HomeMy WebLinkAboutKitty Piercy for Mayor
'RIGINAC
Summary Statement of Contributions and Expenditures PC I
Rev. 12/03
Please type or print legibly in black ink. Page I of2
Candidate or Political Committee Name (use full name):
Kitty Piercy for Mayor
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
P.O. Box 23301, EUQene, OR, 97402
Treasurer's Name: I Telephone Number (day):
C. Michael Arnold 541-338-9111
Committee ID Number: Committee Type, Measure Number or Office:
n/a Candidate for Mayor
[gJ Original D Primary 20_ [gJ General 2004 D Other _
D Amendment D I st Pre-election D 2nd Pre-election D Post-election [gJ 20_ September Supplemental
A-TOTALS FOR THIS B-CUMULATlVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
I. Cash Contributions 0.00 20,075.00
(Accounting Period Total from PC 2)
2. Loans Received (Non-Exempt) + 0.00 + 2,000.00
(Accounting Period Total from PC 2)
3. Total Cash Contributions = 0.00 = 22,075.00
(lines 1+ 2)
4. In-Kind + 0.00 + 803.57
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS = 0 = 22,878.57
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 1,025.00 8,044.41
(Accounting Period Total from PC 3)
7. Loan Payments (Non-Exempt) + 0 + 13,769.87
(Accounting Period Total from PC 3)
8. Total Cash Expenditures = 1,025.00 = 21,814.28
(lines 6 + 7)
9. In-Kind + 0.00 + 803.57
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES = 1,025.00 = 22617.85
(lines 8 + 9)
CASH BALANCE
II. Beginning Cash Balance 2,000.00 FOR OFFICE USE ONL Y
(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 = 2000
(lines II + 12 + 13 + 14)
16. Total Expenditures 1,025.00 RECEIVED
(line 10)
17. Other Disbursements
(Accountin!! Period Total from PC 48) + 0.00
18. Loan Payments (Exempt) 0.00 SEP 0 7 2005
+
(Accounting Period Total from PC 48)
19. EXPENDITURE SUBTOTAL = 1,025.00 CITY RECORDER
(lines 16 + 17 + 18)
20. ENDING CASH BALANCE = 975.00
(line 15 minus line 19)
Summary Statement of Contributions and Expenditures PC I
Rev. 12/03
Please type or print legibly in black ink. Page 2 of2
Candidate or Political Committee Name: Committee ID Number:
Kitty Piercy for Mayor n/a
[gJ Original D Primary 20_ [gJ General 2004 D Other _
D Amendment D I st Pre-election D 2nd Pre-election D Post-election [gJ 2005 September Supplemental
LOAN SUMMARY FOR OFFICE USE ONLY
21. Beginning Outstanding Loans 3,230.13
(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 = 3,230.13
(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
(lines 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS = 3,230.13
(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 SUB TOT AL = 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 = 0.00
(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 975.00
(line 20)
38. Accounts Receivable + 0.00
(Accounting Period Total from PC 5)
39. SUBTOTAL = 975.00
(lines 37 + 38)
40. Total Outstanding Loans 3,230.13
(line 29)
41. Outstanding Personal Expenditures + 0.00
(line 36)
42. Accounts Payable + 0.00
(Accounting Period Total from PC 6)
43. SUBTOTAL = 3,230.13
(lines 40 + 41 + 42)
44. BALANCE/DEFICIT = -2,255.13
(line 39 minus line 43: indicate + or - balance)
I, C. Michael Arnold (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports
are true and correct.
. 910/05
r~~--J
Signature of candidate or treasurer Date signed
PC 3
Cash Expenditures and Loan Payments Rev. 12/03
Candidate or Political Committee Name: Committee ID Number:
Kitty Piercy for Mayor n/a Page 1 of 1
Election: D Primary 2004 [gJ General 2004 D Other _
Report: D I st Pre-election D 2nd Pre-election [gJ Post-election [gJ 2005 September Supplemental
PURPOSE CODES (see back of form for instructions and code definitions) EXPENDITURE TYPES
A Agent 0 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 10#, Exp. Amount of ~
Line # Date Check # if applicable Purpose Type Expenditure Paid
(as it appears on invoice, receipt or check) to AlP
12/30/ 1138 Funk/Levis A (see PC 9) CA $ 825.00 D
1. 2004
2. 8/26/2005 1139 ACDDesign.com 0 CA $ 200.00 D
3. CA $ D
4. CA $ D
5. CA $ D
6. CA $ D
7. CA $ D
8. CA $ D
9. CA $ D
10. CA $ D
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 I.)
on Back and Cash (CA) $ 1.025.00 Cash (CA) $ 1,025.00
in Campaign
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 I
PC 9
Report of Expenditures Made by an Agent Rev. 12/03
Candidate or Political Committee Name: Committee ID Number:
Kitty Piercy for Mayor n/a Page 1 of 1
Election: D Primary 20_ [gJ General 2004 D Other _
Report: D I st Pre-election D 2nd Pre-election D Post-election [gJ 2005 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 FUNK/LEVIS (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 1 1 1138 825.00
PC 2, PC 3 or PC 6 - - - -
PC 2, PC 3 or PC 6 - - - -
PC 5 (of prior report) - - - -
Payee's Name Purpose Amount of
Line # Date (as it appears on invoice, receipt or check) (see purpose codes Expenditure
on back of form)
1. 12/7/04 Eugene Weekly N $ 825.00
2. $
3. $
4. $
5. $
6. $
7. $
8. $
9. $
10. I $
I
See
Instructions Page Total of Agent Expenditures: $ 825.00
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: $ 825.00
Unexpended Balance (if any): $ -
PC9 I (report this amount as an account receivable on form PC 5)
I
Summary Statement of Contributions and Expenditures PC I
Rev. 12/03
Please type or print legibly in black ink. Page I of2
Candidate or Political Committee Name (use full name):
Kitty Piercy for Mayor
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
1371 W. 4th Ave., EUQene, OR, 97402
Treasurer's Name: I Telephone Number (day):
C. Michael Arnold 541-338-9111
Committee ID Number: I Committee Type, Measure Number or Office:
n/a Candidate for Mayor
D Original D Primary 20_ D General 2004 D Other _
[gJ Amendment D I st Pre-election o 2nd Pre-election D Post-election [gJ 2005 September Supplemental
A-TOTALS FOR THIS B-CUMULA TlVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
I. Cash Contributions 0.00 20,075.00
(Accounting Period Total from PC 2)
2. Loans Received (Non-Exempt) + 0.00 + 2,000.00
(Accounting Period Total from PC 2)
" Total Cash Contributions
.). = 0.00 = 22,075.00
(lines 1+ 2)
4. In-Kind + 0.00 + 803.57
(Accounting Period Total from PC 2)
S. TOT AL CONTRIBUTIONS = 0 = 22,878.57
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 1,025.00 8,044.41
(Accounting Period Total from PC 3)
7. Loan Payments (Non-Exempt) + 0 + 13,769.87
(Accounting Period Total from PC 3)
8. Total Cash Expenditures = 1,025.00 = 21,814.28
(lines 6 + 7)
9. In-Kind + 0.00 + 803.57
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES = 1,025.00 = 22617.85
(lines 8 + 9)
CASH BALANCE
II. Beginning Cash Balance 2,000.00 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)
IS. CONTRIBUTION SUB TOT AL = 2000
(lines II + 12+ 13 + 14)
16. Total Expenditures 1,025.00
(line 10) RECEIVED
17. Other Disbursements + 0.00
(Accountin!! Period Total from PC 48)
18. Loan Payments (Exempt) + 0.00 SEP 2 1 2005
(Accounting Period Total from PC 48)
19. EXPENDITURE SUBTOTAL = 1,025.00 CITY RECORDER
(lines 16+ 17+ 18)
20. ENDING CASH BALANCE = 975.00
(line 15 minus line 19)
Summary Statement of Contributions and Expenditures PC I
Rev. 12/03
Please type or print legibly in black ink. Page 2 of2
Candidate or Political Committee Name: I Committee ID Number:
Kitty Piercy for Mayor n/a
D Original D Primary 20_ D General 2004 D Other _
[gJ Amendment D I st Pre-election D 2nd Pre-election D Post-election [gJ 2005 September Supplemental
LOAN SUMMARY FOR OFFICE USE ONL Y
21. Beginning Outstanding Loans 3,230.13
(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 = 3,230.13
(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 accountim! period)
28. LOAN PAYMENT SUBTOTAL = 0
(lines 25 + 26 +27)
29. TOTAL OUTSTANDING LOANS = 3,230.13
(line 24 minus line 28)
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures 0.00
(line 36 of previous report)
3\. Personal Expenditures + 0.00
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUB TOT AL = 0.00
(lines 30 + 31)
33. Personal Expenditure Reimbursements 0.00
(Total expenditures on PC 3 with pumose code R)
34. Forgiven Personal Expenditures + 0.00
(Total nersonal 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 975.00
(line 20)
38. Accounts Receivable + 0.00
(Accounting Period Total from PC 5)
39. SUBTOTAL = 975.00
(lines 37 + 38)
40. Total Outstanding Loans 3,230.13 RECEIVED
(line 29)
41. Outstanding Personal Expenditures + 0.00
(line 36) SEP 2 1 2005
42. Accounts Payable + 0.00
(Accounting Period Total from PC 6)
43. SUBTOTAL = 3,230.13 CITY RECORDER
(lines 40 + 41 + 42)
44. BALANCE/DEFICIT = -2,255.13
(line 39 minus line 43: indicate + or - balance)
I, C. Michael Arnold (name of candidate or treasurer), hereby certify that the above statement and the attached supporting reports
are true and correct.
L~ 9 I J 1/ OS
Signature of candidate or treasurer Date signed