HomeMy WebLinkAboutAmazon Creek Political Action Committee
-.
PC I
Rev. 11/99 Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page lof2
Candidate or Political Committee Name:
Amazon Creek Political Action Committee
Address (street or route, city, state, zip code):
755 Foothill Drive
Treasurer's Name: Telephone Number (day):
Robert E. SieQmund (541 ) 686-8080
Committee ID Number: Committee Type, Measure Number or Office:
Miscellaneous Committee
o Original o Primary 2000 o General 20_ ~ Other _
o Amendment o 1 st Pre-election o 2nd Pre-election o Post -election o September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
1. Cash Contributions 0 + 0
(Accounting Period Total from PC 2) +
2. Loans Received (Non-Exempt) + 0 + 0
(Accounting Period Total from PC 2)
3. Total Cash Contributions 0 = 0
=
(lines 1+2)
4. In-Kind 0 + 0
+
(Accounting Period Total from PC 2)
5. TOTAL CONTRIBUTIONS = 0 = 0
(lines 3 + 4)
EXPENDITURES
6. Cash Expenditures + 198.19 + 0
(Accounting Period Total from PC 3)
7. Loan Payments (Non-Exempt) + 0 + 0
(Accounting Period Total from PC 3)
8. Total Cash Expenditures = 0 = 0
(lines 6 + 7)
9. In-Kind + 0 + 0
(Accounting Period Total from PC 2)
10. TOTAL EXPENDITURES = 198. 19 = 0
(lines 8 + 9)
CASH BALANCE
11. Beginning Cash Balance 198.19 FOR OFFICE USE ONLY
(Ending Cash Balance from previous report)
12. Total Contributions + 0
(line 5)
13. Other Receipts + 0
(Accounting Period Total from PC 4A) RECEIVED
14. Loans Received (Exempt) + 0
(Accounting Period Total from PC 4A)
15. CONTRIBUTION SUBTOTAL = 198.19 APR 0 :3 2006
(lines II + 12 + 13 + 14)
16. Total Expenditures + 198.19 CITY RECORDER
(line 10)
17. Other Disbursements + 0
(Accounting Period Total from PC 4B)
18. Loan Payments (Exempt) + 0
(AccoWlting Period Total from PC 4B)
19. EXPENDITURE SUBTOTAL = 198.19
(Jjnes 16 + 17 + l~n
PC I
Rev. 11/99 Summary Statement of Contributions and Expenditures
Please type or print legibly in black ink. Page 2 of2
Candidate or Political Committee Name: Committee ID Number:
Amazon Creek Political Action Committee
o Original o Primary 2000 o General 20_ ~ Other _
o Amendment o 1 st Pre-election o 2nd Pre-election o Post -election ~ September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans 0 FOR OFFICE USE ONL Y
(Total Outstanding Loans from previous report)
22. Loans Received (Non-Exempt) 0
(line 2) +
23. Loans Received (Exempt) 0
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) = 0
25. Loan Payments (Non-Exempt) 0
(line 7) +
26. Loan Payments (Exempt) 0
(line 18) +
27. Forgiven Loans 0
(Total loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 +27) = 0
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28) = 0
PERSONAL EXPENDITURE SUMMARY
30. Beginning Outstanding Personal Expenditures 0
(line 34 of previous report)
31. Personal Expenditures + 0
(Accounting Period Total from PC 3A)
32. PERSONAL EXPENDITURE SUBTOTAL 0
(lines 30 + 31) =
33. Personal Expenditure Reimbursements 0
(Total expenditures on PC 3 with purpose code R) -
34. OUTSTANDING PERSONAL
EXPENDITURES = 0
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
35. Ending Cash Balance 0
(line 20)
36. Accounts Receivable 0
(Accounting Period Total from PC 5) +
37. SUBTOTAL 0
(lines 35 + 36) =
38. Total Outstanding Loans 0 RECEIVED
(line 29)
39. Outstanding Personal Expenditures + 0 APR 0 3 2006
(line 34)
40. Accounts Payable + 0
(Accounting Period Total from PC 6) CITY RECORDER
41. SUBTOTAL 0
(lines 38 + 39 + 40) =
42. BALANCEIDEFICIT 0
(line 37 minus line 41: indicate + or - balance) =
I, Robert E. Siegmund (name of candidate or treasurer), hereby certify that the above statement and the attached supporting
reports are true and correct.
Q~ ~.~~u. A:2 :c\ ~ ~LO ~
. . ~ .. . ......... ... '" "
~....\.tI>~N'~ '
~
"'9.......r_r,t_-
PC6
Rev. 11199 Accounts Payable
Please type or print legibly in black ink.
Candidate or Political Committee Name: Committee ID Number: Page 1 of 1
Amazon Creek Political Action Committee
Election: o Primary 2000 o General 20_ ~ Other _
Report: o 1st Pre-election o 2nd Pre-election o Post -election o September Supplemental
PURPOSE CODES (see back for instructions and code definitions)
A Agent N Newspaper and Other Periodical Advertising
B Broadcast Advertising (Radio, TV) 0 Other Advertising (yard signs, buttons, etc.)
C Cash Contributions P Postage
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 W Wages, Salaries, Benefits
L Literature, Brochures, Printing Z Preparation and Production of Advertising
M Management Services
Note: Accounts Payable must include all amounts not paid by the end of the accountin~ period. See back of form for instructions.
Une Date Payee's Name Purpose Amount of
# Account Payable
1. 12/30/2005 Mercy Corp. Contribution $ 198. 19
2. $
3. $
4. $
5. $
6. $
7. $
8. $
9. $
10. $
Page Total (Add all accounts payable on this Accounting Period Total (Complete only for last page and
See form. ) transfer these amounts to the Summary Statement, PC 1.)
Instructions Accounts Payable $ 198.19 Accounts Payable $198.19
on Back and Enter on Summary Statement, Colunm A, Line 40
in Campaign
Rin~n...p