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Summary Statement of Contributions and Expenditures PC I
Re\'. 12;03
Please type or print legibly in black ink. Page I of2
Candidate or POlitiCGo~~amd~ fUI~ame):
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
/2.0(} 1+/6H 7/ 11- 2-1 ~GrENE OR- q 7'-10 f
Treasurer's Name: /t7\J Dra2S OJ\J I TelePho:f~4ber~agOD
e-D
Committee ID Number: I Committee Type, MN7x:.ber or Office:
~ Original I 0 Primary 20_ ~ General 202.L J8l0ther ?l.A..PPL~ ENT1H--
o Amendment o I st Pre-election o 2nd Pre-election o Post-election 0 20_ September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOlJNTING PERIOD FOR TillS ELECTION
CONTRIBUTIONS
I. Cash Contributions -B- 5&; 3&5 ~
(Accounting Period Total from PC 2)
2. Loans Received (Non-Exempt) + -e- + -
. (Accounting Period Total from PC 2)
3. Total Cash Contributions = -f}-- 0.00 = 5!.r,3&5 ~3
(lines 1+ 2) -
4. In-Kind , 7g
+ -e- + /1, ~/L{.
(Accounting Period Total from PC 2) -
5. TOTAL CONTRIBUTIONS = -e- 0.00 = (, 7, 7 '60 C+I
(lines 3 + 4) -
EXPENDITURES
6. Cash Expenditures -tr 5"lr / 2 C60 ~
(Accounting Period Tota] from PC 3)
7. Loan Payments (Non-Exempt) + -e- + ----
(Accounting Period Total from PC 3)
8. Total Cash Expenditures 0.00 5~, 2 ~O 0"
= -f}- = -
(lines 6 + 7)
9. In-Kind + -B- 0.00 + If 4-/4- 7~
(Accounting Period Total from PC 2) J
10. TOTAL EXPENDITURES = ..(J- 0.00 = ~71 &qLj- ~
!lines 8 + 9)
CASH BALANCE
II. Beginning Cash Balance 65.57 FOR OFFICE USE ONLY
(line 20 of previous report)
12. Total Contributions + -- 0.00
(line 5)
13. Other Receipts + -
(Accounting Period Total from PC 4A)
14. Loans Received (Exempt) + -
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL = <65. 57 0.00
(lines 11 + 12 + 13 + 14)
16. Total Expenditures - 0.00 RECEIVED
(line 10)
17. Other Disbursements +
..-
(Accounting Period Total from PC 4B) SEP 1 2 2005
18. Loan Payments (Exempt) +
(Accounting Period Total from PC 4B) -
19. EXPENDITURE SUBTOTAL = - 0.00 CITY RECORDEF
(lines 16+ 17+ 18)
20. ENDING CASH BALANCE = <:65.57 0.00
(line 15 minus line 19)
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Summary Statement of Contributions and Expenditures PC J
Re\'. l2i03
Please type or print legibly in black ink. Page 20f2
Candidate or Political Committee Name: I Committee lD Number:
6ltNb of q
~ Original I 0 Primary 20_ ro General20J2L I}(] Other ?up p /e-YYJ e.n tiLJ
o Amendment o 1 st Pre-election o 2nd Pre-election o Post-election 020 September Supplemental
LOAN SUMMARY FOR OFFICE USE ONLY
21. Beginning Outstanding Loans
(line 29 of previous report) -
22. Loans Received (Non-Exempt) + 0.00
(line 2) ---
23. Loans Received (Exempt) + - 0.00
(line ]4)
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 +
(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 ---
(line 36 of previous report)
31. Personal Expenditures +
(Accounting Period Total from PC 3A) --
32. PERSONAL EXPENDITURE SUBTOTAL = -- 0.00
(lines 30 + 31)
33. Personal Expenditure Reimbursements --
(Total cxpenditun:s on PC 3 with purpose code R)
34. Forgiven Personal Expenditures + --
(Total personal expenditures torgiven 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 ~S. S7 0.00
(line 20)
38. Accounts Receivable + -
(Accounting Period Tota] from PC 5)
39. SUBTOTAL = <6t; 57 0.00
(lines 37 + 38) -
40. Total Outstanding Loans - 0.00 RECEIVED
(line 29)
41. Outstanding Personal Expenditures + - 0.00 SEP 12 2005
(line 36)
42. Accounts Payable + -
(Accounting Period Total from PC 6) CITY RECORDER
43. SUBTOTAL = - 0.00
(lines 40 + 41 + 42)
44. BALANCEIDEFICIT = -g 5 ~.? 0.00
(line 39 minus line 43: indicate + or - balance)
I, EV Ar',} D~~N (name of candidate or treasurer), hereby certity that the above
statement and the attached supporting reports are true and correct.
6l~~ '1. / ;). " 05
Signature of candidate or treasurer Date signed
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