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Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page 1 of 2
Candidate or Political Committee Name (use full name):
Committee for a Better Eugene
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
345 Mill St., sro. 100, Eugene, OR 97401,
Treasurer's Name: [ Telephone Number (day):
Tim Bjomstad [ 687-1051
Committee ID Number: I Committee Type, Measure Number or Office:
I
Measure 20-88
[] 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 0.00
(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 = 0.00
(lines 1+ 2)
4. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS = 0.00 = 0.00
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 0.00 0.00
(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 = 0.00 = 0.00
(lines 6 + 7)
9. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES = 0.00 = 0.00
(lines 8 + 9)
CASH BALANCE
11. Beginning Cash Balance 0 00 FOR OFFICE USE ONLY
(line 20 of previous report)
12. Total Contributions + 0.00
(line 5)
13. Other Receipts + 0.00
(Accounting Period Total from PC 4A)
14. Loans Received (Exempt) + 0.00
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL = 13,00
(lines 11 + 12+ 13 + 14)
16. Total Expenditures 0.00
(line 10)
17. Other Disbursements + 0.00 RECEIVED
(Accounting Period Total from PC 4B)
18. Loan Payments (Exempt) + 0.00 SEP g 7 2004
(Accounting Period Total from PC 4B)
19. EXPENDITURE SUBTOTAL = 0.00
(lines 16+ 17+ 18) CiTY RECORDER
20. ENDING CASH BALANCE = 0.00
(line 15 minus line 19)
PC1
Summary Statement of Contributions and Expenditures .ev ,2 o3
Please type or print legibly in black ink. Page 2 of 2
Candidate or Political Committee Name: I Committee ID Number:
Committee for a Better Eugene
I
[] Original [] Primary 20__ [] General 2004 [] Other __
[] Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
LOAN SUMMARY FOR OFFICE USE ONLY
21. Beginning Outstanding Loans
(line 29 of previous report) 0 00
22. Loans Received (Non-Exempt)
(line 2) + 0 00
23. Loans Received (Exempt)
(line 14) + 0.00
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) = 0 00
25. Loan Payments (Non-Exempt) 0.00
(line 7)
26. Loan Payments (Exempt) + 0.00
(line 18)
27. Forgiven Loans
(Total loans forgiven during this accounting period) + 0.00
28. LOAN PAYMENT SUBTOTAL
= 0 00
(hnes 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS
= 0.00
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures 0.00
(line 36 of previous report)
31. Personal Expenditures + 0 00
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUBTOTAL
= 0 O0
(lines 30 + 31)
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
= 0 00
(lines 33 + 34)
36. OUTSTANDING PERSONAL EXPENDITURES
= 0.00
(line 32 minus line 35)
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
37. Ending Cash Balance 0.00
(line 20)
38. Accounts Receivable + 0.00
(Accounting Period Total from PC 5)
39. SUBTOTAL = 0.00
(lines 37 + 38)
40. Total Outstanding Loans 0 00
(line 29)
41. Outstanding Personal Expenditures + 0.00
(line 36)
42. Accounts Payable + 600 00
(Accounting Period Total from PC 6)
43. SUBTOTAL = 600.00
(lines 40 + 41 + 42)
44. BALANCE/DEFICIT
= -600
(line 39 minus line 43: indicate + or - balance)
I, T~m Biornstad (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports are
tree and correct.
'sd
of or tre~ Date signed
PC6
Accounts Payable .er
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene Page 1_ of 1
Election: [] Primary 20__ [] General 2004 [] Other __
Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
PURPOSE CODES (see back for instructions and code definitions)
A Agent O Other Advertising (yard signs, buttons, etc.)
B Broadcast Advertising (Radio, TV) P Postage
C Cash Contributions S Surveys and Polls
F Fundraising Event Expenses T Travel Expenses (describe if over $50)
G General Operational Expenses (describe if over $50) U Utilities
I Interest Payment W Wages, Salaries, Benefits
L Literature, Brochures, Printing Y Petition Circulators
M Management Services Z Preparation and Production of Advertising
N Newspaper and Other Periodical Advertising
Amount of
Line # Date Payee's Name Purpose
Account Payable
1 9/9/04 Lindholm Company, LLC A $ 600.00
2. $
3. $
4. $
5. $
6. $
7 $
8. $
9. $
10. $
See Page Total (Add all accounts payable on this Accounting Period Total (Complete only for last page and
Instructions form.) transfer these amounts to the Summary Statement, PC 1.)
on Back and
in Campaign Accounts Payable $ 600.00 Accounts Payable $ 600.00
Finance Enter on Summary Statement, Column A, Line 42
Manual
PC 6
PC9
Report of Expenditures Made by an Agent
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene Page 1 of 1
Election: [] Primary 20__ [] General 2004 [] Other __
Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
Complete the information in this box for each payment made to an agent and then provide the detail of expenditures made by the
agent in the spaces below:
The following expenditures were made by/INDHOLM COMPANY, LLC (name of agent). The payments to the agent are listed
off:
Form (circle one) Page # Line # Check # Amount
PC 2, PC 3 or PC 6 I ~_ 600.00
PC 2, PC 3 or PC 6
PC 2, PC 3 or PC 6
Purpose Amount of
Payee's Name (see purpose codes Expenditure
Line # Date (as it appears on invoice, receipt or check) on back of form)
I 9/9~04 Eugene City Recorder O $ 300.00
2. 9/9/04 Eugene City Recorder O $ 300.00
3. $
4. $
5. $
6. $
7. $
8 $
9. $
10.
See
Instructions Page Total of Agent Expenditures: $ 600 00
on Back and
in Campaign Complete this box only for last page of the detail of expenditures made by this agent.
Finance
Manual Total Amount of Agent Expenditures: $ 600.00
Unexpended Balance (if any): $ ~
PC 9 (report this amount as an account receivable on form PC 5)
PC1
Summary Statement of Contributions and Expenditures ,2 03
Please type or print legibly in black ink. Page 1 of 2
Candidate or Political Committee Name (use full name):
Committee for a Better Eugene
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
345 Mill St., 101, Eugene, OR 97401
Treasurer's Name: [ Telephone Number (day):
Tim Bjornstad [ 687-1051
Committee ID Number: [ Committee Type, Measure Number or Office:
I
[] Original [] Primary 20__ [] General 2004 [] Other
[] Amendment [] I 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
(Accounting Period Total from PC 2) 1,050.00 1,050.00
2. Loans Received (Non-Exempt) + 0.00 + 0.00
(Accounting Period Total from PC 2)
3. Total Cash Contributions = 1,050.00 = 1,050.00
(lines 1+ 2)
4. ln-Kind + 0 00 + 0 00
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS
= 1,050.00 = 1,050.00
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 746.50 746.50
(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 = 746.50 = 746.50
(lines 6 + 7)
9. In-Kind + 0 00 + 0 00
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES
= 746.50 = 746 50
(lines 8 + 9)
CASH BALANCE
11. Beginning Cash Balance 0.00 FOR OFFICE USE ONLY
(line 20 of previous report)
12. Total Contributions + 1,050.00
{line 5)
13. Other Receipts + 0 00
(Accounting Period Total from PC 4A)
+ o.oo RECEIVED
14.
Loans Received (Exempt)
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL = '1,050 O0
(lines 11 + 12 + 13 + 14) OCT 2 1 2004
16. Total Expenditures 746 50
(line 10) CITY RECORDER
17. Other Disbursements + 0 00
(Accountin~ Period Total from PC 45)
18. Loan Payments (Exempt) + 0.00
(Accounting Period Total from PC 45)
19. EXPENDITURE SUBTOTAL
= 746 50
(lines 16 + 17 + 18)
20. ENDING CASH BALANCE
= 303.50
(line 15 minus line 19)
PC1
Summary Statement of Contributions and Expenditures .ev ,2,0,
Please type or print legibly in black ink. Page 2 of 2
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene
[] Original [] Primary 20__ [] General 2004 [] Other __
[] Amendment [] 1 st 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) + 0.00
(line 2)
23. Loans Received (Exempt) + 0.00
(line 14)
24. LOANS RECEIVED SUBTOTAL
= 0.00
(lines 21 + 22 + 23)
25. Loan Payments (Non-Exempt) 0 00
(line 7)
26. Loan Payments (Exempt) + 0.00
(hne 18)
27. Forgiven Loans + 0.00
(Total loans forgiven during this accounting period)
28. LOAN PAYMENT SUBTOTAL
= 0 00
(lines 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS
= 0 00
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures 0.00
(line 36 of previous report)
31. Personal Expenditures + 0.00
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUBTOTAL
= 0.00
(lines 30 + 31)
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
= 0 O0
(lines 33 + 34)
36. OUTSTANDING PERSONAL EXPENDITURES
= 0 00
(line 32 minus line 35)
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
37. Ending Cash Balance 303 50
(line 20)
38. Accounts Receivable + 0 00
(Accounting Period Total from PC 5)
39. SUBTOTAL = 303.50
(lines 37 + 38)
40. Total Outstanding Loans 0.00
(line 29)
41. Outstanding Personal Expenditures + 0.00
(line 36)
42. Accounts Payable
(Accounting Period Total from PC 6) + ~'/~'5~ ~ ~
43. SUBTOTAL = "/~ C, OO ..l~,0rO13~
(lines 40 + 41 + 42)
44. BALANCE/DEFICIT
(hne 39 minus hne 43: indicate + or - balance) = "' gl°l/' 5'0 -~
I, T~m Biornstad (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports are
true and correct.
ignature of q~fffdate or treasurer Date signed
PC2
Cash Contributions, Loans Received and In-Kind Rev
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene Page 1_ofT_
Election: [] Primary 20__ [] General 2004 [] Other __
Report: [] 1 st 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 Business Entity CA Cash
C Political Committee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organization
O Other
P Political Party Committee
Amount of In-K/nd Purpose
Ltne# Name and Address of Contnbutor
Contribution (see manual for suggested purpose codes)
Occupational Information or Contributor
Date Received Contributing Committee's IDg Aggregate Code I , Code 2
Scott Meisner
1 66 N Adams St. $ 50 00
Eugene, OR 97402
9/28/04 Researcher/writer $ 50.00 I I CA
Jim Torrey
2. 3593 Riverpolnte Dr $ 1,000.00
Eugene, OR 97408
10/11/04 Mayor of Eugene $ 1,000.00 I CA
3 $
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 include aggregates.) transfer these amounts to the Summary Statement, PC 1.)
on Back and Cash (CA) $1,050 00 Cash (CA) $1,050.00
in Campaign Enter on Summary Statement, Column A, Line 1
Finance
Manual In-Kind (1K) $ 0 00 In-Kind (IK) $ 0 00
Enter on Summary Statement, Column A, Lines 4 and 9
PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ 0.00
Enter on Summmy Statement. Colunm A, Line 2
PC3
Cash Expenditures and Loan Payments Rev ,_~/03
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene Page 1_ of l-
Election: [] Primary 20__ [] General 200~4 [] 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 signs, buttons, etc.) CA Cash
B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment
C Cash Contributions R Reimbursement 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 Utilities
L Literature, Brochures, Printing W Wages, Salaries, Benefits
M Management Services Y Petition Circulators
N Newspaper and Other Periodical Advertising Z Preparation and Production of Advertising
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
1. 10/2/04 1001 Bourland Pritlng L CA $ 149.00 []
2. 10/15/04 1002 Towers Marketing O CA $ 597 50 r--1
5. $ []
7, $ r-]
9. $ F-]
10. $ [--]
See Page Totals (Add all expenditures with the san]e 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) $ 746.§0 Cash (CA) $ 746 50
Finance Enter on Smmnary Statement, Column A, Line 6
Manual Loan Payment (LP) $ 0.00 Loan Payment (LP) $ 0.00
Enter on Summary Statement, Column A, Lane 7
PC 3
PC6
Accounts Payable Rev
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene Page 1 of 1
Election: [] Primary 20__ [] General 2004 [] Other ~
Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
PURPOSE CODES (see back for instructions and code definitions)
A Agent O Other Advertising (yard signs, buttons, etc.)
B Broadcast Advertising (Radio, TV) P Postage
C Cash Contributions S Surveys and Polls
F Fundraising Event Expenses T Travel Expenses (describe if over $50)
G General Operational Expenses (describe if over $50) U Utilities
I Interest Payment W Wages, Salaries, Benefits
L Literature, Brochures, Printing Y Petition Circulators
M Management Services Z Preparation and Production of Advertising
N Newspaper and Other Periodical Advertising
Amount of
Line # Date Payee's Name Purpose Account Payable
1 9/9/04 Lindholm Company A $ 600 00
2. 9/23/04 E B Design Z $ 165.00
3 $
4 $
5. $
6. $
7 $
8 $
9. $
lO $
See Page Total (Add all accounts payable on this Accounting Period Total (Complete only for last page and
Instructions form.) transfer these mounts to the Summary Statement, PC 1 .)
on Back and
in Campaign Accounts Payable $ 765.00 Accounts Payable $ 765 00
Finance Enter on Stmunary Stateraent. Colunm A, Line 42
Manual
PC 6
PCI
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):
Committee for a Better Eugene
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
345 Mill St., 101, Eugene, OR 97401
Treasurer's Name: I Telephone Number (day):
Tim Bjornstad [ 687-1051
Committee ID Number: ] Committee Type, Measure Number or Office:
I
[] Original [] Primary 20__ [] General 2004 [] Other __
[] Amendment [] I 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 685.00 1735 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
= 685.00 = 1,735.00
(lines 1+ 2)
4. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS
= 685.00 = 1,735.00
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 165.00 911.50
(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 = 165 00 = 911.50
(lines 6 + 7)
9. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES
= 165 O0 = 911 50
(hnes 8 + 9)
CASH BALANCE
11. Beginning Cash Balance
(hne 20 of previous report) 303 50 FOR OFFICE USE ONLY
12. Total Contributions + 685 00
(line 5)
13. Other Receipts + 0.00
(Account,ng Period Total from PC 4A) RECEIVED
14. Loans Received (Exempt) + 0 00
(Accounting Period Total from PC 4A) NOV 3 0 2004
15. CONTRIBUTION SUBTOTAL
= 988 50
(lines 11 + 12 + 13 + 14)
16. TotalExpenditures 16500 CITY REOORDER
(hne 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
= 165.00
(lines 16 + 17 + 18)
20. ENDING CASH BALANCE
= 823 50
(hnc 15 minus line 19)
PC1
Summary Statement of Contributions and Expenditures .ev ,2,°3
Please type or print legibly in black ink. Page 2 of 2
Candidate or Political Committee Name: I Committee ID Number:
I
Committee for a Better Eugene
[] Original [] Primary 20__ [] General 2004 [] Other ~
[] Amendment [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
LOAN SUMMARY FOR OFFICE USE ONLY
2 l. Beginning Outstanding Loans 0.00
(line 29 of previous report)
22. Loans Received (Non-Exempt) + 0.00
(line 2)
23. Loans Received (Exempt) + 0 00
(line 14)
24. LOANS RECEIVED SUBTOTAL
= 0.00
(lines 21 + 22 + 23)
25. Loan Payments (Non-Exempt) 0.00
(line 7)
26. Loan Payments (Exempt) + 0 00
(line 18)
27. Forgiven Loans + 0.00
(Total loans forgiven during this accounting period)
28. LOAN PAYMENT SUBTOTAL
= 0.00
(lines 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS
= 0.00
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures 0.00
(line 36 of previous report)
31. Personal Expenditures + 0.00
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUBTOTAL
= 0.00
(lines 30 + 31)
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
= 0 O0
(lines 33 + 34)
36. OUTSTANDING PERSONAL EXPENDITURES
= 0.00
(Dine 32 minus line 35)
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
37. Ending Cash Balance 823 50
(line 20)
38. Accounts Receivable + 0 00
(Accounting Period Total from PC 5)
39. SUBTOTAL = 0.00
(lines 37 + 38)
40. Total Outstanding Loans 0.00
(line 29) RECEIVED
41. Outstanding Personal Expenditures + 0.00
(line 36)
42. AccoantsPayable + 2,150.00 NOV 2 0 2004
(Accounting Period Total from PC 6)
43. SUBTOTAL = 2,150.00
(lines 40 + 41 + 42) CITY RECORDER
44. BALANCE/DEFICIT = -1,326.50
(line 39 minus line 43: indicate + or - balance)
I, Tim Bjornstad (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports are
true and correct.
Signature of c~easurer Date signed
RECEIVED=
In'KindN v 0 2004' e ,2,03
Cash Contributions, Loans Received and
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene C f
Election: [] Primary 20__ [] General 2004 [] Other __
Report: [] 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 Business Entity CA Cash
C Political Committee (includes business and union PACs) CO Cosigner Obligation
F Candidate's Immediate Family (includes candidate) IK In-Kind
I Individual LR Loan Received
L Labor Organization
O Other
P Political Party Committee
Amount of In-Kind Purpose
Line # Name and Address of Contributor
Contfibutton (see manual for suggested purpose codes)
Occupational Information or Contributor I
Date Received Contributing Committee's ID~ Aggregate Code 1 ~ Code 2
WBGS Architecture and Planning Inc
1. 72 W. Broadway $ 250 00
Eugene, OR 97401
10/21/04 Architectural Firm $ 250.00 B CA
Matthew K Scheibe
2 2175 Eastwood Lane $ 100.00
Eugene, OR 97401
10/26/04 Landscapre Architect $ 100.00 I [ CA
Duncan and Brown
3. 1260 Charnelton $ 250.00
Eugene, OR 97401
11/1/04 Architect, WBGS $ 250 00 B I CA
Miscellaneous Contributions not more than
4 $50.00 $ 85.00
10/26/04 to
11/1/04 $ I CA
5. $
$
See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and
Instructions contribution type. Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1.)
on Back and Cash (CA) $ 685 00 Cash (CA) $ 685.00
in Campaign Enter on Summary Statement, Column A, Line 1
Finance
Manual In-Kind (IK) $ 0.00 In-Kind (IK) $ 0.00
Enter on Summary Statement, Column A, Lines 4 and 9
PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ 0.00
Enter on Summmy Statement, Column A, Lme 2
PC3
Cash Expenditures and Loan Payments :{ F C F IV ~2,o3
Candidate or Political Committee Name: Committee ID Number:
Committee for a Better Eugene N~I/~)~ 2004
Election: [] Primary 20__ [] General 2004 [] Other ~
Report: r--] 1st Pre-election [] 2nd Pre-election ~,. Post-election [] 20__C ~$~m~(~l~lR
PURPOSE CODES (see back of form for instructions and Cofle.definitidns) EXPENDITURE TYPES
A Agent O Other 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 Funclraising 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 Utilities
L Literature, Brochures, Printing W Wages, Salaries, Benefits
M Management Services Y Petition Circulators
N Newspaper and Other Periodical Advertising Z Preparation and Production of Advertising
Payee's Name and Payee's Committee lDO, []
Line # Date Check # if applicable Purpose Exp. Amount of
(as it appears on invoice, receipt or check) Type Expenditure Paid
to A/P
1. 10/21/04 1003 E B Design Z CA $ 165.00
2. $ I--I
3. $ ['-]
4. $ I-]
5. $ i-]
6. * [~
7. $ ~l
8. $ [~
9. $ [~]
10. $ [~l
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) $165.00 Cash (CA) $165.00
Finance Enter on Summary Statement, Column A, Line 6
Manual Loan Payment (LP) $ 0.00 Loan Payment (LP) $ 0.00
Enter on Summary Statement, Column A, Line 7
PC 3
PC6
Accounts Payable R F C
Candidate or Political Committee Name: Committee ID Number:
1~ot01
Election: ['-]Primary20_ [] Oenera1200__ [] O er__ C [rYmgeE u 0 R
Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20__ epte r ppleme
PURPOSE CODES (see back for instructions and code definitions)
A Agent O Other Advertising (yard signs, buttons, etc.)
B Broadcast Advertising (Radio, TV) P Postage
C Cash Contributions S Surveys and Polls
F Fundraising Event Expenses T Travel Expenses (describe if over $50)
G General Operational Expenses (describe if over $50) U Utilities
I Interest Payment W Wages, Salaries, Benefits
L Literature, Brochures, Printing Y Petition Circulators
M Management Services Z Preparation and Production of Advertising
N Newspaper and Other Periodical Advertising
Amount of
Line # Date Payee's Name Purpose Account Payable
1. 11/1/04 Lindholm Company A $ 1,550 00
2. 9/9/04 Lindholm Company A $ 600 00
3 $
4. $
5. $
6 $
7. $
8. $
9. $
10. $
See Page Total (Add all accounts payable on this Accounting Period Total (Complete only for last page and
Instructions form.) transfer these mounts to the Summary Statement, PC 1 .)
on Back and
in Campaign Accounts Payable $ 2,150.00 Accounts Payable $ 2,1§0 00
Enter on Surmnary Statement, Column A, Line 42
Finance
Manual
PC 6
Report of Expenditures Made by an Agent ~ [~ [!~,~ [~) '2~°~
Candidate or Political Committee Name: Committee ID Number: ~{0 V' 3 0 /.004
Committee for a Better Eugene Page ~_ of 1
Election: [] Primary 20__ [] General 2004 [] Other__ !TY S [ C 0 ~ DEbl
Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS
Complete the information in this box for each payment made to an agent and then provide the detail of expenditures made by the
agent in the spaces below:
The following expenditures were made by ~ (name of agent). The payments to the agent are listed on:
Form (circle one) Page # Line # Check # Amount
PC 2, PC 3 or PC 6 ~_ I 1.550 00
PC 2, PC 3 or PC 6
PC 2, PC 3 or PC 6
PC 5 (of prior report) __
Purpose Amount of
Payee's Name (soo purpose codes Expenditure
Uno it Date (as it appears on invoice, receipt or chock) on back of fo~)
1 11/1/04 Verb Creative M $ 1,550 00
2. $
3. $
4. $
5. $
6. $
7. $
$
9. $
10. $
See
Instructions Page Total of Agent Expenditures: $1550.00
on Back and
in Campaign Complete this box only for last page of the detail of expenditures made by this agent.
Finance
Manual Total Amount of Agent Expenditures: $1550 00
Unexpended Balance (if any): $ 0 0,0
PC 9 (report this mount as an account receivable on form PC 5)