HomeMy WebLinkAboutAndrea Ortiz for City Council
PC 1
Summary Statement of Contributions and Expenditures Rev. 12/03
Please type or print legibly in black ink. Page 1 of2
Candidate or Political Committee Name (use full name):
Andrea Ortiz for City Council
Mailing Address as it Appears on Statement of Organization (street, route or box number, city, state, zip code):
189 Foch Street Eugene, OR 97402
Treasurer's Name: I Telephone Number (day):
Tamara Miller (541) 521-5855
Committee 10 Number: I Committee Type, Measure Number or Office:
N/A Eugene City Council, Ward 7
IKI Original D Primary 20_ IKI General 20~ o Other
D Amendment D 1 st Pre-election D 2nd Pre-election o Post-election 1K120~ September Supplemental
A-TOTALS FOR THIS B-CUMULA TlVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
1. Cash Contributions 0.00 520.00
(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 = 520.00
(lines 1+ 2)
4. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS = 0.00 = 520.00
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures 40.00 453.00
(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 = 40.00 = 453.00
(lines 6 + 7)
9. In-Kind + 0.00 + 0.00
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES = 40.00 = 453.00
(lines 8 + 9)
CASH BALANCE
11. Beginning Cash Balance 317.92 FOR OFFICE USE ONLY
(line 20 of previous report)
12. Total Contributions + 0.00
(line 5)
13. Other Receipts + 0.10
(Accounting Period Total from PC 4A) RECE\VED
14. Loans Received (Exempt) + 0.00
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL = 318.02 SfP 2 0 2005
(lines II + 12 + 13 + 14)
16. Total Expenditures 40.00 CiTY RECORDER
(line 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 = 40.00
(lines 16 + 17 + 18)
20. ENDING CASH BALANCE = 278.02
(line 15 minus line 19)
PC 1
Summary Statement of Contributions and Expenditures Rev. 12/03
Please type or print legibly in black ink. Page 2 of2
Candidate or Political Committee Name: I Committee 10 Number:
Andrea Ortiz for City Council N/A
D Original D Primary 20_ D General 20~ o Other
D Amendment D 1 st Pre-election D 2nd Pre-election D Post-election D 2005 September Supplemental
LOAN SUMMARY FOR OFFICE USE ONLY
21. 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 = 0.00
(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 278.02
(line 20)
38. Accounts Receivable + 0.00 RECEIVED
(Accounting Period Total from PC 5)
39. SUBTOTAL = 278.02
(lines 37 + 38) SEp 2 0 2005
40. Total Outstanding Loans 0.00
(line 29) CITY RECORDER
41. Outstanding Personal Expenditures + 0.00
(line 36)
42. Accounts Payable 0.00
(Accounting Period Total from PC 6) +
43. SUBTOTAL = 0.00
(lines 40 + 41 + 42)
44. BALANCEIDEFICIT = 278.02
(line 39 minus line 43: indicate + or - balance)
I, Tamara E. Miller (name of candidate or 6derebY certify that the above
statement and the attached supporting reports"are true and correct.
~ Dalo '~n'~ rh
~ 'T U\
.7" ,
Signature of candidat(Qr treasur~
-
PC 3
Cash Expenditures and Loan Payments Rev. 12/03
Candidate or Political Committee Name: Committee 10 Number:
Andrea Ortiz for City Council N/A Page~of~
Election: D Primary 20_ !KI General 20~ D Other
Report: D 1st Pre-election D 2nd Pre-election D Post-election !KI20 05 September Supplemental
PURPOSE CODES (see back ofform 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)
1 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) toNP
11/30/04 Debit Pacific Cascade Federal Credit Union G
1. CA $ 4.00 D
12/31/2004 Debit Pacific Cascade Federal Credit Union G D
2. CA $ 4.00
1/31/2005 Debit Pacific Cascade Federal Credit Union G
3. CA $ 4.00 D
2/28/2005 Debit Pacific Cascade Federal Credit Union G D
4. CA $ 4.00
3/31/2005 Debit Pacific Cascade Federal Credit Union G D
5. CA $ 4.00
4/30/2005 Debit Pacific Cascade Federal Credit Union G
6. CA $ 4.00 D
5/31/2005 Debit Pacific Cascade Federal Credit Union G D
7. CA $ 4.00
6/30/2005 Debit Pacific Cascade Federal Credit Union G
8. CA $ 4.00 D
7/31/2005 Debit Pacific Cascade Federal Credit Union G D
9. CA $ 4.00
8/31/2005 Debit Pacific Cascade Federal Credit Union G D
10. CA $ 4.00
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 $ 40.00 Cash (CA) $ 40.00
in Campaign Cash (CA)
Finance Enter on Summary Statement, Colunill A, Line 6
Manual Loan Payment (LP) $ 0.00 Loan Payment (LP) $ 0.00
Enter on Summary Statement, Colunm A, Line 7
PC 3
PC4A
Other Receipts Rev. 12/03
Candidate or Political Committee Name: Committee ID Number:
Andrea Ortiz for City Council N/A Page ~ of 1
Election: D Primary 20_ !KI General 20~ D Other
Report: D 1st Pre-election D 2nd Pre-election o Post-election !KI20 05 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 Receipt
Line # Received (required for codes EL, OM and RF; Transaction Type Other Receipt Amount
optional for codes FM and IN) Code
11/30/2004 Pacific Cascade Federal Credit Union IN
1. $ 0.01
12/31/2004 Pacific Cascade Federal Credit Union IN
2. $ 0.01
1/31/2005 Pacific Cascade Federal Credit Union IN
3. $ 0.01
2/28/2005 Pacific Cascade Federal Credit Union IN
4. $ 0.01
3/31/2005 Pacific Cascade Federal Credit Union IN
5. $ 0.01
4/30/2005 Pacific Cascade Federal Credit Union IN
6. $ 0.01
5/31/2005 Pacific Cascade Federal Credit Union IN
7. $ 0.01
6/30/2005 Pacific Cascade Federal Credit Union IN
8. $ 0.01
7/31/2005 Pacific Cascade Federal Credit Union IN
9. $ 0.01
8/31/2005 Pacific Cascade Federal Credit Union IN
10. $ 0.01
See Page Totals (Add all Other Receipt Transaction Accounting Period Totals (Complete only for last page and
Instructions Type Codes specified.) transfer these amounts to the Summary Statement, PC 1.)
on Back and Codes FM, IN, OM, RF $ 0.10 0.10
in Campaign Codes FM, IN, OM, RF $
Finance Enter on Summary Statement, Column A, Line 13
Manual Code EL $ 0.00 Code EL $ 0.00
Enter on Summary Statement. Column A. Line 14
PC4A