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Home My WebLink AboutWrite-In Jim Torrey PC 1 Summary Statement of Contributions and ,-xpenditures Rev ,2,°3 Please type or print legibly tn black mk. Page 1 of 2 Candidate or Political Committee Name (use full name): Write-In Jim Torrey Mailing Address as it Appears on Statement of Orgamzat~on (street, route or box number, city, state, mp code): c/o Jones & Roth, PC PO Box 10086 Eugene, OR 97440 Treasurer's Name: I Telephone Number (day): Tricia Duncan 1541-687-2320 Committee ID Number: I Committee Type, Measure Number or Office: g Mayor, City of Eugene I mal /~rimary 20__ [] General 2004 [] Other ~ -II Amendment L~[_? .1.!t Pre-electqon [] 2nd Pre-election [] Post-election [] 20__ September Supplemental ' ' ~ A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1. Cash Contributions 11,085.00 11,085.00 (Accounting Period Total fi.om PC 2) 2. Loans Received (Non-Exempt) + 200.00 + 200.00 (Accounting Period Total from PC 2) 3. Total Cash Contributions = 11,285.00 = 11,285.00 (hnes 1+ 2) 4. In-Kind + 500.00 + 500.00 (Accounting Period Total fi.om PC 2) 5. TOTAL CONTRIBUTIONS = 11,785.00 = 11,785.00 (lines 3 + 4) EXPENDITURES 6. Cash Expenditures 11,223.95 11,223.95 (Accounting Period Total fi.om PC 3) 7. Loan Payments (Non-Exempt) + + (Accounting Period Total fi.om PC 3) 8. Total Cash Expenditures = 11,223.95 = 11,223.95 (lines 6 + 7) 9. In-Kind + 500.00 + 500.00 (Accounting Period Total fi.om PC 2) 10. TOTAL EXPENDITURES = 11,723.95 = 11,723.95 (hnes 8 + 9) CASH BALANCE 11. Beginning Cash Balance 0.00 FOR OFFICE USE ONLY (line 20 of prewous report) 12. Total ContnbuUons + 11,785.00 (hne 5) 13. Other Receipts + 0.00 (Accounting Period Total fi.om PC 4A) 14. Loans Received (Exempt) + 0.00 (Accounting Period Total from PC 4A) 15.(hnesCONTRIBUTIONI 1 + 12 + 13 + SUBTOTAL14) = 11,785.00 RECEIVED 16. Total Expenditures 11,723.95 (line 10) SEP 2 7 2004 17. Other Disbursements + 0.00 (Accounting Period Total from PC 4B) 18. Loan Payments (Exempt) + o.oo CiTY RECORDER (Account~n§ Period Total fi.om PC 4B) 19. EXPENDITUR~ SUBTOTAL = 11,723.95 (lines 16+ 17+ 18) 20. ENDING CASH BALANCE = 61.05 (line 15 minus line 19) PC 1 Summary Statement of Contributions and xpenditures Rev Please type or pnnt legibly m black mk. Page 2 of 2 Can&date or Polltmal Committee Name: [ Committee ID Number: Write-la Jim Torrey I none [] Original [] Primary 20__ [] General 2004 [] Other ~ [] Amendment [] 1 st Pre-election [] 2nd Pre-elecUon [] Post-election [] 20__ September Supplemental LOAN SUMMARY 21. Beginnmg Outstandmg Loans FOR OFFICE USE ONLY (line 29 of prewous report) 0.00 22. Loans Received (Non-Exempt) (line 2) + 200.00 23. Loans Recmved (Exempt) (line 14) + 0.00 24. LOANS RECEIVED SUBTOTAL (hnes 21 + 22 + 23) = 200.00 25. Loan Payments (Non-Exempt) 0.00 (hne 7) 26. Loan Payments (Exempt) + 0.00 (hne 18) 27. Forgzven Loans + 0.00 (Total loans forgzven during th~s accounting period) 28. LOAN PAYMENT SUBTOTAL = 0.00 (hnes 25 + 26 +27) 29. TOTAL OUTSTANDING LOANS (hne 24 minus line 28) = 200.00 PERSONAL EXPENDITURE SUMMARY 30. Begmmng Outstanding Personal Expenditures 0.00 (line 36 of prewous report) 31. Personal Expenditures (Accounting Period Total from PC 3A) + 9,643.00 32. PERSONAL EXPENDITLTRE SUBTOTAL = 9,643.00 (hnes 30 + 31) 33. Personal Expenditure Remabursements (Total expenditures on PC 3 with purpose code R) 9,643.00 34. Forgiven Personal Expenditures + 0.00 (Total personal expenditures forgiven this acctg, period) 35. REIMBURSEMENT SUBTOTAL (hnes 33 + 34) = 9,643.00 36. OUTSTANDING PERSONAL EXPENDITURES : 0.00 (line 32 n~nus hne 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37. Ending Cash Balance 61.05 (hne 20) 38. Accounts Receivable + 0.00 (Accounting Period Total from PC 5) 39. SUBTOTAL = 61.05 (lines 37 + 38) 40. Total Outstanding Loans 200.00 (line 29) 41. Outstandmg Personal Expenditures + 0.00 (hne 36) 42. Accounts Payable (Accounting Period Total from PC 6) + 16,109.19 43. SUBTOTAL (lines 40 + 41 + 42) = 16,309.19 44. BALANCE/DEFICIT (line 39 rmnus hne 43. indicate + or - balance) = -16,248.14 [name 6f candidate or measurer), hereby certify that the above statement and the attached supporting repons are tree and corre, c~. ~S~gnature of candidate or treasurer / Date signed PC 2 Cash Contributions, Loans Received and In-Kind Rev ,2,0, Candidate or Political Comrmttee Name: Comrmttee ID Number: Write-In Jim Torrey None Page 1 of 7 Elect~on: [] Primary 20__ [] General 2004 [] Other __ Report: [] 1 st Pre-electron [] 2nd Pre-election [] Post-elect~on [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor lype CODE 2: Contribution Type B Business Entity CA Cash C Political Comnuttee (includes business and umon PACs) CO Comgner Obligation F Candzdate's Immediate Family (includes candidate) IK In-Kind I Individual LR Loan Recezved L Labor Orgamzatton O Other P Pohtical Party Cornn~ttee Amount of In-Kind Purpose Line # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information or Contributor Code 1 I Code 2 Date Received Contributing Commtttee's ID# Aggregate Taylor Ramsey Properties 1. PO Box 2220 $ 100.00 Eugene, OR 97402 08/16/2004 - $ 100.00 B CA Joan Obie 2. 3694 Plumtree $ 100.00 Eugene, OR 97402 08/1612004 Bookkeeper $ 100.00 I CA Greg Jenkins 3. 3425 Chambers St. $ 70.00 Eugene, OR 97405 08/16/2004 Contractor $ 70.00 I CA Kay Toolson 4. 87180 Oakdale Dr. $ 1,000.00 Eugene, OR 97402 08/16/2004 RV Manufacturer $ 1,000.00 I CA David Davini, Jr, 5. 36159 Camp Creek Road $ 100.00 Springfield, OR 97477 08/16/2004 Real estate developer $ 100.00 I CA See Page Totals (Add all amounts w~th the same Accounting Period Totals (Complete only for last page and Instmctaons contribution type. Do not include aggregates.) transfer these amounts to the SurrLmary Statement, PC 1.) on Back and Cash (CA) $1,370.00 Cash (CA) $ ~ in Campaign Enter on Suramary Statement, Column A, Line 1 Finance Manual In-Kind (IK) $ ~ In-Kind (IK) $ ~ Enter on Summary Statement, Colunm A, Ltnes 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ Enter on Summary Statement, Columa A, Line 2 PC 2 Cash Contributions, Loans Received and In-Kind Rev,2,0, Candidate or Political Committee Name: Committee ID Number: Write-In Jim Torrey None Page 2 of 7 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 Bus~ness Entity CA Cash C Political Comrmttee (includes business and union PACs) CO Cosigner Obhganon F Candidate's Immediate Family (includes candidate) IK In-Kind I Individual LR Loan Received L Labor Orgamzation O Other P Political Party Committee Amount of In-Kind Purpose Line # Name and Address of Contributor Contnbution (see manual for suggested purpose codes) Occupattonal Information or Contributor I Date Received Contributing Committee's ID# Aggregate Code 1 , Code 2 Charles Warren 1. PO Box 1818 $ 100.00 Eugene, OR 97440 08/16/2004 Retail - cutlery $ 100.00 I CA J.H. Gonyea II 2. PO Box 269 $ 1,000.00 Spnngfield, OR 97477 08/16/2004 Wood products CEO $ 1,000.00 I I CA David Gonyea 3. PO Box 269 $ 100.00 Springfield, OR 97477 08/16/2004 Wood products manager $ 100.00 I CA Michael B. Edlin 4. 35650 Zephyr Way $ 100.00 Pleasant Hill, OR 97455 08/16/2004 Wood products sales $ 100.00 I CA Craig Smith 5. 3174 Metolius Drive $ 100.00 Eugene, OR 97408 08/16/2004 Wood products sales manager $ 100.00 I I CA See Page Totals (Add all amounts vath 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) $1.400.00 Cash (CA) $ ~ in Campaign Enter on Summary Statement, Column A, Line 1 Finance Manual In-Kind (IK) $ ~ In-Kind (IK) $ .~ Enter on Summary Statement, Column A, Lines 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ Enter on Summary Statement, Colurrm A, Line 2 PC 2 Cash Contributions, Loans Received and In-Kind Rev Candidate or Political Committee Name: Committee ID Number: Write-In Jim Torrey None Page 3 of 7 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 Polincal Comrmttee (includes business and union PACs) CO Comgner Obligation F Candidate's Immediate Farmly (includes candidate) IK In-Kind I Indiwdual LR Loan Received L Labor Organization O Other P Political Party Committee Line # Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor Code 1 Code 2 Contributing Commtttee's ID# Aggregate Al Emrick, Jr. 1. 90680 Coburg Hills Drive $ 100.00 Eugene, OR 97408 08/16/2004 Wood products CFO $ 100.00 I CA Paul Haugen 2. 2773 Tomahawk Lane $ 100.00 Eugene, OR 97401 08/16/2004 Wood products Eastern sales manager $ 100.00 I CA Joseph H. Genyea III 3. 1810 Firland Blvd $ 100.00 Eugene, OR 97405 08/16/2004 Wood products sales $ 100.00 I CA McDougal Bros. Investments 4. PO Box 518 $ 1,000.00 Creswell, OR 97426-0518 08/18/2004 $ 1,000.00 B CA Greg Demers 5. PO Box 876 $ 2,000.00 Veneta, OR 97487-0876 08/18/2004 Real estate developer $ 2,000.00 I CA 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) $ 3,300.00 Cash (CA) $ ~ m Campaign Enter on Sunanary Statement, Colunm A, Line 1 Finance Manual In-Kind (IK) $ __ In-Kind (IK) $ __ Enter on Story Statement, Column A, Lines 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ ~ Enter on Summary Statement, Column A, Line 2 PC 2 Cash Contributions, Loans Received and In-Kind .er 12/03 Candidate or Pohtical Comnuttee Name: Committee ID Number: Write-In Jim Torrey None Page 4 of 7 Election: [] Primary 20__ [] General 2004 [] Other ~ Report: [] 1 st Pre-elecUon [] 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 Entity CA Cash C Pohtical Committee (includes business and umon PACs) CO Cosigner Obhgat~on F Candidate's Immediate Farmly (includes candidate) IK In-Kind I Individual LR Loan Received L Labor Orgamzation O Other P Pohtlcal Party Committee Line # Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Informatton or Contributor Code 1 Code 2 Contributing Committee's ID# Aggregate Norman N. McDougal 1. PO Box 518 $ 1,000.00 Creswell, OR 97426-0518 08/18/2004 Rent estate developer $ 1,000.00 I CA Cochran Investment Company 2. 3298 Lakemont Drive $ 100.00 Eugene, OR 97408 08/27/2004 $ 100.00 B CA Dawd E. Carmichael Attorney at Law 3. 777 High Street $ 100.00 Eugene, OR 97401 08/27/2004 $ 100.00 B CA Imperial Floors 4. 355 Lincoln Steet $ 100.00 Eugene, OR 97401 08/27/2004 $ 100.00 B CA Joan Obie 5. 3694 Plumtree $ 500.00 Eugene, OR 97402 08/27/2004 Bookkeeper $ 600.00 I CA 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 Summary Statement, PC 1.) on Back and Cash (CA) $1,800.00 Cash (CA) $ ~ m Campaign Enter on Summary Statement, Colunm A, Line 1 Finance Manual In-Kind (IK) $ __ In-Kind (IK) $ ~ Enter on Summary Statement, Column A, Lmes 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ ~ Enter on Sunm~ry Statement, Column A, L~ne 2 PC 2 Cash Contributions, Loans Received and In-Kind Candidate or Pohtical Cornnuttee Name: Committee ID Number: Write-In Jim Torrey None Page 5 of 7 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 lype CODE 2: Contribution Type B Busmess Entity CA Cash C Political Committee (includes busmess and union PACs) CO Comgner Obligation F Candidate's Immediate Family (includes candidate) IK In-Kmd I Indiwdual LR Loan Received L Labor Organization O Other P Political Party Committee Line # Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor Code 1 Code 2 Contributing Commtttee's ID# Aggregate Robert C. Loomis 1. 660 Sand Avenue $ 100.00 Eugene, OR 97401 08/27/2004 Retired $ 100.00 I CA Marvin D. Reveal 2. 2924 Adams Street $ 100.00 Eugene, OR 97405-2672 08/27/2004 Insurance agent $ 100.00 I CA Gene Stringfield Building Materials 3. PO Box 2707 $ 150.00 Eugene, OR 97402 08/31/2004 $ 150.00 B CA Leanne Collis 4. 1615 Williamsburg Way $ 100.00 Eugene, OR 97401 08/31/2004 Homemaker $ 100.00 I CA Allace Plummet 5. 1722 Russet Drive $ 100.00 Eugene, OR 97401 09/02/2004 Wood products company owner $ 100.00 I CA 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) $ 550.00 Cash (CA) $ ~ in Campaign Enter on Summary Statement, Column A, Line 1 Finance Manual In-Kmd (IK) $ ~ In-Kind (IK) $ Enter on Sunmaaw Statement, Column A, Lmes 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ ~ Enter on Summary Statement, Colunm A, Lme 2 PC 2 Cash Contributions, Loans Received and In-Kind Rev Candidate or Pohtlcal Committee Name: Committee ID Number: Write-In Jim Torrey None Page 6 of 7 Election: [] Primary 20__ [] General 2004 [] Other __ Report: [] 1 st Pre-election [] 2nd Pre-elecUon [] 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 Orgamzation O Other P Political Party Committee Line # Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor Code 1 Code 2 Contributing Committee's ID# Aggregate Jane Moshofsky 1. 1240 E. 22nd Ave. $ 100.00 Eugene, OR 97403 09/02/2004 Homemaker $ 100.00 I CA Abris 2. 1117 West 3rd $ 500.00 website services Halsey, OR 97348 08-14-04 $ 500.00 B IK Philip Marvin 3. PO Box 2055 $ 100.00 Eugene, OR 97402 09/02/2004 Real estate sales $ 100.00 I CA Olsson Industrial Electric 4. PO Box 70413 $ 100.00 Eugene, OR 97401 09/07/2004 $ 100.00 B CA Wildish Sand & Gravel 5. PO Box 7428 $ 500.00 Eugene, OR 97401 09/07/2004 $ 500.00 B CA 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) $ 800.00 Cash (CA) $ ~ m Campaign Enter on Summary Statement, Cohmm A, Line 1 Finance Manual In-Kind (IK) $ 500 00 In-Kind (IK) $ ~ Enter on Sunmmry Statement, Column A, Lines 4 and 9 PC 2 Loans Received (LR) $ 0.00 Loans Received (LR) $ ~ Enter on Sunmary Statement, Colunm A, Line 2 PC 2 Cash Contributions, Loans Received and In-Kind Rev ,2,03 Candidate or Political Committee Name: Committee ID Number: Write-In Jim Torrey None Page_7 of Z Election: [] Primary 20__ [] General 2004 [] Other ~ Report: [] 1 st Pre-elect~on [] 2nd Pre-election [] Post-electron [] 20m September Supplemental SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution lype B Business Entity CA Cash C Political Committee (includes business and union PACs) CO Cosigner Obhgation F Candidate's Immediate Family (includes candidate) IK In-K~nd I Individual LR Loan Recmved L Labor Orgamzation O Other P Political Party Comnuttee Amount of In-Kind Purpose Line # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information or Contnbutor [ Date Received Contributing Committee's ID# Aggregate Code 1 ~ Code 2 Miscellaneous cash contributions $50 and 1. under. From 08-16-04 through 9-16-04 $ 1,315.00 various $ 1,315.00 I CA Miscellaneous cash contributions $50 and 2. under. From 8-16-04 through 9-16-04 $ 50.00 various $ 50.00 B CA Jeff Miller 3. 450 Country Club Road $ 500.00 Eugene, OR 97401 09-10-04 Insurance agent_ $ 500.00 I CA Jeff Miller 4. 450 Country Club Road $ 200.00 Eugene, OR 97401 09-16-04 Insurance agent $ 200.00 I I LR I 5. $ $ See Page Totals (Add all amounts wuth the same Accounting Period Totals (Complete only for last page and Instmctuons contribution type. Do not include aggregates.) transfer these mounts to the Summary Statement, PC 1.) on Back and Cash (CA) $1,865 00 Cash (CA) $11,085.00 in Campaign Enter on Stmmmry Statement, Column A, Line 1 Finance Manual In-Kind (IK) $ __ In-Kind (IK) $ 500.00 Enter on Sunanary Slatement, Column A, Lines 4 and 9 PC 2 Loans Received (LR) $ 200.00 Loans Recmved (LR) $ 200.00 Enter on Sunanary Statement, Column A, Line 2 PC 3 Cash Expenditures and Loan Payments Rev ,2,0, Candidate or Pohtical Committee Name: Comrmttee ID Number: Write-In Jim Torrey None Page 1_ of l- Election: [] Primary 20__ [] General 2004 [] Other __ Report: [] 1st Pre-elecUon [] 2nd Pre-elecUon [] Post-election [] 20__ September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES A Agent O Other Advemsing (yard signs, buttons, etc.) CA Cash B Broadcast Advertising (Radio, TV) P Postage LP Loan Payment C Cash Contributions R Reimbursement for Personal Expenchtures F Fundra~smg Event Expenses S Surveys and Polls G General Operational Expenses (descnbe if over $50) T Travel Expenses (describe if over $50) I Interest Payment U Utilities L Literature, Brochures, Pnnting W Wages, Salaries, Benefits M Management Services Y Petition Ctrculators N Newspaper and Other Periodical Advemsmg Z Preparation and Production of Advertising Payee's Name and Payee's Commtttee ID#, Exp. Amount of Ltne# Date Check # /f applicable Purpose Type Expenditure Paid (as it appears on invoice, receipt or check) to A/P 1. 08-18-04 Jeff Miller R CA $ 7,260.00 E~ 2. 09-08-07 501 Jeff Miller R CA $ 2,383.00 E] 3. 09-16-04 514 Abris O- Website CA $ 1,580.95 4. $ [---] 5. $ 6. $ 7. $ ~ 8. $ [] 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 in Campmgn Cash (CA) $11,223.95 Cash (CA) $11,223.95 Enter on Summary Statement, Column A, Lane 6 Finance Manual Loan Payment (LP) $ Loan Payment (LP) $ ~ Enter on Summary Statement, Column A, Lane 7 PC 3 PC 3A Personal Expenditures for Reimbursement .er ~2~03 Candidate or Political Comrmttee Name: Cornrmttee ID Number: Write-In Jim Torrey None Page 1 of 1 Election: [] Primary 20__ [] General 2004 [] Other __ Report: [] 1st Pre-election [] 2nd Pre-election [] Post-elecnon [] 20__ September Supplemental PURPOSE CODES (see back of form for instructions and code definitions) A Agent O Other Adver~smg (yard signs, buttons, etc.) B Broadcast Advertising (Radio, TV) P Postage C Cash Contributions S Surveys and Polls F Fundralsing 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 Petinon Circulators M Management Services Z Preparation and Production of Advertising N Newspaper and Other Periodical Advertising Amount of Line # Date Payee's Name Purpose Expenditure 1. 08-10-04 Lane Events Center 0 - Fair booth $ 690.00 2. 08-18-04 American Flyer Advertising N $ 8,953.00 3. $ 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ 10. $ See Page Total Accounting Period Total (Complete only for last page and Instmcnons transfer t!'ns amount to the Summary Statement, PC 1.) on Back and Personal Expenditures $ 9,643.00 in Campaign Personal Expenditures $ 9,643.00 Finance Enter on Sunmmry Statement, Line 31 Manual PC 3A PC 6 Accounts Payable Rev 12/03 Candidate or Pohtical Committee Name: Committee ID Number: Write-In Jim Torrey None Page 1_ of 2 Election: [] Pr,mary 20__ [] General 2004 [] Other ~ Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-elect~on [] 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 Fundralsmg Event Expenses T Travel Expenses (describe if over $50) G General Operatmnal Expenses (describe if over $50) U Utilities I Interest Payment W Wages, Salaries, Benefits L Literature, Brochures, Printing Y Petition C~rculators 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. 08-10-04 Ad Art Design O $ 1,690.00 2. 08-11-04 Tim Clevenger G - copywriting $ 212.50 3. 08-16-04 Sign Pro O $ 25.00 4. 08-17-04 Ad Art Design O $ 750.00 5. 08-17-04 Ad Art Design O $ 140.00 G - Fair $ 118.98 6. 08-20-04 Georgian~ne Weber expenses 7. 08-25-04 Ad Art Design O $ 1,320.00 8. 08-25-04 Ad Art Design O $ 615.00 9. 08-26-04 American Flyer Advertising N $ 5,337.71 10. 08-27-04 Sign Pro 0 $ 1,170.00 See Page Total (Add all accounts payable on th_is 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 $11.379.19 Accounts Payable $ . Enter on Summary Stat~ment~ Column A, Line 42 Finance Manual PC 6 PC Accounts Payable Candidate or Political Comrmttee Name: Cornmattee ID Number: Write-In dim Tormy None Page 2_ of 2_ Election: [] Primary 20__ [] General 2004 [] Other Report: [] 1st 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 Advert]sing (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 Utdmes 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 Advemsmg Amount of Line # Date Payee's Name Purpose Account Payable 1. 08-31-04 Adams + Hull, Inc. L $ 1,925.00 2. 08-31-04 Prevedello & Associates M $ 2,805.00 3. $ 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ 10. $ See Page Total (Add all accounts payable on tins Accounting Period Total (Complete only for last page and Instructions form.) transfer these amounts to the Summary Statement, PC 1.) on Back and m Campaign Accounts Payable $ 4,730.00 Accounts Payable $16,109.19 Enter on Story Statement, Coltmm A, Line 42 Finance Manual PC 6 PC 1 Summary Statement of Contributions and Expenditures Please type or print legibly m black ink. Page 1 of 2 Candidate or PohUcal Committee Name (use full name): Write-In dim/orrey Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code): c/o ,Jones & Roth, PC PO Box 10086 Eugene, OR 97440 Treasurer's Name: I Telephone Number (day): /ricia Duncan 1541-687-2320 Committee ID Number: [ Committee Type, Measure Number or Office: None I Mayor, City of Eugene [] Original [] Primary 20__ [] General 2004 [] Other ~ [] Amendment [] 1 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) 8,400.00 19,485.00 2. Loans Received (Non-Exempt) (Accounting Period Total from PC 2) + 16,200.00 + 16,400.00 3. Total Cash Contributions = 24,600.00 = 35,885.00 (lines 1+ 2) 4. In-K~nd + -0.00 + 500.00 (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS = 24,600.00 = 36,385.00 (lines 3 + 4) EXPENDITURES 6. Cash Expenditures 16,109.19 27,333.14 (Accounting Period Total from PC 3) 7. Loan Payments (Non-Exempt) + 8,000.00 + 8,000.00 (Accounting Period Total from PC 3) 8. Total Cash Expenditures = 24,109.19 = 35,333.14 (lines 6 + 7) 9. In-Kind + + 500.00 (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 24,109.19 = 35,833.14 (lines 8 + 9) CASH BALANCE 11. Beginning Cash Balance 61.05 FOR OFFICE USE ONLY (hne 20 of previous report) 12. Total Contributions + 24,600.00 (hne 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 = 24,661.05 (hnes 11+]2+ 13+ 14) EIVED 16. Total Expenditures 24,109.19 REC (hne 10) 17 Other Disbursements + o.oo OCT 2 1 2004 (Accounting Period Total from PC 4B) 18. Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) CITY RECORDER 19. EXPENDITURE SUBTOTAL = 24,109.19 (hnes 16 + 17 + 18) 20. ENDING CASH BALANCE = 551.86 (hne 15 rmnus hne 19) PC 1 Summary Statement of Contributions and Expenditures Rev Please type or print legibly in black ink. Page 2 of 2 Candidate or Political Committee Name: [ Committee ID Number: Write-In dim Tormy I none [] Original [] Primary 20__ [] General 200~4 [] Other ~ [] Amendment [] 1st Pre-elecUon [] 2nd Pre-election [] Post-election [] 20__ September Supplemental LOAN SUMMARY FOR OFFICE USE ONLY 2 l. Beginning Outstanding Loans 200.00 (line 29 of previous report) 22. Loans Received (Non-Exempt) (line 2) + 16,200.00 23. Loans Received (Exempt) + 0.00 (line 14) 24. LOANS RECEIVED SUBTOTAL = 16,400.00 (lines 21 + 22 + 23) 25. Loan Payments (Non-Exempt) (line 7) 8,000.00 26. Loan Payments (Exempt) + 0.00 (line 18) 27. Forgiven Loans + 0.00 (Total loans forgiven dunng this accounting period) 28. LOAN PAYMENT SUBTOTAL = 0.00 (lines 25 + 26 +27) 29. TOTAL OUTSTANDING LOANS = 8,400.00 (hne 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 w~th 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 551.86 (line 20) 38. Accounts Receivable + 0.00 (Accounting Period Total from PC 5) 39. SUBTOTAL = 551.86 (lines 37 + 38) 40. Total Outstanding Loans 8,400.00 (line 29) 41. Outstanding Personal Expenditures + 0.00 (line 36) 42. Accounts Payable + 0.00 (Accounting Period Total from PC 6) 43. SUBTOTAL = 8,400.00 (hnes 40 + 41 + 42) 44. BALANCE/DEFICIT = -7,848.14 (line 39 minus hne 43' Indicate + or - balance) I, Tricia Duncan, Treasurer (name of candidate or treasurer), hereby cemfy that the above statement and the attached supporting repo. o.o.o~ ale tree and correct. Signature of candidate or treasurer Datd signed PC2 Cash Contributions, Loans Received and In-Kind Candidate or Poi/t/cai Committee Name: Comm/ttee ID Number: Write-In Jim Torrey None Page ! of 2 Election: [] Primary 20__ [] General 2004 [] Other 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 Polit/cal Committee (includes business and union PACs) CO Cosigner Obligation F Candidate's/mmediate Family (includes candidate) IK h-Kind I Individual LR Loan Received L Labor Organization O Other P Polit/cal Party Committee D'ne tl Name and Address of Contributor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor I Contributing Committee's ID# Aggregate Code 1 ~ Code 2 Clark Roeder, DMD 1. 1717 Centennial Blvd $ 100.00 Springfield, OR 97477 09-28-04 $ 100.00 B I CA J.K. Pratt & Company 2. PO Box 40880 $ 100.00 Eugene, OR 97404 09-28-04 $ 100.00 B [ CA Arlie Air, LLC 3. 871 Country Club Road $ 8,000.00 Eugene, OR 97401c 10-05-04 $ 8,000.00 B I CA Dorothy Stedman 4. 1465 Roundup Drive $ 100.00 Eugene, OR 97401 10-05-04 Administrative assistance - insurance $ 100.00 I I CA June Cone 5. 2130 Olive Street $ 100.00 Eugene, OR 97405 10-08-04 Homemaker $ 100.00 I CA See Page Totals (Add all amounts with the same Accounting Period Totals (Complete only for last page and l. ustmctions contribut/on type. Do not include aggregates.) transfer these amounts to the Summary Statement, PC 1.) on Back and Cash (CA) $ 8,400.00 Cash (CA) $ Campaign ~r o~ s'~~ Sta~n~-n~, C~n A, L~e ~ Finance Manual In-Kind (IK) $ ~ In-Kind OK) $~ Ealt~ on ~ Statement, Colurml A, Lm~ 4 sad 9 PC 9_ Loans Received (LR) $ ~ Loans Received (LR) $ ~ Eater on Sun~n~ Statmnmt, Column A, Line 2 PC2 Cash Contributions, Loans Received and In-Kind Candidate or Political Comnfittcc Name: Committee ID Number: Write-in Jim Torrey None Page 2 of 2_ Election: [] Primary 20__ [] General 2004 [] Other__ Report: [] 1st Pre-election [] 2ad Pre-election [] Post-election [] 20_. September Supplm~ntal SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Political Co~afittee (includes business and union PAC0 CO Cosigner Obligation F Candidate's Immediate Family (includes candidate) IK In-Kind I Individual LR Loan Received L Labor OrganiTation O Other P Political Party Committee Line # Name and Address of Cont#butor Amount of In-Kind Purpose Contribution (see manual for suggested purpose codes) Occupational Information or Contributor Code I I ! Code 2 Date Received Contributing Committee's ID# Aggregate Jeff Miller 1. 450 Country Club Road $ 16,200.00 Eugene, OR 97401 09-27-04 Insurance agent $ 16,400.00 I LR 2. $ 3. $ 4. $ 5. $ See Page Totals (Add all amouats with the same Accounting Period Totals (Complete only for last page and Instructions contribution type. Do not include aggregates.) transfer these amounts to the Smmnary Statement, PC 1.) on Back and Cash (CA) $ Cash (CA) $ 8.400.00 in Campaign ~ o~ sum~ s~, Co~ A, t~ l Finance Man~al In-mad (IK) $ ,., In-Kind (~K) $ ~ Eat~ on Smnm~y Statement, Colmm A, Liaes 4 and 9 PC 2 Loans Received (LR) $16.200.00 Loans Received (LR) $16.200.00 Fair oa Summa~/Stamamt, Column A, Li~ 2 PC 3 Cash Expenditures and Loan Payments Rev Candidate or Political Committee Name: Committee ID Number: Write-In Jim Torrey None 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 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 Reanbursement 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, Prmting W Wages, Salaries, Benefits M Management Services Y Petition C~rculators 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 tt appears on invoice, receipt or check) to A/P 1. 09-30-04 502 Ad Art Design O CA $ 4,515.00 2. 09-30-04 503 Tim Clevenger G - copywriting CA $ 212.50 [~] 3. 09-30-04 504 Sign Pro O CA $ 1,195.00 [~] G Fair 4. 09-30-04 505 Georgianne Weber ' CA $ 118.98 [] expenses 5. 09-30-04 506 American Flyer Advertising N CA $ 5,337.71 6. 09-30-04 507 Adams + Hull L CA $ 1,925.00 7. 09-30-04 508 Prevedello & Associates M CA $ 2,805.00 [~ 8. 10-05-04 509 Jeff Miller Loan repay LP $ 8,000.00 [~ 9. $ [~ 10. $ [~ See Page Totals (Add all expenditures wuth the same Accounting Period Totals (Complete only for last page and Instruct'tons expenditure type.) transfer these amounts to the Summary Statement, PC 1.) on Back and in Campaign Cash (CA) $16,109.19 Cash (CA) $16,109.19 Finance Enter on Summary Statement, Colunm A, Line 6 Manual Loan Payment (LP) $ 8,000.00 Loan Payment (LP) $ 8,000.00 Enter on Sunam~ Statement, Colunm A, Lme 7 PC 3 PC 2 Amendn~nt Amendments-Cash Contributions, Loans Received and In-Kind 12/0:3 Candidate or Political Committee Name: Cornnuttee ID Number: Write-In ,Jim Tormy none Page 1_ of l- Election: [] Primary 20__ [] General 200...~4 [] Other Report: [~] 1 st 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 Entity CA Cash C Political Committee (includes business and union PACs) CO Cosigner Obligation F Candidate's Immediate Fan~ly (includes candidate) IK In-Kind I Individual LR Loan Received L Labor Organization O Other P Pohtlcal Party Comnuttee Amending Page # Name and Address of Contributor Amount of la-Kind Purpose and Line # Contribution (see manual for suggested purpose codes) Date Received Occupational Information or Contributor Code 1 Code 2 Contributing Committee's ID# Aggregate Page.__ L~ne__ Greg Jenkins [] New Entry 3425 Chambers Street $ 70.00 [] Correcbng [] Delet, ng Eugene, OR 97405 08-16-04 Construction contractor $ 70.00 I CA Page Dne__ [] New Entry $ [] Correcting [] Deleting $ Page.__ L~ne__ [] New Entry $ [] Correcbng [] Delebng $ Page__ L~ne [] New Entry $ [] Correchng [] Delebng $ Page__ L~ne [] New Entry $ [] Correcting [] Deleting $ Instructtons on Back and in Campmgn Finance -'~natureofcand]ffate~ 0CT 1 5 2004 Manual D/a~s 1/gn~ed~ PC2 ~C// CITY RECORDER Amendment PC2A~ Amendments-Cash Contributions, Loans Received and In-Kind Candidate or Political Convnittee Name: Coii~mittee ID Number: Wdte-ln Jim Torrey none ~,ag¢ ~ Electio-: [] hima~ 2o__[] c,~al ~o~_[] other Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] 20__ September Supplemental SEE BACK FOR INSTRUCTIONS AND ceDI[ DEFINITIONS CODE 1: Contributor Type CODE 2: Contribution Type B Business Entity CA Cash C Political Committee (includes business and talon PACs) CO Cosigner Obligation F Candidate's Invnediate Family (includes candidate) IK In-Kind I Individual LR Loan Reccived L Labor Org_ani,,,ation O Other P Political Party Committee Amending Page # Name and Address of Cont#bufor Amount of In.Kind Purpose and line # Contribution (see manua/for suggest~ purpose codes) Occupational Information or Contributor Date Received Contribu~ng Committee's I~ Aggregate Code 1 . Code 2 Pao~ u~__._ Oreg Jenkins [] Naw Er~ 3425 Chambers Street $ 70.00 I~ Core.ling [] D~n~ Eugene, OR 97405 I 08-16-04 Construction contractor $ 70.00 I CA Page Erie [] New Entry [] Deleting D N~w EnW $ [] Deteting $ Page.__ IJne I-I New EnW $ .,~__u.o__ UUI 1 4 Z[IU4 [] Corr~ang []..,.o CITYRF RDFR $ Instructions on Back and in Campaign o Finance Amendment ~Jate~s~gn~d PC 1 Summary Statement of Contributions and Expenditures Rev Please type or print leg]Ny ,n black ,nk. Page 1 of 2 Can&date or Pohtical Cornrmttee Name (use full name): Write-In Jim Torrey Marling Address as it Appears on Statement of Orgamzation (street, route or box number, city, state, zip code): c/o ,Jones & Roth, PC PO Box 10086 Eugene, OR 97440 Treasurer's Name: I Telephone Number (day): Tricia Duncan I 541-687-2320 Comm2ttee ID Number: I Cornn~ttee Type, Measure Number or Office: None IMayor, City of Eugene [] Original [] Pr,mary 20__ [] General 2004 [] Other __ [] Amendment [] 1st Pre-election [] 2nd Pre-elect,on [] Post-elect, on [] 20__ September Supplemental A-TOTALS FOR THIS B-CUMULATIVE TOTALS ACCOUNTING PERIOD FOR THIS ELECTION CONTRIBUTIONS 1 Cash Contribut,ons (Accounting Period Total from PC 2) 1,750 00 21,235 00 2. Loans Rece,ved (Non-Exempt) + 0.00 + 16,400.00 (Accounting Period Total from PC 2) 3. Total Cash Contnbut,ons = 1,750 O0 : 37,635.00 (hnes 1+ 2) 4. In-K,nd + 0.00 + fi00 00 (Accounting Period Total from PC 2) 5. TOTAL CONTRIBUTIONS = 1,750.00 = 38,135 00 (hnes 3 + 4) EXPENDITURES 6. Cash Expenditures 0.00 27,333.14 (Accounting Period Total from PC 3) 7. Loan Payments (Non-Exempt) + 0.00 + 8,000 00 (Accounting Period Total from PC 3) 8. Total Cash Expenditures = 0.00 = 35,333.14 (lines 6 + 7) 9. In-Kind + 0 00 + 500.00 (Accounting Period Total from PC 2) 10. TOTAL EXPENDITURES = 0 00 = 35,833.14 (hnes 8 + 9) CASH BALANCE 11. Beglnmng Cash Balance (line 20 of previous report) 551.86 FOR OFFICE USE ONLY 12. Total Contnbut,ons + 1,750.00 (line 5) 13. Other Rece,pts + 0.00 (Accounting Period Total from PC 4A) 14 Loans Received (Exempt) + 0.00 (Accounting Period Total from PC 4A) 15. CONTRIBUTION SUBTOTAL = 2,301.86 (lines 11 + 12 + 13 + 14) 16. Total Expenditures 0.00 (line 10, RECEIVED 17. Other D,sbursements + 0.00 (Accounting Period Total from PC 4B) DEC 0 ~ 18 Loan Payments (Exempt) + 0.00 (Accounting Period Total from PC 4B) 19. EXPENDITURE SUBTOTAL = 0.00 C i~Y h ~. C 0 ~DE~ (lines 16+ 17+ 18) 20. ENDING CASH BALANCE = 2,301.86 (line 15 minus line 19) PC 1 Summary Statement of Contributions and Expenditures Please type or pnnt legibly in black ink. Page 2 of 2 Candidate or Poht~cal Comnuttee Name: Committee ID Number: Write-In Jim Torrey none [] Original [] Primary 20__ [] General 2004 [] Other ~ [] Amendment [] 1st Pre-election [] 2nd Pre-electron [] Post-election [] 20__ September Supplemental LOAN SUMMARY 21. Beginning Outstanding Loans FOR OFFICE USE ONLY (hne 29 of previous report) 8,400.00 22 Loans Recmved (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 (hne 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 = 8,400.00 (line 24 minus line 28) PERSONAL EXPENDITURE SUMMARY 30. Beginmng 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 (hnes 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 hne 35) FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD 37. Ending Cash Balance 2,301.86 (line 20) 38. Accounts Receivable + 0.00 (Accounting Period Total from PC 5) 39. SUBTOTAL = 2,301.86 (lines 37 + 38) 40. Total Outstanding Loans 8,400.00 RECEIVED (line 29) 41. Outstand]ng PersonalExpendimres + 0.00 ~[C 0 2 2[']04 (line 36) 42. Accounts Payable + 0.00 (Accounting Period Total from PC 6) CITY RECORDER 43. SUBTOTAL = 8,400.00 (lines 40 + 41 + 42) 44 BALANCE/DEFICIT = -6,0§8.14 (line 39 minus line 43. indicate + or - balance) I, Tr~c~a Duncan, Treasurer (name of candidate or treasurer), hereby certify that the above statement and the attached supporting rep~ are true and correct. Szgnature of candidate or treasurer PC 2 Cash Contributions, Loans Received and In-Kind Rev ,=o3 Candidate or Political Comrmttee Name: Committee ID Number: Write-In Jim Torrey None Page 1 of 1 Election: [] Pr,mary 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 Farmly 0ncludes candidate) IK In-Kind I Individual LR Loan Received L Labor Organization O Other P Political Party Committee Amount of In-Ktnd Purpose Line # Name and Address of Contributor Contribution (see manual for suggested purpose codes) Occupational Information or Contributor Date Received Contributtng Committee's ID# Aggregate Code 1 , Code 2 Solin & Associates 1. 1500 Valley River Drive, Suite 250 $ 250.00 Eugene, OR 97401 11-17-04 $ 250.00 B CA Sterling Furniture 2. 3194 Gateway Loop $ 1,000.00 Spnngfield, OR 97477 11-17-04 $ 1,000.00 B CA Charles Warren 3. PO Box 1818 $ 500.00 Eugene, OR 97440 11-09-04 Retail - cutlery $ 600 00 I I CA I 4. $ , REC _IVbu D[C 0 2 2004 5. $ $ CITY iilCORDER 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 Stmunary Statement, PC 1.) on Back and Cash (CA) $1,750.00 Cash (CA) $1,750.00 lB Campaign Enter on Summary Statement, Column A, Line 1 Finance Manual In-K~nd (IK) $ In-Kind (IK) $ __ Enter on Snmmary Statement, Cohmm A, Lines 4 and 9 PC 2 Loans Received (LR) $ ~ Loans Received (LR) $ ~ Enter on Summary Statement, Colunm A, Line 2