HomeMy WebLinkAbout11/05/1996 CANDIDATE C&E,:,,,gs Summary Statemept of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type'or print legibly in black ink. Pa~e I of 2
Candida~ or Principal Campaign CommiRee:
Address (street or route, city, state, zip code):
v
Treasurer's Name: Telephone Number (day):
Identification Number: Office (include county or district name. position, deparlment or zone number, if applicable)
[]Original [] Prima~ 19__ ~'~eneral 19 ~4~ ~] Other
~mendment [] 1st Pre-election [] 2nd Pre-election ~fPost-election [] September Supplemental
A-TOTAI~ FOR TItI$ B-CUMIJLATIYE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
1. Cash Contributions
(Accounting Period Total from CC 2) + +
2. Loans Received (Non-Exempt)
(Accounting Period Total from CC 2) + +
3. Total Cash Contributions
(lines 1+ 2) = =
4. In-Kind
(Accounting Period Total from CC 2) + +
5. TOTAL CONTRIBUTIONS (lines 3 + 4) =
O
EXPENDITURES
6. Cash Expenditures
(Accounting Period Total from CC 3) + +
7. Loan Payments (Non-Exempt)
(Accounting Period Total from CC 3) + +
8. Total Cash Expenditures
(lines 6 + 7) =
9. In-Kind
(Accounting Period Total from CC 2) + + '~.- "~-- ~
10. TOTAL EXPENDITURES (lines S + 9)
CASH BALANCE
11. Beginning Cash Balance
(Ending Cash Balance from previous report) (~ n~)L~. L./6 [ FOR OFFICE USE ONLY
12. Total Contributions
(line 5) +
13. Other Receipts
(Accounting Period Total from CC 4A) +
14. Loans Received (Exempt)
(Accounting Period Total from CC 4A) +
15. CONTRIBUTION SUBTOTAL
16. Total Expenditures
(..e 10) +
17. Other Disbursements
(Accounting Period Total from CC 4B) +
18. Loan Payments (Exempt)
(Accounting Period Total from CC 4B) +
19. EXPENDITURE SUBTOTAL
(lines 16+ 17+ ,8) = t t b Y, q t Cl} DEO 1. $ 1996
20. ENDING CASH BALANCE (line 15 minuslinc 19) =
Summary Statemeht of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink. Page 2 of 2
Candidate or Principal Campaign Committee: Identification Number:
[] Original [] Prima, 19 ]~eneral 19 '/L, [] Other
~"~'mendment [] I st Pre-election [] 2nd Pre-election [] Post-election September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) +
26. Loan Payments (Exempt)
(line 18) +
27. Forgiven Loans
(Total amount of loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 + 27) =
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28) =
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
30. Ending Cash Balance
(line 20)
31. Accounts Receivable
(Accounting Period Total from CC 5) +
32. SUBTOTAL
(lines 30 + 31) =
33. Total Outstanding Loans
(line 29)
34. Accounts Payable
(Accounting Period Total from CC 6) +
35. SUBTOTAL
(lines 33 + 34)
36. BALANCE/DEFICIT
(line 32 minus line 35: indicate + or - balance) = fi, 00
and the attached supporting reports are true and correct.
(candidate or treasurer), hereby certify that the above statement
Signature of Candidate or Treasurer
Date
1996
Cash Expenditures and Loan Payments
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Election: ~ Prim~ 19 ~Oenem119 ~g ~ Oher
Re~.: ~ 1st ~e-election ~ 2nd ~e-election ~ Post-election ~ September Supplemental
CODES FOR CLASSIFYING PURPOSES:
If one or more of the following pu~se codes is used to describe ~ expenditure pu~ose, no o~er description is ge~gally needed.
The exceptions a~:
I. When repoaing travel expenses over $50 describe the ~pe of expenses (e.g. lodging, aiffare, food gas,
2. lf~ expenditure is made on behalf of the commiRee by an agent such as ~ adveaising agency you must ~nelu& a completed
"Agent" fo~ (CC 9) or submit a copy of an invoice if it contains the s~e info~ation.
3. If an expen&~re ~s made which ~s an in-kind conmbutmn to another ~litmal commerce, cand!~ or ~date'S principal
campaign commiRee in ~e pu~se column identi~ the expenditure ~ ~ in-kind contribution ~ad identiffj,~e name of the
recipient candidate or ~litical commiRee.
PURPOSE CODES (See back of form for definitions of purpose codes)
A Agent (see back) M Ma~ag~ent~i~
B Broadcast Adveaising (Radio, TV) ~ ~ewsp~t and Periodical Adve~ising
C Cash Contributions /~ O ~er AdveRising (yard signs, hurons, etc.)
F Fun~aising Ev~t Ex.rises /~
G General O~mtional Expenses , ~a S~*~s ~d Polls
I Inte~st Payment ~m~l Expenses (d*scri~ if over $50)
L Literature, Broch~*s, Printing ~ages, Sallies, Ben*fits
EXPENDITURE TYPE: C - Cash LP - Lo~ P~yment
Page ~ and Pa~'s Na~ ~ (u~ pu~ ~e or
A~unt
of
Line ~ ~k ~ as it appeam on in~, ~i~ ~ ch~k pm~e descdption) Exp. T~e Ex~nd~um Pa~
Date ~
~ N~ En~
Signature of Candidate or Treasurer
Date ~...C~) ~EO 1__ a 1996
m ,cc' Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black inlc Page l of 2
Candidate or Principal Campaign Committee:
Address (street or route, city, state, zip code):
Treasurer's Name: Telephone Number (day):
Identification Number: Office (include county or district name, position, dcpmtm~nt or zone number, if applicable)
AAriginal [] Primary 19 ~ General 19 cl Jo [] Other
mandment [] I st Pre-election [] 2nd Pre-election [~Post-election [] September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
I. Cash Contributions
(Accounting Period Total from CC 2)
2. Loans Received (Non-Exempt) .~
(Accounting Period Total from CC 2) +
3. Total Cash Contributions
(Accounting Period Total from CC 2) +
5. TOTAL CONTRIBUTIONS (lines 3 + 4)
EXPENDITURES
6. Cash Expenditures
(Accounting Period Total from CC 3)
7. Loan Payments (Non-Exempt)
(Accounting Period Total from CC 3)
8. Total Cash Expenditures
(Accounting Period Total from CC 2) + -
CASH BALANCE
11. Beginning Cash Balanco
(Ending Cash Balance from previous report) ~ FOR OFFICE USE ONLY
12. Total Contributions :
13. Other Receipts
(Accounting Period Total from CC 4A) +
14. Loans Received (Exempt)
(Accounting Period Total from CC 4A) +
15. CONTRIBUTION SUBTOTAL
16. Total Expenditures
17. Other Disbursements I
(Accounting Pcriod Total from CC 4B) + ~ 0'~_~ 9~r..C ~ 5 ~000~5 1
18. Loan Payments (Exempt)
(Accounting Period Total from CC 4B) +
19. EXPENDITURE SUBTOTAL
(lines 16 + 17 + 18) = ~ ~ dC ~.~
I
20. ENDING CASH BALANCE (line 15 minus line 19)
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink. Page 2 of 2
Candidate or Principal Campaign Committee: Identification Number:
[] Original [] Primary 19 [] General 19 q ~, [] Other
[] Amendment [] 1 st Pm-election [] 2nd Pm-election ~ Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from p~vious report) (~ FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2)
23. Loans Received (Exempt)
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) = O
25. Loan Payments (Non-Exempt)
(line 7) 4-
26. Loan Payments (Exempt)
(line 18)
27. Forgiven Loans
(Total amount of loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL .
(lines 25 + 26 + 27)
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28)
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
30. Ending Cash Balance
(line 20)
31. Accounts Receivable r
(Accounting Period Total from CC 5) + '--~I
32. SUBTOTAL
(lines 30 + 31) --' -
33. Total Outstanding Loans
(linc 29) O
34. Accounts Payable
(Accounting Period Total from CC 6) + '-~
35. SUBTOTAL
(lines 33 + 34) = '-~
36. BALANCE/DEFICIT
(line 32 minus line 35: indicate + or - balance) = ~ (~"
I, E_~ ~(::,~__~L.~ (candidate or treasurer), hereby certify that the above statement
and the attached supporting reports are true and correct.
Signature of Candidate or Treasurer
Date
OEC 1996
CC 3
~'~'~ Cash Expenditures and Loan Payments
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Election: [] Primary 19 "~ General 19 cl ~ [] Other
Report: [] 1st Pre-election [] 2nd Pre-election '~Post-election [] September Supplemental
CODES FOR CLASSIFYING PURPOSES:
If one or more of the following purpose codes is used to describe an expenditure purpose, no other description is generally needed.
The exceptions are:
1. When reporting travel expenses over $50, describe the type of expenses (e.g., lodging, airfare, food, gas, etc.)
2. If an expenditure is made on behalf of the committee by an agent such as an advertising agency you must include a completed
"Agent" form (CC 9) or submit a copy of an invoice if it contains the same information.
3. If an expenditure is made which is an in-kind contribution to another political committee, candidate or candidate's principal
campaign committee, in the purpose column identify the expenditure as an in-kind contribution and identify the name of the
recipient candidate or political committee.
PURPOSE CODES (See back of form for definitions of purpose codes)
A Agent (see back) M Management Services
B Broadcast Advertising (Radio, TV) N Newspaper and Periodical Advertising
C Cash Contributions O Other Advertising (yard signs, buttons, etc.)
F Fundraising Event Expenses P Postage
G General Operational Expenses S Surveys and Polls
I Interest Payment T Travel Expenses (describe if over $50)
L Literature, Brochures, Printing W Wages, Salaries, Benefits
EXPENDITURE TYPE: C - Cash LP - Loan Payment
Line # Purpose []
Payee's Name (use purpose code or Amount of
Date Check # as it appear~ on invoice, receipt or check provide description) Exp. Type Expenditure Paid
to AlP
POI 0__$ []
$ []
$ []
Page Totals (Add all expenditures with the A¢conuting Feriod Totals (Complete only for last page and
See Iustrn¢linu~ same expenditure type.) .~ ~.,~ transfer these amonnts to the Summary Statement, CC 1.)
Campaign Cash (C) $ ~ -- Cash (C) $
Enter on SummaO' St~¢ra~t, Column A, Line 6
Finance Manual Loan Payment (LP) $ ~ Loan Payment (LP)
Enlor on SummaO' Statement, Column A, Line 7
~5 Other Receipts
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Election: [] Primary 19 __ ~PGeneral 19 ~ [] Other
Report: [] 1 st Pre-election [] 2nd Pre-election '~ost-election [] September Supplemental
SEE BACK OF FORM FOR INSTRUCTIONS AND CODE DEFINITIONS.
Other Receipts Transaction Type Codes:
EL Exempt Loan Proceeds
I Interest Earned
F Items Sold at Fair Market Value
OM Miscellaneous (complete description must be provided)
RF Refund of Deposit
Line # Name Other Receipt Transaction Other
Data Received (required for C,~des EL, OM and RF, optional for C_~des I and F) Type Code Receipt Amount
l, $
2. $
3. $
4. $
5. $
See Instructions
on Back and in
Campaign
Finance Manual
Page Totals (Add all amounts for the Other
Receipt Transaction Types specified.)
Codes I, F, OM, RF $ c~ (~
Code EL $ '~
Accounting Period Totals (Complete only for last page and
transfer these amounts to the Summary Statement, CC 1.)
Codes 1, F, OM, RF $. ~
Enter on Summary Statement, Column A, Line 13
Code EL $. ~
Enter on Suraraaty Statcmem, Column A, Lines 14
:0 0 5 !996 D'
~C ~
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink. Page 1 of 2
Candidate or Principal Campaign Committee:
Don Laws for Council Committee
Address (street or route, city, state, zip code):
P.O. Box 465t Ashland, OR 97520-0016
Treasurer's Name: Telephone Number (day):
Martin H. LEvine, CPA 541/482-7801
Identification Number: Office (include county or district name, position, department or zone number, if applicable)
N/A Ashland City Council
[] Original [] Primary 19 __ [] General 19 96 [] Other
[] Amendment [] I st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
l. Cash Contributions
(Accounting Period Total from CC 2) + '~'
2. Loans Received (Non-Exempt)
(Accounting Period Total from CC 2) + 137.00 .. 137.00
3. Total Cash Contributions
(lines l+ :2) = 137.00 _ 137.00
4. In-Kind
(Accounting Period Total from CC 2) +
5. TOTAL CONTRIBUTIONS (lines 3 + 4) = 137.00 = 137.00
EXPENDITURES
6. Cash Expenditures
(Accounting Period Total from CC 3) + 137.00 . 137.00
7. Loan Payments (Non-Exempt)
(Accounting Period Total from CC 3) + +
8. Total Cash Expenditures
(lines 6 + 7) = 137.00 = 137.00
9. In-Kind
(Accounting Period Total from CC 2) + +
10. TOTAL EXPENDITURES (lines 8 + 9)
= 137.00 = 137.00
CASH BALANCE
11. Beginning ,Cash Balance
(Ending Cash'Balance from previ6us report) NON~ FOR OFFICE USE ONLY
12. Total Contributions
(line 5) + 137.00
13. Other Receipts
I
(Accounting Period Total from CC dA) +
14. Loans Received (Exempt)
(Accounting Period Total from CC dA) +
15. CONTRIBUTION SUBTOTAL
(lines 11 + 12+ 13-r 14) = 137.00
16. Total Expenditures
(line 10) + 137.00
17. Other Disbursements
Period Total from CC dB) +
(Accounting
18. Loan Payments (Exempt)
(Accounting Period Total from CC dB) +
19. EXPENDITURE SUBTOTAL
(lines 16 + 17 + 18) = 137.00
20. ENDING CASH BALANCE (line 15 minus llne 19)
= NONE
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink. Page 2 of 2
Candidate or Principal Campaign CommiUee: Identification Number:
Don Laws for Council Cc~mittee N/A
[~Original [] Primary 19 __ [] General 19 96 [] Other
[~ Amendment [] 1st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) NONE FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) + 137.00
23, Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 * 22 + 23) = 1 37.00
25. Loan Payments (Non-Exempt)
(line 7) +
26. Loan Payments (Exempt)
(line 18) +
27. Forgiven Loans
(Total amount of loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 + 27)
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28) = 1 37.00
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
30. Ending Cash Balance
(line 20) NONE
31. Accounts Receivable
(Accounting Period Total from CC 5) +
32. SUBTOTAL
(lines 30 + 31) =
33. Total Outstanding Loans
(linc 29) 1 37.00
-~. Accounts Payable
(Accounting Period Total from CC 6) +
35. SUBTOTAL'~
(lines 33 + 34) = 1 37.00
-~. BALANCE/DEFICIT
(line 32 minus line 35: indicate + or- balance) = -137.00
I, ~in H. Y.~vir~, CPA
and the attached supposing repo~ true and correct.
Signature of Candidate or Treasurer t
(candidate or treasurer), hereby certify that the above statement
12/2/96
Date
DEC 0 41996
CC 2
Cash Contributions, Loans Received and In-Kind
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Don Laws for Council Committee N/A Page 1 of 1
Election: [] Primary 19 __ [] General 19 96 [] Other
Report: [] 1 st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS.
CODE 1: Contributor Type CODE 2: Contribution Type
I Individual C Cash
IC Intermediary CO Cosigner Obligation
IF Immediate Family (includes candidate) IK In-Kind
O Other LR Loans Received (see back for exempt loans)
PC Political Committee
PPC Politiea{ Party Committee
[] Check this box for cash contributions designated by the contributor to retire a deficit from a previous election.
Line # Name and Address of Contributor Amount of Aggregate
Contribution a. contributor aggregate
b. election aggregate 1 []
c. election a.q,qregate 2
Date Occupational Information, Contributing Code J Coda In.Kind Purposa
Received Committee ID~, or Description if Coda I is "0' 1 ~ 2 (Sea manual fo~ suc, lgest~ purpose codes)
Don Laws a. b. c.
1. 968 Hillview Drive,Ashland,OR97520; $ 137.00 $137.0C $137.00 $ []
10/28/96 Candidate - College Professor IF , LR
a. b. c.
2. $ $ $ $ []
a. b. c.
3. $ $ $ s []
a. b. c.
4. $ $ $ $ []
a. b. c.
Page Totals (Add all amounts with thc same Accounting Period Totals (Complete only for last page and
See Instructions con~'ibution type. Do not include aggregate.) transfer these amounts to the Summary Statement, CC 1,)
on Back and in
Campaign Cash (C) $ NONE Cash (C) $. NONE
Finance Manual £.,c, on Summary Slalcment, Column A. Lint 1
in-kind (IK) $ NONE
In-kind (IK) $. NONE
Loans Received (LR) $ 137.00 £.,er on Summary Statement, CoLumn A, Lines 4 and
EEC1) DEC 0 4 1996 Loans Received (LR) $. 137.00
cc 3
Cash Expenditures and Loan Payments
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Don Laws for Council Cc~mittee N/A Page 1 of I__
Election: [] Primary 19 [] General 19 96 [] Other
Report: [] 1st Pre-election [] 2nd Pre-election [] Post-election [] September Supplemental
CODES FOR CLASSIFYING PURPOSES:
If one or more of the following purpose codes is used to describe an expenditure purpose, no other description is generally needed.
The exceptions are:
1. When reporting travel expenses over $50, describe the type of expenses (e.g., lodging, airfare, food, gas, etc.)
2. If an expenditure is made on behalf of the committee by an agent such as an advertising agency you must include a completed
"Agent" form (CC 9) or submit a copy of an invoice if it contains the same information
3. If an expenditure is made which is an in-kind contribution to another political committee, candidate or candidate's principal
campaign committee, in the purpose column identify the expenditure as an in-kind contribution and identify the name of the
recipient candidate or political committee.
PURPOSE CODES (See back of form for definitions of purpose codes)
A Agent (see back) M Management Services
B Broadcast Advertising (Radio, TV) N Newspaper and Periodical Advertising
C Cash Contributions O Other Advertising (yard signs, buttons, etc.)
F Fundraising Event Expenses P Postage
G General Operational Expenses S Surveys and Polls
I Interest Payment T Travel Expenses (describe if over $50)
L Literature, Brochures, Printing W Wages, Salaries, Benefits
EXPENDITURE TYPE: C - Cash LP - Loan Payment
Line # Purpose []
Payee's Nome (use purpose code or Amount of
Date Check # as it appears on invoice, receipt or check provide description) Exp. Type Expenditure Paid
to .4/P
1.
$ []
10/28/96 N/A Ashland Daily Tidings N C 137.00
2.
4.
5.
Page Totals (Add aH expenditures with the A¢¢oantiag Pariod Totals (Complete only for last page ~nd
See Instructions same expenditure type.) transfer these amounts to the Summary Statement, CC 1.)
on Back and in
Campaign Cash (C) $ 137,00 Cash (C) $ 137.00
Loan Payment (LP) $
Loan Payment (LP) $
n -n n
12/05/96 16:41 '~505 488 5311 CITY HALL-ADMIN ...... ~004/004 . .
cc,w,~ Summary statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please t~pe or print lel~ibl¥ ~n blnek ink Pa~ I of 2
Candidate or Principal Campaign Commigee:
· ^ddmss (sleet 5r route, ci~', state, zip code):
Trea~mr's N~me: '~ Telephone Number (an),):
IdentificaTion Number:
~ [] Amencirnent [] Ist Pr~.elec~ion [] 2nd Pm-election ~ost-election [] Sep~mber Supplemm~l
A-TOTALS FOR THIS B-CUMUL.e. TIVE TOT^LS
ACCOUNTING PERIOD FOR T]~$ F..LECTION
I. Cash Contributions
2. LOans Received (No~-Exempt)
3. Tots{ Cash Con~ibations
4. In-Kind
(A~o=tin~ Period TolaJ ~e,,m CC 2)
EXPI;N01TUEF..S
6. Casl~ Ex~ndirures
?. Loan pagme~ts (No~-Exempt) ......-.-
8. Total Cash Expenditures
(lines 6 '+ 7)
(ACco~mtin8 ~eriod Total .fio,m CC 2) + ~- +
10. TOTAL EXPENDITURES (line~ 8 + 9)
CASH BALANCE
11. Bc~nnin~ Cash Balaace
(£nclin~ Cash Bnl~ee from previom teperl) ~'O. g 0 ;OR OFFICE USE ONLY
12. ToIal Con~ibulions
(lioc 5)
' 13. Other Keceipts
(A~=c0unting ?~riod T01al from CC
14. Loans R,-ceived (Exempt)
(AC¢ountin~ Period Total from CC
I$. CONTRIBUTION SUBTOTAL
16. Tetat Expendimre, s
I 7. Other Disbu~ements ~t~'~
(A~.'oumln8 Pe~od Total fto~ CC
18. Loan Payments (Ex-rip0
(Account[n~ Po~od Tetnl from CC
i9. EXPENDITURE SUBTOTAL ,~ ....
12~05,96 16:41 ~'$03 488 5311 CITY HALL-AD,lIN. ~uu~,uo4
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
PIcn.~ ty~, .or print legibly in.black ink. p~e 2 of 2
Candid~ts or Principal Campaign Committee: Identification NUmber,
[] Amendment I--J ]st Pre-election [~ 2nd Pm-election t~::Post-cl¢~o, [] St. ptember Suppk~ne. nt~l
LOAN SUMMARY
21. Be~ianing Outstanding Loans
(Tot~ Outsta~i.r~ Loans frem previous report) ~~ FOR OFFICE USE ONLY
22. Loans Received ('Non-Exempt)
(l~c 2)
23. Loans Received (Exerapt)
24. LOANS RECEIVED SUBTOTAL
(IMes 2~ -~ 22 * 23)
25. Loan Payments 0~on-Exempt)
26. Loan Payments (Exempt)
(line I $)
27, Forgiven Loans
(Toud amount or' loans forgiven durln& ~[s acceunting period)
28. LOAN PAYMENT SUBTOTAL
29. TOTAL OUTSTANDING LOANS
(linc 24 minus li~e 28) .. = .,.
FINANCIAL b'TATU$ AT CLOSE OF ACCOUNTING PERIOD
30. Endins Cash Balnnce
(acco~llltin[~ Fca'Jori Total from CC 5) -
~2. SUBTOTAL
33. Toni Oul~tandin~ Loans
]4. Ac¢O~L~IIs Payzbl~
(,~c~fi~ l~tj~l Toni f~olm CC ~) +
3S. SUBTOTAL
I, ~ /_ ~._~ , (candidate or treasurer), hereby certify that the above statement
and the aua hc ~d support~lt~ reports'are tru~ ~[nd correct.
~ignatut~ of C~ndid~te or Tj~asurer
~a5 Certificate of Limited Contributions and Expenditures
Candidates/Principal Campaign Committees
Please type or print legibly in black ink.
Candidate or Principal Campaign Committee: Identification Number:
Treasurer's Name (if different than candidate): Telephone Number:
Address (street or route, city, state, zip): Office Filed For:
Election: [] Primary 19 __ [] General 19 ~ ~) [] Other.
I, E mt) ~ (~' ~ ~ t~.~[~, Ow,/ (name of candidate), hereby certify I expect neither the
aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy for this
election to exceed $500 in total.
Date
· If a candidate or a candidate's principal campaign committee EXPEC. TS to neither receive nor expend a tota of more
than $500 for the entire election, a Certificate of Limited Contributions and Expenditures may be filed. Candidates may
file this certificate when they file for office, accept a nomination or at the first pre-election reporting period. A candidate
or a candidate's principal campaign committee may not tile this certificate at a second pre-election, post-election or
any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form cannot be used by chief petitioners of initiatives, referendums or recalls.
,, When either total contributions or total expenditures for the election exceed $500, detailed statements of contributions
and expenditures forms CC 2 - CC 10 must be filed. These statements must be tiled within the current tiling period and
shall reflect all contributions and expenditures to date. Refer to the Campaign Finance Manual for Candidates for
further information.
· Deadline dates for tiling a Certiticate of Limited Contributions and Expenditures or detailed statements of contributions
and expenditures MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to
impose a civil penalty against a candidate and the treasurer for tiling a late or insufficient detailed statement of
contributions or expenditures or Certiticate of Limited Contributions and Expenditures.
FOR OFFICE USE ONLY
REC'D OCT 4 1996
CC' ~
~ Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print lel~ibly in black ink. Papee 1 of 2
Candidate or Principal Cam~l~ign Committee:
Address (street ~r route, city; state, zip code):
Treasurer's Name: T~ephone Number (day):
Ct'rice (include county or district name, position, department or zone number, if ~pplicable)
[] Original [] Primary 19 ~ General 19~_~ [] Other.
]~ Amendment [] 1st Pre-election [] 2nd Pre-election__ ~ Post-election []
September
Supplemental
A-TOTAtS EO~ THIS S-C~tAT~V~ TOTAtS
ACCOUNTING PERIOI) FOR Tills eLECTION
CONTRIBUTIONS
I. Cash Contributions
(Accounting Period Total from CC 2) +
2. Loans Received (Non-Exempt)
(Accounting Period Total from CC 2) + +
3. Total Cash Contributions
(lines I+ 2) = =
4. In-Kind
(Accounting P, eriod Total from CC 2) + +
5. TOTAL CONTRIBUTIONS (lines3+ 4) =
EXPI:NDITURI:$
6. Cash Expenditures
(Accounting Period Total from CC 3) +
7. Loan Payments (Non-Exempt)
(Accounting Period Total from CC 3) + +
8. Total Cash Expenditures
(lines 6 + 7) = =
9. In-Kind
(Accounting Period Total from CC 2) + +
CASH BALANCE
I I. Beginning Cash Balance
(Ending Cash Balance from previous report) ~'~'J/x '~ "~'/ FOR OFFICE USE ONLY
12. Total Contributions
(linc 5) +
13. Other Receipts
(Accounting Period Total from CC 4A) +
14. Loans Received (Exempt)
(Accounting Period Total from CC 4A) +
15. CONTRIBUTION SUBTOTAL
16. Total Expenditures
(iineI0) + oWq.
17. Other Disbursements
(Accounting Period Total from CC 4B) +
18. Loan Paymants (Exempt)
19. EXPENDITURE SUBTOTAL
(lines 16 + 17 + 18_)
20 ENOING CASH BALANCE (line 15 minusline 19) =
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink Page 2 of 2
Candidate or Principal Campaign Committee: Identification Number:
[] Original [~ P;ima~ 19 [~ General 19 ~' [] Other
[~ Amendment [] 1st Pre-election [] 2nd Pre-election [~ Post-election [] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECElVED SUBTOTAL
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) +
26. Loan Payments (Exempt)
(line 18) +
27. Forgiven Loans
(Total amount of loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 + 27) =
29. TOTAL OUTSTANDING LOANS
(line 24 minus line 28) =
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
30. Ending Cash Balance
(,ine:O) II q.
31. Accounts Receivable
(Accounting Period Total from CC 5) +
SUBTOTAL
(lines 30 + 31) =
33. Total Outstanding Loans
(linc 29)
34. Accounts Payable
(Accounting Period Total from CC 6) +
35. SUBTOTAL
(lines 33 + 34) "~
36. BALANCE/DEFICIT
(line 32 minus line 35: indicate+ or-balance) = //'~ ,~
I, ~ff~r~/,~, ~_//, ~-~ (candidate or treasurer), hereby certify that the above statement
and the a~hed supporting reports are true and correct.
Signature o?2andidate or Treasurer
Cash Contributions, Loans Received and In-Kind
Candidate/Principal Campaign Committee
Please type or print legibly in black ink.
I Candidate/Committee Name: Identification Number:
Page / or
Election: [] Primary 19 __ [~ General 19 ~a [] Other
Rel:mrt: [] I st Pre-election [] 2nd Pre-election ~ Post-election [] September Supplemental
SEE BACK FOR INSTRUCTIONS AND CODE DEFINITIONS.
CODE t: Contributor Type CODE 2: Contribution Type
I Individual C Cash
lC Intermediary CO Cosigner Obligation
IF Immediate Family (includes candidate) Il( In-Kind
0 Other LR Loans Received (se01~kfor examines)
PC Political Committee
PPC Political Party Committee
' [] Check this box for cash contributions designated by the contributor to retire a deficit from a p~Us elect ~,~
Amending Name and Address of Contdbutor Amount of Agg gate
Page # and Contribution e, cont~butor aggregate
'~ ~i~ b~ ~ti~ff°n aggregate 1
Line # ~, ~ ,c. electton' aggregate 2
Date Occupational Information, Contributing Code Co~/e In-Kind Purpose
Received Committee ID#, or DescHption if code 1 is '0' 1 2 (See menuel for suggested purpose codes)
~Deleting
I
[3 Correcting $ $ $
I
n New Entry $ $ $ $
[] Deleting
Page__ Line__ a. b. c.
0 New Erttl~
[] Correc~.9 $ $ $ $
Page__ Line__ a. b. C,
[~ New Entry
[~ Corr~r~ $ $ $ $
Signature~C:'~dldate or Tre~urer ~
r
CC I
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please t/pc or print lel~ibly in black ink. Page 1 of 2
Candidate or Principal Campaign Committee:
Address (street or route~city state zip code):
Treasurer's Name: T, elepho.ne Number (day):
Identification Number: Office (include county or district name, position, department or zone number, if applicable)
~ Original F-] Primary 19 [~ General 19 ~p_~ ~1 Other
[] Amendment [] I st Pre-election [] 2nd Pre-election [] Post-election ~ September Supplemental
A-TOTALS FOR THIS B-CUMULATIVE TOTALS
ACCOUNTING PERIOD FOR THIS ELECTION
CONTRIBUTIONS
1. Cash Contributions
(Accounting Period Total from CC 2) + ~ +
2. Loans Received (Non-Exempt)
(Accounting Period Total from CC 2) + +
3. Total Cash Contributions
(lines I+ 2) -- =
4. In-Kind
(Accounting P. eriod Total from CC 2) + +
S. TOTAL CONTRIBUTIONS (lines 3 + 4)
EXPENDITURES
6, Cash Expenditures
(Accounting Period Total from CC 3) + +
7. Loan Payments (Non-Exempt)
(Accounting Period Total from CC 3) + +
8. Total Cash Expenditures
(lines 6 + 7) = =
9. In-Kind
(Accounting Period Total from CC 2) + +
10. TOTAL EXPENDITURES (lines 8 + 9) =
CASH BALANCE
Il.
Beginning
Cash
Balance
//q','~~ ~ FOR OFFICE USE ONLY
(Ending Cash Balance from previous report)
12. Total Contributions
(line 5) +
13. Other Receipts
(Accounting Period Total from CC 4A) +
14. Loans Received (Exempt)
(Accounting Period Total from CC 4A) +
(lines I 1 + 12 + 13 + 14) =
16. (lineT°tall0)Expenditures + //~t
17. Other Disbursements
(Accounting Period Total from CC 4B) +
(Accounting Period Total from CC 4B) +
19' EXPENDITURE SUBTOTAL //~,~
(lines 16 + 17 + Ig)
20. ENDING CASH BALANCE (line 15 minus line 19)
Summary Statement of Contributions and Expenditures
Candidate/Principal Campaign Committee
Please type or print legibly in black ink. Page 2 of 2
Candidate or Principal Campaign Committee: Identification Number:
~ Original [] Primary 19 [~ General 19 z~ ~ [] Other
[] Amendment [] I st Pre-election [] 2nd Pre-election [] Post-election ~] September Supplemental
LOAN SUMMARY
21. Beginning Outstanding Loans
(Total Outstanding Loans from previous report) FOR OFFICE USE ONLY
22. Loans Received (Non-Exempt)
(line 2) +
23. Loans Received (Exempt)
(line 14) +
24. LOANS RECEIVED SUBTOTAL
(lines 21 + 22 + 23) =
25. Loan Payments (Non-Exempt)
(line 7) +
26. Loan Payments (Exempt)
(line 18) +
27. Forgiven Loans
(Total amount of loans forgiven during this accounting period) +
28. LOAN PAYMENT SUBTOTAL
(lines 25 + 26 + 27) =
29. TOTAL OUTSTANDING LOANS
(lige 24 minus line 28)
FINANCIAL STATUS AT CLOSE OF ACCOUNTING PERIOD
30. Ending Cash Balance
(line 20)
3 I. Accounts Receivable
(Accounting Period Total from CC 5) +
32. SUBTOTAL
(lines 30 + 31) =
33. Total Outstanding Loans
(line 29)
34. Accounts Payable
(Accounting Period Total from CC 6) +
35. SUBTOTAL
(lines 33 + 34)
36. BALANCE/DEFICIT
(line 32 minus line 35: indicate + or - balance) =
and the a~/ached supporting reports are true and correct.
Signatare ~~¢~
(candidate or treasurer), hereby certify that the above statement
Date
cc 3
Cash £xponditur®$ and Loan Paymants
Candidate/Principal Campaign Cornmittee
Please type or print legibly in black ink.
Candidate/Committee Name: Identification Number:
Election: [] Primary 19 __ ¢ General 19~' [] Other
Report: [] I st Pre-election [] 2nd Pre-election [] Post-election ~ September Supplemental
CODES FOR CLASSIFYING PURPOSES:
If one or more of the following purpose codes is used to describe an expenditure purpose, no other description is generally needed.
The exceptions are:
1. When reporting travel expenses over $50, describe the type of expenses (e.g., lodging, airfure, food, gas, etc.)
2. If an expenditure is made on behalf of the committee by an agent such as an advertising agency you must include a completed
"Agent" form (CC 9) or submit a copy of an invoice if it contains the same information.
3. If an expenditure is made which is an in-kind contribution to another political committee, candidate or candidate's principal
campaign committee, in the purpose column identify the expenditure as an in-kind contribution and identify the name of the
recipient candidate or political committee.
PURPOSE CODES (See back of form for definitions of purpose codes)
A Agent (see back) M Management Services
B Broadcast Advertising (Radio, TV) N Newspaper and Periodical Advertising
C Cash Contributions O Other Advertising (yard signs, buttons, etc.)
F Fundraising Event Expenses P Postage
G General Operational Expenses S Surveys and Polls
I Interest Payment T Travel Expenses (describe if over $50)
L Literature, Brochures, Printing W Wages, Salaries, Benefits
EXPENDITURE TYPE: C - Cash LP - Loan Payment
Line # Purpose []
Payee's Name (use purpose c~le or Amount of
Date Check # as it appears on invoice, receipt or check provide deecdption) Exp. Type Expenditure Paid
toA/P
2.
$ []
3.
$ []
4.
$ []
5.
$ []
Page Totals (Add all expenditures with thc Accounting Period Totals (Complete only for last page and
See Instructions same expenditure type.) transfer these amounts to the Summary Statement, CC 1.)
on Back ,*nd in
cump,ig. Cash C) $ II /,,tp Cash<C) $
Loan Payment (LP) $
Loan Payment (LP) $.
CC7 OR~ 260.112
. Certificate of Limited Contributions and Expenditures
Candidates/Principal Campaign Committees
Please type or print legibly in black ink.
.~.a_.~~Camp~ C~q?m_i~ee~: ) Identification Number:
Address (slze. et or mute, city, state, zip): Office Filed For:
Election: [] Primary 19 [~General 19 ~/~ [] Other
I, '~t~ ~ ~ (name of candidate), hereby certify I expect neither the
[aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy for this
!election to exceed $500 in total.
Can'~didate' s Signature Date'
· If a candidate or a candidate's principal campaign corem ttee EXPE .C. TS to neither receive nor expand a total of more
than $500 for the entire election, a Certificate of Umited Contributions and Expenditures may be filed. Candidates may
file this certificate when they file for office, accept a nomination or at the first pre-election reporting period. A candidate
or a candidate's principal campaign committee may not file this certificate at a second pre-election, post-election or
any supplemental reporting period.
· A separate certificate must be filed for each election.
· This form cannot be used by chief petitioners of initiatives, referendums or recalls.
· When either total contributions or tutal expenditures for the election exceed $500, detailed statements of contributions
and expenditures forms CC 2 o CC 10 must be filed. These statements must be filed within the currant filing period and
shall reflect all contributions and exl)enditures to date. Refer to the Campaign Finance Manual for Candidates for
further information.
· Deadline dates fur filing a Certificate of Umited Contributions and Expenditures or detailed statements of contributions
and expenditures MUST BE strictly observed. By statute (ORS 260.232), the Secretary of State is authorized to
impose a civil panal[y against a candidate and the treasurer for filing a late or insufficient detailed statement of
contributions or expenditures or Certificate of Limited Contributions and Expenditures.
- FOR OFFICE USE ONLY
Certificate of Limited Contributions and Expenditures
Candidates/Principal Campaign Committees
Please type or print legibly in black ink.
--Candidate or Principal Campaign Committee: Identification Number:
Treasurer's Name (fl~dmffe~nt than candidate): Telephone Number:
Address (street or mute, city, state, zip): Office Filed For:
l~lecfion: [] Primary 19 [] General 19 ,~J ~,~ [] Other
I, ,-T-~ ' C ~ ,.9 tg~dq ~ (name of candidate), hereby certify I expect neither the
aggregate contributions received nor the aggregate expenditures made by or on behalf of my candidacy for this
election to exceed $500 in total.
~date's Sil~a~ure //
· f a cand date or a cand date'a prinoipe campa 9n committee £XPEG. TS to naither receive nor expend a total of mom
than $500 for tha ~nfire elacfion, a Card§cate of I.imRed Gontfibutiona and Expenditures malt be filed. Caodidatea malt
fila this c~rtificate when they ~a for office, accept a nomination or at th~ flint pm-~lc~'tion reporting Imriod. A candidata
or a candidata'a prin~pel campaign committee malt not file this certificate at a ~oood pr~-~lecfion, poat-~l~:flon or
any auppiemantal reporting period.
· A aeperate c~rtificata mu~t ba filed for each election.
· This form cannot be used ~ chiaf pelilionera of initlativ~, refarendun~ or
· When ~lmr total contfibuflone or total ax~ndltum~ for tha ai~tion ~xca~d 8500, al®tailed atat~mante o~ contflbuflon$
and axpendRurea forme CC 2 - ¢C '10 mu~t be fled. The.ne $tatementa must be flied within aha currant illin0 period and
ahall refi~:t all contributions and axpeoditurea to data. Rater to tha Campelgn Finance Manual for Candidatae for
forthar information.
· ~eadlinadata$for~lngaC`~r~cate~fL~mlted~ntribu~n~andF-xpeod~t~re.~rd~talledatatam~nte~f~ntribut~n$
and ea~ndRur~a M[JST mae atricfly charred. Blt statut~ (ORS 260.2~2}, the 8ecratev/of grate la atahorized to
impe~ a cml penal~ againat a candidat, and ~ha treasurer for §lin§ a let, or Inauffioiant detailed atat~mant of
oontfibut~on$ or expenditures or C~rtificate of mimit~ Contributiona and I-'xpenditure$.
· FOR OFFI~:E [JOg: ONLY