Limited Contributions and
Expenditures
FOR OFFICE USE ONLY
RECEIVED
SEP o 2004
CITY RECORDER